PEDS TEST 1 REVIEW

Infant psychosocial development

-Trust vs. Mistrust (Erickson): determines development of empathy: CONSISTENCY! 3 months: Social smile starts 6-8 months: Stranger Anxiety 10 months: Object Permanence Temperament: 6-9 months Discipline: "no" starts as mobility increases (6-9 months age).

Samantha, a 10-year-old girl, is brought into your clinic for a well-child examination. Her mother states "Samantha's friend group seems to be so much more important to her these days." As the nurse caring for her, how would you explain the role of peers in the school-age child?

20/50

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration?

A less discriminating sense of taste.

The school nurse is planning a screening program. What items should be included to address issues related to the "new morbidity"?

Academic difficulties, violence, and other mental health issues

When giving parents guidance for the adolescent years, the nurse would advise the parents to:

Accept the adolescent as a unique individual Listen and try to be open to the adolescent's views Respect the adolescent's privacy Provide unconditional love

Foods High in Iron

Beef, chicken, seafood, liver Tofu Nuts and seeds lentils and legumes Eggs Dark leafy vegetables such as spinach Iron fortified cereals, whole-grain breads, and pastas

Selected Religious Beliefs Affecting Children's Health

Buddhist Illness from karmic causes (ignorant craving) Illness as an opportunity to develop the soul Ultimate goal of achieving nirvana/Enlightenment (state of supreme tranquility, purity, and stability) No restrictions for medications, vaccines, nutritional therapies, or other therapeutic interventions Moderation in diet encouraged Some sects vegetarian; some branches have strict dietary regulations while others do not; therefore, important to ask questions about child's preferences No baptism Last rite chanting at bedside soon after death If there is hope for recovery and continuing the pursuit of enlightenment all means of intervention are encouraged Organ donation acceptable Cremation common Christian Scientist Disease viewed as error of human mind that can be dispelled by spiritual truth Health viewed within a spiritual framework; healing through prayer and spiritual regeneration Possible contact of own healing ministry (Christian Science practitioners) if child is hospitalized General opposition to human interventions with drugs or other therapies except for legally required immunizations Usually do not use blood or blood components, seek transplants or act as donors, or seek biopsies or physical examination No special requirements Abstinence of alcohol and tobacco and possibly tea and coffee No baptism or last rites Unlikely to seek medical means to prolong life; use of prayer for recovery Disposal of body in death left for family to decide Hindu Illness due to sins committed in previous life Acceptance of most medical practice/care Nonviolent approach to life Meat consumption forbidden (especially beef) Some are strict vegetarians No baptism View of death as a step in an ongoing cycle to reach nirvana Certain prescribed rites after death, such as washing the body by family and restrictions on who touches the body Cremation common Islam Belief that God cures but will accept treatment Compulsory prayers at dawn, noon, afternoon, after sunset, and after nightfall Ingestion of pork and pork products and alcohol forbidden Fasting (by boys from age 7, girls from age 9, and adults) required during Ramadan (ninth month of Islamic year); (exceptions for pregnant/nursing mothers, elderly or very ill) No baptism Special party (Aqeeqa) to celebrate birth Specific burial rituals (rinsing and washing, wrapping, special prayers, and burial) Judaism (orthodox and conservative) Illness as possible reason for violating some dietary restrictions No treatments or procedures on Sabbath (which begins 18 minutes before sunset on Friday and ends 42 minutes after sunset on Saturday) or holy days Ingestion of blood (such as raw meat) prohibited Kosher dietary laws; highly individualized observance Abstinence from ingestion of pork and predatory fowl and no mixing of milk dishes with meat dishes; ingestion of only fish with fins and scales; no shellfish (strict followers) Fasting during Yom Kippur, and matzo replaces leavened bread during Passover week No baptism Ritual circumcision of male infants on eighth day of life Ritual of washing body after death; family and close friends remain with the deceased for a period of time No cremation Mormon (Church of Jesus Christ of Latter-Day Saints) Belief in divine health via laying on of hands Medical therapy not prohibited Common use of herbal folk remedies Ingestion of caffeinated tea, coffee, and alcohol and use of tobacco prohibited Fasting (no food or drink including water) once a month for 24 hours on a designated day; exceptions made (pregnant women, very young or old, and ill) Baptism at older age (∼8 yrs old); infant blessed by church official after the birth Death believed to be another step in eternal progression Cremation discouraged, but not forbidden Roman Catholic Care of sick encouraged Misuse of any substance considered harmful to the body and a sin Eucharist as the food of healing and health Moderation in diet encouraged Fasting and abstinence from meat and meat products on Ash Wednesday and Good Friday Abstinence on Fridays during Lent, but exceptions made if ill Infant baptism Sacrament of the sick if prognosis poor while child is alive; anointing of the sick Burial and treatment of the body with respect and honor Cremation acceptable in certain circumstances

Safety Issues and Interventions of the School-Age Child

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 back seat. Childproof locks should be used in 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 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 life guard. 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 potential dangerous material in a safe place.

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health?

Clean your baby's gums, then new teeth, with a washcloth

Which would the nurse identify as a protective factor for youth violence?

Commitment to academic performance

The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. What is the nurse's best response?

Consistently meeting the infant's needs helps promote a sense of trust.

The successful resolution of developmental tasks for the school-age child, according to Erikson, would be identified by:

Developing a sense of worth and competence

TABLE 1.1 Milestones in Federal Programs in Support of Children's Health

Date Action Impact 1909 First White House Conference on Care of Dependent Children (convened by President Theodore Roosevelt) Addressed the poor working and living conditions of many children in the United States. Aimed at improving the lives of children. 1912/1913 U.S. Children's Bureau Established the first governmental agency to oversee children's health and environmental conditions. Purpose is to research and report all issues pertaining to all children's well-being; to assist states and local government in preventing child abuse and neglect. 1921 Maternity & Infancy (Sheppard-Towner) Act Provided grants to states to establish maternal and child health divisions in state health departments 1930 White House Conference on Child Welfare Standards Produced the Children's Charter, documenting the child's need for health, education, welfare, and protection 1935 The Social Security Act Established federal-state partnership and provided Aid to Dependent Families and Children (ADFC), maternal and child health services, and child welfare services 1946 National School Lunch Program Provided nutritious, well-balanced lunches to children each day at school for free or a low cost. It also provides meal supplements for children in afterschool care and nutrition programs for homeless children. 1962 National Institute of Child Health and Human Development (NICHD) Supported and performed research on child, maternal, adult, and family health issues 1964 Head Start Developed Head Start provides child development programs to pregnant women, families, and children from birth to age 5 with the overarching goal of increasing school readiness for children from low-income families. 1965 Medicaid Program under Title XIX of Social Security Act; special programs such as Child Health Assessment Program Provided state block grants to reduce financial barriers to health care for the poor and special services to pregnant women, young children, and people with disabilities 1966/1974 Women, Infants, Children (WIC) program Provided nutritional supplementation and education to low-income families; pregnant, postpartum, and lactating women; and infants and children up to age 5 1968 Expansion of Lunch & Nutrition Act Provide food for low-income school-age children year round along with low-income children in daycare and Head Start programs 1969 U.S. Children's Bureau moved to Office of Health, Education & Welfare (HEW) Established greater presence for the programs 1972 Head Start to Serve Handicapped Children Impact: Congress mandated that at least 10% of the children enrolled in Head Start must be handicapped children. 1975 Education for All Handicapped Children Act (Public Law 94-142) Title XX Social Services Established federally mandated special education in public schools Provided block grants to day care, emergency shelters, counseling, family planning, and other services for children 1976 The Supplemental Security Income (SSI) Disabled Children's Program Provided cash to low income children with disabilities to help their families manage their healthcare costs. 1981 Alcohol, Drug Abuse & Mental Health block grants Began funding services for children and adolescents with mental health issues 1986 Education of Handicapped Act Amendments (Public Law 99-457) Established federal funding for states to create statewide, comprehensive, coordinated, and multidisciplinary early-intervention services for handicapped infants and toddlers 1990 Omnibus Budget Reconciliation Act Extended Medicaid coverage to all children (6-18 years) with family income below 133% of poverty level 1990 Bright Futures Initiated Provided a comprehensive set of child health supervision guidelines for health professionals, families and communities and train these groups to work toward optimal child health 1991 Healthy Start Initiated Community-based program that provides services to at-risk women from preconception to postpartum to help reduce infant mortality 1993 Family & Medical Leave Act (FMLA) Allowed eligible employees to take up to 12 weeks of unpaid leave from their jobs every year to care for newborns or newly adopted children or children, parents, or spouses who have a serious health condition; employee can return to previous job or a comparable job with the same conditions 1995 Early Head Start Program Federally funded community-based program for low-income families (infants, toddlers, and pregnant women) that focused on child development 1997 Children's Health Insurance Program (CHIP) (formerly known as State Children's Health Insurance Program [SCHIP]) Offered federal assistance to state-based health insurance for low-income families that are not eligible for Medicaid but cannot afford private insurance 2000 Children's Health Act Led to increased research and treatment of health issues concerning children such as autism, asthma, epilepsy, and oral health 2002 No Child Left Behind Act To ensure that all children in all classrooms receive research-based curriculum, well-prepared teachers, and a safe learning environment 2006 Combating Autism Act Lead to increasing autism awareness by increasing funding for research, surveillance, diagnosis, and treatment 2007 WIC Food Package Revised Designed to improve nutritional intake of WIC recipients by supporting and promoting long-term breastfeeding and adding fruits and vegetables, whole grains, soy-based foods, and a variety of culturally appropriate foods 2008 Newborn Screening Saving Lives Act Provided increased funding for newborn screening grants and provided more education and outreach, coordination of follow-up care after screening and evaluation of newborn screening programs effectiveness 2009 Children's Health Insurance Program Reauthorization Act Expanded the program to cover more uninsured children 2009 American Recovery and Reinvestment Act Designated money to fund and expand programs such as Head Start, foster care and the Supplemental Nutrition Assistance Program (Food Stamp Program) as well as creating new jobs and improving services such as community health centers and unemployment benefits during the economic recession 2010 Affordable Care Act (Patient Protection & Affordable Care Act; Health Care & Education Reconciliation Act) Increases coverage by expanding Medicaid, ends pre-existing conditions exclusion for children; holds insurance companies accountable by ending lifetime coverage limits, requiring insurance companies to publicly justify premium increases; decreases healthcare costs; increases choice and enhances quality of care for all Americans by covering all preventative care 2014 Birth to Five: Watch me Thrive A federal initiative program that promotes developmental and behavioral screening for children with the goal to improve early diagnosis and treatment of children with developmental delays 2018 HEALTHY KIDS (Helping Ensure Access for Little One, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act) Extends funding for CHIP through 9/2023

Key Nutrients Provided by Fruits and Vegetables

Dietary fiber: applesauce, carrots, corn, green beans, mangos, pears Folate: avocados, broccoli, green peas, oranges, spinach and dark greens, strawberries Vitamin A: apricots, cantaloupe, carrots, mangos, spinach and dark greens, sweet potatoes Vitamin C: broccoli, cantaloupe, green peas, oranges, potatoes, strawberries, tomatoes

What has the most influence in deterring an adolescent from beginning to drink alcohol?

Drinking habits of peers

Nutritional Requirements infant

Fluid 140-160 mL/kg/day 100 mL/kg/day for first 10 kg 50 mL/kg/day for next 10 kg Calories 105-108 kcal/kg/day 1-6 months: 108 kcal/kg 6-12 months: 98 kcal/kg

To gain cooperation from a toddler, what is the best approach by the nurse?

Kneel in front of the toddler while he or she is on the mother's lap.

The nurse is developing a community outreach program to help reduce childhood mortality. What topic below would be essential to include?

MVA

Factors Influencing the Adolescent's Diet

Peer pressure Busy schedules Concern about weight control Convenience of fast food

infant cognitive development

Piaget • Sensorimotor phase of learning • Increased muscle control • Imitation of gestures • Object permanence - realization that objects that leave visual field still exist

Which activities will promote weight loss in an obese school-age child?

Role modeling by family . Becoming active in sports Involving child in meal planning and grocery shopping

2.1 Teaching to Promote Effective Discipline

Set clear, consistent, and developmentally appropriate expected behaviors; offer choices whenever possible. Maintain consistency in responding to behaviors; provide encouragement and affection. Role model appropriate behaviors. Provide an age-appropriate explanation of the consequence that will occur if the child demonstrates unacceptable behavior. Always administer the consequence soon after the unacceptable behavior. Keep the consequence appropriate to the age of the child and the situation. Stay calm but firm without showing anger when administering the consequence. Always praise the child for displaying appropriate behavior. Set the environment to assist the child in accomplishing the appropriate behavior; remove temptations that may lead to inappropriate behavior. Reinforce that the child's behavior was bad, not that the child was bad.

Avoiding Choking

Slowly add foods that are more difficult to chew as the toddler becomes more adept at chewing. Cut all foods into bite-sized pieces. Avoid foods that are hard to chew and may become lodged in the airway, such as: Nuts Gumdrops or other chewy candies Raw carrots Peanut butter (by itself) Popcorn Cut hotdogs and grapes into quarters. Cook carrots until soft; if serving raw, then grate them. Always supervise the toddler while he or she is eating.

Tips for Reading With Young Children

Start at early age. Read at least a few minutes every day. Encourage your toddler to turn the pages. Read stories over and over to help the toddler learn. Ask the toddler questions about the book. Use voices for the story characters. Use body motions during the story. Ask questions about the story and about the pictures. Read anywhere, at any time.

Which is associated with early adolescence?

Still at times wants to be dependent upon parents Is influenced by peers and values memberships in cliques

In an effort to control healthcare costs, what is the best recommendation by the nurse?

Stress primary prevention, using the healthcare system for check-ups

ch 2 key concepts

The child's gender and race; the child's biologic traits, including some behavioral traits or aspects of temperament; and certain diseases or illnesses are directly linked to genetic inheritance. The way a child experiences a particular event will be influenced by his or her temperament, and the child's temperament will influence the responses of others, including the parents, to the child. Developmental level has a major impact on the health status of children. Generally, the distribution of diseases varies with age. Adequate nutrition can provide a rich environment for the developing child; conversely, nutritional deprivation can seriously interfere with brain development and other functions. Lifestyle choices that can affect a child's health include patterns of eating; exercise; use of tobacco, drugs, or alcohol; and methods of coping with stress. With advances in medicine, most chronic health problems today arise due to a person's lifestyle. In the case of children, the lifestyle of the parents basically is the lifestyle of the child. Environmental exposures can have a detrimental impact on the child. The term resilience refers to the qualities that enable an individual to cope with significant adverse events or stresses and still function competently and have positive outcomes (National Scientific Council on the Developing Child, 2015). Internal factors that promote resiliency include the person's ability to take control and be proactive, to be responsible for his or her own decisions, to understand and accept his or her own limits and abilities, and to be goal directed, knowing when to continue or when to stop. External factors that promote resiliency include caring relationships with a family member; a positive, safe learning environment at school (including clubs and social organizations); and positive influences in the community. Access to health care is affected negatively by lack of health insurance. Medicaid and the CHIP are both public programs available to provide health insurance to low-income children and their parents. Even with the public programs available to assist children and families, barriers to appropriate, cost-effective, coordinated, and timely health care remain. Barriers can be financial, sociocultural, or ethnic, or part of the healthcare system itself. The family is considered the basic social unit. The family into which a child is born will greatly influence his or her development and health. Children learn healthcare activities, health beliefs, and health values from their family. Typical parental roles include nurturer/caregiver, financial provider, decision maker, schedule manager, financial manager, problem solver, counselor, teacher, behavior support manager, and health manager. Four major parenting styles are seen: authoritarian; authoritative; permissive; and uninvolved, rejecting, or neglecting. Each represents the amount of support and control exerted over the child by the parent. Discipline is a process that has as its goal increasing desirable behavior and decreasing or eliminating undesirable behavior. Punishment involves a negative or unpleasant experience or consequence for doing or not doing something. Culture plays a critical role in shaping a child, including his or her health and health practices. With today's changing demographic patterns, nurses must be able to incorporate cultural knowledge into their interventions so that they can care effectively for culturally diverse children. Spirituality, a major influence for many individuals, provides a meaning and purpose to life and is a foundation for and a source of love, relationships, and service. Spiritual and religious beliefs and views can provide strength and support to children and families during times of stress and illness. Religion also can determine the way in which a family interprets and responds to illness; for example, some religions view illness as a punishment for wrongdoing or as a test of strength. The community surrounding a child affects many aspects of his or her health, development, and general welfare. The child's community consists of the family, school, neighborhood, youth organizations, and other peer groups. Some children spend more awake time in school and child care settings than in their family home. Thus, schools and child care settings have become major influences on children. A child's friends can have a major influence, positive or negative, on his or her growth and development. Suicide is a serious public health problem affecting young people today. Youth violence affects both the family and the community in terms of disrupted social services, increased healthcare costs, and decreased property values. Children may witness violent acts in the school, home, or community. They also may be victims of violence. However, not all children exposed to violence suffer negative consequences. In addition to resiliency, certain protective factors can help buffer them from the effects of violence, helping to reduce the risk that they too will develop violent behaviors. Basic financial stability enhances the general health and well-being of children, and thus an important negative influence on children's health is poverty. Children living in poverty are more likely to have poor health, be retained in a grade or drop out of school, experience violent crimes, and become poor adults (Children's Defense Fund, 2017). Children who are homeless are exposed to an environment that is not conducive to growth and development. Children who are homeless commonly have physical health problems such as upper respiratory, ear, and skin infections; gastrointestinal disorders; and infestations.

The nurse is teaching a group of students about the possible effects of immigration on the health status of children. Which response by the group would indicate the need for additional teaching?

The children of immigrants have better access to preventive care.

BOX 1.1 Key Elements of Informed Consent

The decision maker must be of legal age in that state, with full civil rights, and be competent (have the ability to make the decision). Present information that is simple, concise, and appropriate to the level of education and language of the individual responsible for making the decision. The decision must be voluntary, without coercion, force, or influence of duress. Have a witness to the process of informed consent. Have the witness sign the consent form.

A 2-year-old is having a temper tantrum. What advice should the nurse give the mother?

The tantrum should be ignored as long as the toddler is safe.

nurse caring for a preschooler who says she need to leave the hospital because her doll is scared to be home alone nurse recognize the child is exhibiting which of the following characteristics of preoperational thought

animism

A 5-year-old child is not gaining weight appropriately. Organic problems have been ruled out. What is the priority action by the nurse?

assess usual intake at home

Pediatric Temperature

at 2hr of age temp is 99 temp stabilize by 4 hr of age to 98.6 axillary- 97.6 (36.5) oral 98.6 (37 c) tympanic 98.6 (37) rectal 99.6 (37.6)

A single mother asks the nurse for suggestions on disciplining her 2-year-old son. Which suggestion would be most appropriate?

child spend 2 minutes in time out

Nurse on an acute care unit assisting with education program working with families which of the following should a nurse recommend to include when discussing developmental theory

define consistencies in how families change.

nurse reinforcing anticipatory guidance to the parents of a toddler which of the following instruction should nurse include

develop food habits to prevent dental carries expression of bedtime fears is common expect behaviors associated with negativism and ritualism

nurse inspecting ears of 3yr old during well visit which of the following should the nurse expect

external auditory canal walls are pink

nurse reinforcing teaching with a group of parents of early adolescents females about expected changes during puberty which of following statements indicate understanding of teaching

females usually stop growing about 2 years after menarche

nurse assisting with data collection for developmental screening on 10 mo old which fine motor skill should nurse expect infant to perform

grasp a rattle by handle uses a crude pincer grasp

nurse is discussing prepubescence and preadolescence with a group of parents of school aged children which of the following information should the nurse include in discussion

growth differences between male and female become evident

nurse collecting data from 21/2 yr old toddler at well child visit which finding should be reported

head circumference exceed chest circumference

nurse assisting the provider with developmental screening on 3 yr old which of the following gross motor skills should nurse expect child to perform

ride a tricycle

nurse reinforcing teaching about recommended activities with parents of school aged child which activity should the nurse suggest

team play

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse?

"The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

Development of Fine Motor Skills in Infancy

1 month Fists mostly clenched Involuntary hand movements 3 months Holds hand in front of face, hands open 4 months Bats at objects 5 months Grasps rattle 6 months Releases object in hand to take another 7 months Transfers object from one hand to the other 8 months Gross pincer grasp (rakes) 9 months Bangs objects together 10 months Fine pincer grasp Puts objects into container and takes them out 11 months Offers objects to others and releases them 12 months Feeds self with cup and spoon Makes simple mark on paper Pokes with index finger

Motor Skill Development preschhol

3 years Climbs well Pedals tricycle Runs easily Walks up and down stairs with alternate feet Bends over easily without falling Undresses self Copies circle Builds tower of 9 or 10 cubes Holds a pencil in writing position Screws/unscrews lids, nuts, bolts Turns book pages one at a time 4 years Throws ball overhand Kicks ball forward Catches bounced ball Hops on one foot Stands on one foot up to 5 seconds Alternates feet going up and down steps Moves backward and forward with agility Uses scissors successfully Copies capital letters Draws circles and squares Traces a cross or diamond Draws a person with two to four body parts Laces shoes 5 years Stands on one foot 10 seconds or longer Swings and climbs well May skip Somersaults May learn to skate and swim Prints some letters Draws person with body and at least six parts Dresses/undresses without assistance Can learn to tie laces Uses fork, spoon, and knife (supervised) well Copies triangle and other geometric patterns Mostly cares for own toileting needs

Communication Skills in the Preschool Child

4 years Speaks in complete sentences using adult-like grammar Tells a story that is easy to follow 75% of speech understood by others outside of family Asks questions with "who," "how," "how many" Stays on topic in a conversation Understands the concepts of "same" and "different" Asks many questions Knows names of familiar animals Names common objects in books and magazines Knows at least one color Uses language to engage in make-believe Follows a three-part command Can count a few numbers Vocabulary of 1,500 words 5 years Persons outside of the family can understand most of the child's speech Explains how an item is used Participates in long, detailed conversations Talks about past, future, and imaginary events Answers questions that use "why" and "when" Can count to 10 Recalls part of a story Speech should be completely intelligible, even if the child has articulation difficulties Speech is generally grammatically correct Vocabulary of 2,100 words Says name and address

A 9-month-old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response?

Cow's milk is poor in iron and does not provide the proper balance of nutrients for the infant.

Emancipation may be considered in any of the following situations, depending on the state's laws.

Membership in a branch of the armed services Marriage Court-determined emancipation Financial independence and living apart from parents Pregnancy Mother younger than 18 years of age The emancipated minor is considered to have the legal capacity of an adult and may make his or her own healthcare decisions

When caring for an adolescent, in which case must the nurse share information with the parents no matter which state the care is provided in?

TB

pediatric bill of rights

To be called by name To receive compassionate health care in a careful, prompt, and courteous manner To know the names of all providers caring for the child To have basic needs met and usual schedules or routines honored To make choices whenever possible To be kept without food or drink when necessary for the shortest time possible To be unrestrained if able To have parents or other important persons with the child To have an interpreter for the child and family when needed To object noisily if desired To be educated honestly about the child's health care To be respected as a person (not having people talk about the child within earshot unless the child knows what is happening) For all physicians to respect the child's confidentiality about his or her illness at all times

nurse preparing to examine a preschool age child which of the following should the nurse take to prepare the child

allow child to role play using miniature equipment

nurse collecting data from 12 mo old during well child visit which should you report to provider

birth wt doubled

nurse reinforcing teaching with the parent of a preschooler about sleep promotion which parent statement indicates understanding

i will keep a dim light on in my childs room during the night

nurse reinforcing teaching about age appropriation activities to parent of 24 mo old which indicates the parent understands information

i will send my child favorite stuffed animal when napping away from home

expected pulse and resp by age

newborn - 2days 110-160 / 30-60permin infant to 1 year 90-160/25-30 min toddler to 3 yr 80-140 /25-30 min preschool (3-5) 70-120/ 20 to 25 min school age 6-12yr 60-110/ 20 to 25 min adolescent 13-18 yr 50 -100/ 16-20 min

The mother of a 4-year-old asks for advice on using time-out for discipline with her child. What advice should the nurse give the mother?

time out4 minutes

CH 2 Take note

-Third-hand smoke is residual tobacco smoke and carcinogens that remain after a cigarette is extinguished. These toxins cling to the smoker's hair and clothes and can be present on any surface in the house, such as carpet and cushions. Children are particularly susceptible to third-hand smoke since they breathe near, crawl, touch, and mouth-contaminated surfaces -Adolescents face vast challenges adjusting to adoption at this age because of the added complexity of identity issues facing this age group -The amount of time that a child spends in time-out is typically 1 minute per year of age; around the age of 3 the parent could allow the child to dictate their own time-out length, such as saying come back when you feel ready and calm, this allows the child to learn self-management skills -Other forms of discipline, if used incorrectly, can also cause problems for the child and interfere with the caregiver-child relationship. For example, disapproval using tone of voice, facial expression, or gestures can be effective in stopping inappropriate behavior, but if the disapproval comes in the form of verbal statements that attack the child rather than the behavior, negative consequences may occur -Pediatric nurses can help to shape an individual's lifelong perceptions of health and health services. An understanding of how the child's and family's culture affects their health practices gives the nurse an opportunity to incorporate appropriate and beneficial health practices into the family's cultural milieu, providing sources of strength rather than areas of conflict. -Non-hispanic Native American/Alaskan Natives and non-hispanic whites have the highest rate of suicide -American Indian or Alaska Native and African American children have higher rates of abuse and neglect -The AAP discourages the use of media, with the exception of video chatting, in children less than 18 months. In children 18 to 24 months media should be limited to educational programming with adult interaction during the media viewing and no more than 1 hour a day of media for children 2 to 5 years of age. For children greater than 5 years of age the recommendation includes 2 hours or less of sedentary screen time daily and no screens during meals or 1 hour before bed -

Developmental Theories toddler

Erikson Autonomy vs. shame and doubt Age: 1-3 years Achieves autonomy and self-control Separates from parent/caregiver Withstands delayed gratification Negativism abounds Imitates adults and playmates Spontaneously shows affection Is increasingly enthusiastic about playmates Cannot take turns in games until age 3 years Piaget Sensorimotor Substage 5: tertiary circular reactions Age: 12-18 months Substage 6: Mental combinations Age: 18-24 months Preoperational Age: 2-7 years Differentiates self from objects Increased object permanence (knows that objects that are out of sight still exist [e.g., cookies in the cabinet]) Uses ALL senses to explore environment Places items in and out of containers Imitates domestic chores (domestic mimicry) Imitation is more symbolic Starting to think before acting Understands requests and is capable of following simple directions Has a sense of ownership (my, mine) Time, space, and causality understanding is increasing Uses mental trial and error rather than physical Makes mechanical toys work Plays make-believe with dolls, animals, and people Increased use of language for mental representation Understands concept of "two" Starting to make connections between an experience in the past and a new one that is currently occurring Sorts objects by shape and color Completes puzzles with four pieces Play becomes more complex Freud Anal stage Age: 1-3 years Focus is on achieving anal sphincter control. Satisfaction and/or frustration may occur as the toddler learns to withhold and expel stool.

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior?

Separation anxiety is normal at this age; the infant recognizes parents as separate beings.

ch 4 key concepts

The toddler's organ systems are continuing to mature, and growth slows during this period as compared with infancy. The psychosocial task of the toddler years is to attain a sense of autonomy and to experience separation and individuation. Cognitive development in toddlerhood progresses from sensorimotor in nature to preoperational. The toddler refines gross motor skills after learning to walk and builds fine motor skills through the use of utensils and various manipulative toys. The toddler progresses from limited expressive language capabilities to a vocabulary of 900 words by age 3 years. Toddlers use all of their senses to explore and learn about their environment. Visual acuity progresses to at least 20/50 in the toddler period. Negativism abounds in toddlers as they attempt to exert their independence. Very ritualistic, toddlers feel safer and more secure when clear limits are enforced, and a structured routine is followed. The toddler is starting to learn right from wrong and bases actions on punishment avoidance. Toddler development may be promoted through active gross motor play, books, music, and block building. Safety is a primary concern in the toddler years as the child is more mobile, very curious, and experimenting with autonomy. Poisoning in the toddler period may be prevented through proper storage of medications and other potentially poisonous substances and appropriate supervision. Consistent bedtime rituals help ease the toddler's transition to sleep. All primary teeth are erupted by 30 months of age and may be kept healthy with appropriate tooth brushing and fluoride supplementation. The toddler may experience a decrease in appetite as growth slows, yet he or she still needs appropriate nutritional intake for continued development. Toilet teaching can be achieved after myelination of the spinal cord is complete, usually around 2 years of age. Thumb sucking, pacifier use, security items, and temper tantrums are expected issues in the toddler years. Toddler discipline should focus on clear limits and consistency. It should not involve spanking. It should be balanced with a caring and nurturing environment along with frequent praise for appropriate behavior. Parental role modeling of appropriate behavior, especially related to dealing with frustration, is beneficial to toddlers. Parents play an important role in toddler development, not only by providing a loving environment but also by role modeling appropriate behavior in most areas of daily life.

TABLE 2.1 Summary of Major Theories Related to Family

Theory Description Key Components Friedman's structural functional theory Emphasizes the social system of family, such as the organization or structure of the family and how the structure relates to the function Identified five functions of families: Affective function: meeting the love and belonging needs of each member Socialization and social placement function: teaching children how to function and assume adult roles in society Reproductive role: continuing the family and society in general Economic function: ensuring the family has necessary resources with appropriate allocation Healthcare function: involving the provision of physical care to keep family healthy Duvall's developmental theory Emphasizes the developmental stages that all families go through, beginning with marriage; the longitudinal career of the family is also known as the family life cycle Described eight chronologic stages with specific predictable tasks that each family completes: Marriage: beginning of family Childbearing stage Family with preschool children Family with school-aged children Family with adolescents Family with young adults Middle-aged parents Family in later years Von Bertalanffy: general system theory applied to families Emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components; the family is not the sum of its parts but is characterized by wholeness and unity Used to define how families interact with and are influenced by the members of their family and society and how to analyze the interrelationships of the members and the impact that change affecting one member will have on other members Family stress theory Addresses the way families respond to stress and how the family copes with the stress as a group and how each individual member copes Described elements of stress as occurring internally within the family (e.g., values, beliefs, structure) that the family can control or change or externally from outside the family (e.g., culture of the surrounding community, genetics, the family's current time or place) over which the family has no control Described mobilization of family resources resulting in either a positive response of constructive coping or a negative response of a crisis Identified the main determinant of adequate coping based on the meaning of the stressful event to the family and its individual members Resiliency model of family stress and family adjustment, and adaptation response model Addresses the way families adapt to stress and can rebound from adversity Identified the elements of risks and protective factors that aid a family in achieving positive outcomes

nurse reinforcing education about introducing new food to parents of 4 mo old nurse should recommend parents introduce what food first

iron fortified cereals

nurse in a providers office preparing to administer immunization to a 5 yr old which immunizations should nurse plan to administer

DTAP IPV(INACTIVATED POLIO) MMR

What is the best advice about nutrition for the toddler?

Encourage cup drinking and give water between meals and snacks.

The nurse is assessing the vital signs of a child who is being evaluated in an urgent care center. The child is to be seen by the PNP. The mother asks, "Why is my child seeing the PNP and not the doctor?" What is the best response by the nurse?

"The PNP is an experienced RN with advanced education in the diagnosis and treatment of children."

CH 4 TAKE note

-As more grandparents are assuming the primary caregiver role for their grandchildren, nurses should be alert to the possibility of increased stress that is placed upon the older caregiver, particularly during the active and sometimes trying years of toddlerhood -Young children exposed to more than one language may experience simultaneous acquisition of both languages. The first word may be slightly delayed as compared with single language speakers, but still occurs within the normal range

take note ch 1

-Non-Hispanic African American infants have consistently had higher infant mortality rates compared to other ethnic groups. -In the United States, American Indian/Alaska Natives children, followed by African American children, have the highest unintentional injury death rate -In 2004, the American Academy of Colleges of Nursing (AACN) recommended that nurse practitioner education be moved from the master's to the doctoral level by the year 2015 due to the increasing complexity of the healthcare environment. Progress has been made in reaching this goal as doctoral nurse practitioner (DNP) programs offered have increased; all 50 states now have a DNP program available and there has also been a rise in enrollment in these programs -advocates for children, nurses support policies that protect children's rights and improve children's health care. -Never assume that the adult accompanying the child is the parent or legal guardian. Always clarify the relationship of the accompanying adult. -Whenever possible assent for participation should be obtained from the child.

The mother of two sons, ages 6 and 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother?

. Levels of coordination and concentration differ, so the boys need to be on different teams.

Language Development in Toddlers

12 months Understands common words independent of context Follows a one-step command accompanied by gesture Uses a finger to point to things Imitates or uses gestures such as waving goodbye Communicates desires with word and gesture combinations Vocal imitation First word 15 months Looks at adult when communicating Follows a one-step command without gesture Understands 100-150 words Repeats words that he or she hears Babbles in what sounds like sentences 18 months Understands the word "no" Comprehends 200 words Sometimes answers the question, "What's this?" Uses at least 5-20 words Uses names of familiar object 24 months Points to named body parts Points to pictures in books Enjoys listening to simple stories Names a variety of objects in the environment Begins to use "my" or "mine" Vocabulary of 40-50 words Sentences of two or three words ("me up," "want cookie") Asks questions ("what that?") Uses simple phrases Uses descriptive words (hungry, hot) Two thirds of what child says should be understandable Repeats overheard words 30 months Follows a series of two independent commands Vocabulary of 150-300 words 36 months Understands most sentences Understands physical relationships (on, in, under) Participates in short conversations May follow a three-part command Speech usually understood by those who know the child, about half understood by those outside family Asks "why?" Three- to four-word sentences Talks about something that happened in the past Vocabulary of 1,000 words Can say name, age, and gender Uses pronouns and plurals

Which of the following are reasons that stealing occurs in school-age children?

to escape punishment Lack of sense of property . Strong desire to own something

Signs of Developmental Delay preschool

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 Has 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 5 years Is unhappy or sad often Has little interest in playing with other children Is 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 Is easily distracted; cannot concentrate on single activity for 5 minutes Rarely engages in fantasy play Has trouble with eating, sleeping, or using the toilet Cannot use plurals or past tense Cannot brush teeth, wash and dry hands, or undress efficiently

ch 7 key concepts

Adolescence is a period of rapid and variable growth in the areas of physical, psychosocial, cognitive, and moral development. The adolescent is developing his or her own identity, becoming an abstract thinker, and developing his or her own set of morals and values. Inability to successfully develop an individual identity leads to poor preparation for the challenges of adulthood. Relationships with parents fluctuate widely during adolescence. The teenager eventually becomes emancipated from his or her parents. Peers become most important—guiding mainly the early and middle adolescent in his or her decisions, while the late adolescent can usually formulate his or her own decisions. Adolescence is a critical time in the development of sexuality. Sexuality includes the thoughts, feelings, and behaviors surrounding the adolescent's sexual identity. The egocentric and invincible thought processes of the adolescent can lead to injuries. Health care providers must emphasis safety regarding cars, bikes, water, firearms, and fire. Motor vehicle accidents are the number one cause of death in adolescents (Curtin et al., 2018). Nutritional habits of the adolescent lead to deficiency in vitamins and minerals needed for the rapid growth during this period. Obesity in adolescents is a growing health concern. Health care providers are facing increased numbers of adolescents with hypertension, type 2 diabetes, and hyperlipidemia. Substance abuse and experimentation is common during adolescence; it is associated with other risk-taking behaviors such as injuries and sexual activity. Health care providers must work collaboratively with the adolescent in the development of interventions to promote health.

Signs of Developmental Delay toddler

After independent walking for several months Persistent tiptoe walking Failure to develop a mature walking pattern By 18 months Not walking Not speaking 15 words Does not understand function of common household items By 2 years Does not use two-word sentences Does not imitate actions Does not follow basic instructions Cannot push a toy with wheels 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

Motor Skill Development toddler

Age Expected Gross Motor Skill Expected Fine Motor Skills 12-15 months Walks independently Feeds self-finger foods Uses index finger to point 18 months Climbs stairs with assistance Pulls toys while walking Masters reaching, grasping, and releasing: stacks blocks, puts things in slots Turns book pages (singly with board book, multiple if paper) Removes shoes and socks Stacks four cubes 24 months Runs Kicks ball Can stand on tiptoe Carries several toys, or a large toy while walking Climbs onto and down from furniture without assistance Builds tower of six or seven cubes Right- or left-handed Imitates circular and vertical strokes Scribbles and paints Starting to turn knobs Puts round pegs into holes 36 months Climbs well Pedals tricycle Runs easily Walks up and down stairs with alternate feet Bends over easily without falling Undresses self Copies circle Builds tower of nine or ten cubes Holds a pencil in writing position Screws/unscrews lids, nuts, bolts Turns book pages one at a time

Development of Gross Motor Skills in Infancy

Age Gross Motor Skills 1 month Lifts and turns head to side in prone position Head lag when pulled to sit Rounded back in sitting 2 months Raises head and chest, holds position Improving head control 3 months Raises head to 45 degrees in prone Slight head lag in pull-to-sit 4 months Lifts head and looks around Rolls from prone to supine Head leads body when pulled to sit 5 months Rolls from supine to prone and back again Sits with back upright when supported 6 months Tripod sits 7 months Sits alone with some use of hands for support 8 months Sits unsupported 9 months Crawls, abdomen off floor 10 months Pulls to stand Cruises 12 months Sits from standing position Walks independently

Appropriate Toys for Preschoolers

Blocks, simple jigsaw puzzles (four to six large pieces), pegboards, wooden bead with string Supplies for creativity: chalk, large crayons, finger paint, Play-Doh or clay, washable markers, paper, paint and paintbrush, scissors, paste, or glue Puppets, dress-up clothes, and props for dramatic play Bucket, plastic shovel, and other containers for sand and water play Play kitchen with accessories and pretend food (empty food boxes can be recycled for kitchen play) Squeaking, floating, squirting toys for the bath Sandbox with shovel and various toys for building Dolls that can be dressed and undressed (large buttons, zippers, and snaps), doll care accessories (diapers, bottles, carriage, crib) Gross motor toys: tricycle or big wheel (with helmet), jungle gym or swing set (with supervision), hula hoop, tunnel, wagon Blocks, Legos, cars and trucks, plastic animals, trains, plastic figures (family, community helpers), stuffed animals, balls, sewing cards Tape or CD players for music, various musical instruments Simple card and board games (older preschooler) Dollhouse with furniture and accessories, people, and animals

Daily Calcium and Iron Recommendations for Preschool Children

Calcium: 700 mg (3-year-old), 1,000 mg (4- to 8-year-old) Calcium in Foods 8-ounce low-fat or whole milk: 275-300 mg 8-ounce low-fat yogurt: 313-415 mg 1½-ounce cheddar cheese: 307 mg 1-ounce dried white beans (cooked): 75 mg ¼ cup tofu: 138-253 mg ½ cup raw broccoli: 21 mg Iron: 7 mg (3-year-old), 10 mg (4- to 8-year-old) Iron in Foods ¾ cup 100% fortified prepared cereal: 18 mg 3-ounce beef: 3 mg 3-ounce chicken (dark meat): 1.1 mg ½ cup cooked lentils: 3 mg 3-ounce chicken (white meat): 0.9 mg 15.2-cm (6-in) slice watermelon: 0.7 mg ¼ cup fresh cooked spinach: 1.6 mg ¼ cup tofu: 1.7 mg ¼ cup raisins: 1 mg 1 slice enriched bread: 0.8-0.9 mg ¼ cup frozen spinach, cooked: 0.85 mg

Factors Contributing to Adolescent 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

Nightmares Versus Night Terrors

Definition Scary or bad dream followed by awakening Partial arousal from deep sleep When parents become aware Child awakens parent after episode is over Screaming and thrashing during the episode awakens the parent Timing Usually in the second half of the night Usually about an hour after falling asleep Behavior Crying, may be scared after awakening Sits up, thrashes, cries, screams, talks, looks wild-eyed. Sweats, may have racing heartbeat Responsiveness Responsive to parent's soothing and reassurances Child unaware of parent's presence, may scream and thrash more if restrained Return to sleep Difficulty going back to sleep if afraid Rapidly returns to sleep without full awakening Memory of occurrence May remember the dream and talk about it later No memory of event

Risk Factors for Gang Involvement

Delinquency involvement, especially at a young age History of or victim of physical violence or aggression Alcohol and drug use; drug dealing Associated with delinquent or aggressive peers Poverty/low socioeconomic status Family with criminal history, drug or alcohol problems, violence in the home Poor parental supervision/involvement Poor academic performance Living in a community with a large number of troubled youth, access to firearms and drugs

Risk Factors for Suicide in Adolescents

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

Physiologic Changes of Adolescence

Early adolescence (10-13 years) Pubic hair begins to curl and spread over mons pubis; genitalia pigmentation increases Breast bud and areola continue to enlarge; no separation of breasts First menstrual period (average 12 years, normal range 9-16 years) Pubic hair spreads laterally, begins to curl; pigmentation increases Growth and enlargement of testes in scrotum (scrotum reddish in color) and continued lengthening of penis Leggy look due to extremities growing faster than the trunk Middle adolescence (14-16 years) Pubic hair becomes coarse in texture and continues to curl; amount of hair increases Areola and papilla separate from the contour of the breast to form a secondary mound Pubic hair becomes coarser in texture and takes on adult distribution Testes and scrotum continue to grow; scrotal skin darkens; penis grows in width, and glans penis develops May experience breast enlargement Voice changes; more masculine due to rapid enlargement of the larynx and pharynx as well as lung changes Late adolescence (17-20 years) Mature pubic hair distribution and coarseness Mature pubic hair distribution and coarseness Breast enlargement disappears Adult size and shape of testes, scrotum, and penis; scrotal skin darkening

In developing a weight-loss plan for an adolescent, which would the nurse include?

Eat slowly and place the fork down between each bite .C. Have the family exercise together. D. Refer to an adolescent weight-loss program. E. Keep a food and exercise diary.

school age Developmental Theories

Erikson Industry vs. inferiority Interested in how things are made and run Success in personal and social tasks Increased activities outside home—clubs, sports Increased interactions with peers Increased interest in knowledge Needs support and encouragement from important people in child's life Needs support when child is not successful Inferiority occurs with repeated failures with little support or trust from those who are important to the child Piaget Concrete operational Learns by manipulating concrete objects Lacks ability to think abstractly Learns that certain characteristics of objects remain constant Understands concepts of time Engages in serial ordering, addition, subtraction Classifies or groups objects by their common elements Understands relationships among objects Starts collections of items Can reverse thought process Kohlberg Conventional Stage 3: interpersonal conforming, "good child, bad child," age 7-10 years Stage 4: "law and order," age 10-12 years An act is wrong because it brings punishment Behavior is completely wrong or right Does not understand the reason behind rules If child and adult differ in opinions, the adult is right Can put self in another person's position Begins to exercise the "golden rule" Acts are judged in terms of intention, not just punishment Freud Latency A time of tranquility between the Oedipal phase of early childhood and adolescence—focuses on activities that develop social and cognitive skills Develops social skills in relating to same-sex friends through joining clubs like Brownies, Girl Scouts, Boy Scouts

Developmental Theories preschooler

Erikson Initiative vs. Guilt Age: 3-6 years Likes to please parents Begins to plan activities, make up games Initiates activities with others Acts out the roles of other people (real and imaginary) Develops sexual identity Develops conscience May take frustrations out on siblings Likes exploring new things Enjoys sports, shopping, cooking, working Feels remorse when makes wrong choice or behaves badly Cooperates with other children Negotiates solutions to conflicts Piaget Preoperational substage: preconceptual phase Age: 2-4 years Exhibits egocentric thinking, which lessens as the child approaches age 4 Has short attention span Learns through observing and imitating Displays animism Forms concepts that are not as complete or as logical as the adult's Is able to make simple classifications By age 4 understands the concept of opposites (hot/cold, soft/hard) Reasoning is that of specific to specific Has an active imagination Preoperational substage: intuitive phase Age: 4-7 years Is able to classify and relate objects Has intuitive thought processes; knows if something is right or wrong, though cannot state why Tolerates others' differences but does not understand them Is very curious about facts Knows acceptable cultural rules Uses words appropriately but often without true understanding of their meaning Has a more realistic sense of causality May begin to question parents' values Kohlberg Punishment-obedience orientation Age: 2-7 years (preconventional morality) Determines good vs. bad dependent upon associated punishment Children may learn inappropriate behavior at this stage if parental intervention does not occur (if the child hits, bites, or is verbally disrespectful but is not punished for these activities, the child will view those behaviors as good and continue to participate in them) Freud Phallic stage Age: 3-7 years Child's pleasure centers on genitalia and masturbation. Superego is developing, and conscience is emerging. Oedipal stage occurs: jealousy and rivalry toward same-sex parent, with love of the opposite-sex parent. This usually resolves by the end of the preschool years, when the child develops a strong identification with the same-sex parent.

key concepts ch 1

In the past, health was defined simply as the absence of disease; health was measured by monitoring the mortality and morbidity of a group. Over the past century, however, the focus of health has shifted to disease prevention, health promotion, and wellness. The WHO (2018) defines health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." In the 21st-century unintentional injuries continue to be the leading cause of death in children older than 1 year, but health problems such as obesity, environmental toxins, allergies, drug abuse, child abuse and neglect, and mental health problems endanger children's health today (CDC/National Center for Health Statistics, 2017). Healthy People provides a comprehensive health promotion and disease prevention agenda with specific goals and objectives that emphasizes children's health and improving the health and well-being for all. One method to establish the aggregate health status of infants, children, and adolescents is by using statistics such as mortality and morbidity rates. The infant mortality rate is low in the United States, but it is still higher than in other industrialized countries. This high rate may be the result of the number of preterm and low-birth weight infants born in this country. The three general concepts that form the philosophy of pediatric nursing care are family-centered care, atraumatic care, and evidence-based care. Pediatric nurses use these three concepts to provide quality, cost-effective care that is continuous, comprehensive, and compassionate. The primary role of the pediatric nurse is to provide direct nursing care to children and their families, being an advocate, educator, and manager. The pediatric nurse also serves as a collaborator, care coordinator, and consultant. A standard of care is a minimally accepted action expected of an individual of a certain skill or knowledge level and reflects what a reasonable and prudent person would do in a similar situation. Professional standards from regulatory agencies, state or federal laws, nurse practice acts, and other specialty groups regulate nursing practice in general. The nursing process, a problem-solving method based on the scientific method, is used to care for the child and family during health promotion, maintenance, restoration, and rehabilitation. The nursing process is applicable to all healthcare settings and consists of five steps: assessment, nursing diagnosis, outcome identification and planning, implementation, and outcome evaluation. Ethical nursing care includes the basic principles of autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Advances in science and technology have led to ethical dilemmas in health care; when parents refuse treatment or the child's desires conflict with the parents' decision, an ethical dilemma results. Children are entitled to a healthcare bill of rights just as adults are. Minor children (younger than age 18 years) must have their parents or legal guardians provide consent for health care in most cases. Nurses must be knowledgeable about the laws related to health care of children in the state where they practice as well as the policies of their healthcare institution. Informed consent is required for major and minor surgery; invasive procedures such as lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk, such as chemotherapy or radiation therapy; procedures or treatments involving research; application of restraints; and photography involving children. The nurse's responsibility related to informed consent includes determining that the parents or legal guardians understand what they are signing by asking them pertinent questions, ensuring that the consent form is completed with signatures from the parents or legal guardians, and serving as a witness to the signature process. In certain states, mature minors and emancipated minors may consent to their own health care. Depending on state law, certain health care may be provided to adolescents without parental notification, including pregnancy counseling, prenatal care, contraception, testing for and treatment of sexually transmitted infections and communicable diseases (including HIV), substance abuse and mental illness counseling and treatment, or health care required as a result of a crime-related injury.

Developmental Theories

Erikson Trust vs. Mistrust (birth to 1 year) Caregivers respond to the infant's basic needs by feeding, changing diapers, cleaning, touching, holding, and talking to the infant. This creates a sense of trust in the infant. As the nervous system matures, infants realize they are separate beings from their caregivers. Over time the infant learns to tolerate small amounts of frustration and trusts that although gratification may be delayed, it will eventually be provided. Piaget Sensorimotor (birth to 2 years) Substage 1: use of reflexes (birth to 1 month) Substage 2: primary circular reactions (1 to 4 months) Substage 3: secondary circular reactions (4 to 8 months) Substage 4: coordination of secondary schemes (8 to 12 months) Infant uses senses and motor skills to learn about the world. Reflexive sucking brings the pleasure of ingesting nutrition. Infant begins to gain control over reflexes and recognizes familiar objects, odors, and sounds. Thumb sucking may occur by chance; then the infant repeats it on purpose to bring pleasure. Imitation begins. Object permanence begins. Infant shows affect. Infant repeats actions to achieve wanted results (e.g., shakes rattle to hear the noise it makes). The infant's actions are purposeful but the infant does not always have an end goal in mind. Infants coordinate previously learned schemes with previously learned behaviors. They may grasp and shake a rattle intentionally or crawl across the room to reach a desired toy. Infant can anticipate events. Object permanence is fully present at about 8 months of age. The infant begins to associate symbols with events (e.g., waving goodbye means someone is leaving). Freud Oral stage (birth to 1 year) Pleasure is focused on oral activities: feeding and sucking.

Developmental Theories adolescence

Erikson (psychosocial) Identity vs. role confusion or diffusion Early (10-13 years) Focuses on bodily changes Experiences frequent mood changes Importance placed on conformity to peer norms and peer acceptance Strives to master skills within peer groups Defining boundaries with parents and authority figures Early stage of emancipation—struggles to separate from parents while still desiring dependence upon them Identifies with same-sex peers Takes more responsibility for own behaviors Middle (14-16 years) Continues to adjust to changed body image Tries out different roles within peer groups Need for acceptance by peer group at the highest level Interested in attracting opposite gender Time of greatest conflict with parents/authority figures Late (17-20 years) Able to understand implications of behavior and decisions Roles within peer groups established Feels secure with body image Has matured sexual identity Has idealistic career goals Importance of individual friendships emerges Process of emancipation from family almost complete Piaget (cognitive) Formal operations Early (10-13 years) Limited abstract thought process Egocentrical thinking Eager to apply limited abstract process to different situations and to peer groups Middle (14-17 years) Increased ability to think abstractly or in more idealistic terms Able to solve verbal and mental problems using scientific methods Thinks he or she is invincible—risky behaviors increase Likes making independent decisions Becomes involved/concerned with society, politics Late (17-20 years) Abstract thinking is established Develops critical thinking skills—tests different solutions to problems Less risky behaviors Develops realistic goals and career plans Kohlberg Postconventional level III Morals based on peer, family, church, and societal morals Early (10-13 years) Asks broad, usually unanswerable questions about life Middle (14-17 years) Developing own set of morals—evaluates individual morals in relation to peer, family, and societal morals Late (17-20 years) Internalizes own morals and values Continues to compare own morals and values to those of society Evaluates morals of others

Appropriate Toys for Toddlers

Familiar household items such as plastic bowls and cups of various sizes, large plastic serving utensils, pots and pans, wooden spoons, cardboard boxes and tubes (from paper towel rolls), old magazines, baskets, purses, hats Child-size household item toys (kitchen, broom, vacuum cleaner, lawnmower, telephone, and so on) Blocks, cars and trucks, plastic animals, trains, plastic figures (family, community helpers), simple dolls, stuffed animals, balls, doll beds, and carriages Manipulative toys with knobs, wind-ups, and buttons that make things happen; putting large pegs or shapes into matching holes; stringing large beads on shoelaces; blocks and containers that stack; jigsaw puzzles with large pieces; toys that can be taken apart and put back together again Gross motor toys: play gym, push and pull toys, wagons, tricycle or other ride-on toys, tunnels Tape or CD players for music, various musical instruments Chalk, large crayons, finger paint, Play-Doh, washable markers Bucket, plastic shovel, and other containers for sand and water play Squeaking, floating, and squirting toys for the bath

The mother of a 3-year-old is concerned about her child's speech. She describes her preschooler as hesitating at the beginning of sentences and repeating consonant sounds. What is the nurse's best response?

Hesitancy and dysfluency are normal during this period of development.

Foods to Avoid in Infancy

Honey Egg yolks and meats (until 10 months of age) Excessive amounts of fruit juice Foods likely to cause choking Popcorn Other small hard foods (e.g., raw carrot chunks) Grapes and hot dog slices (must be cut in smaller pieces) Foods likely to result in allergic reaction Citrus Strawberries Wheat Cow's milk Egg whites

ch 3 key concepts

Infancy encompasses the period from birth to age 12 months. The infant exhibits tremendous growth, doubling the birth weight by 6 months of age and tripling it by 12 months of age. Most organ systems are immature at birth and develop and mature over the first year of life. Child development is orderly, sequential, and predictable, progressing in a cephalocaudal and proximodistal fashion. The infant is mastering the psychosocial task of Trust versus Mistrust. Cognitive development in infancy is sensorimotor; infants use their senses and progressing motor skills to master their environment. The 12-month-old babbles expressively and uses two or three words with meaning. Promotion of safety is of key importance throughout infancy. Breastfeeding is the natural and preferred method for infant feeding. Breastfed and bottle-fed infants should both be fed on cue rather than on a parent-designed schedule. Solid foods should be introduced at age 4 to 6 months. A spoon should be used to feed the infant, and rice cereal should be the first food. New foods should be introduced no more frequently than every 3 to 5 days. The cup may be introduced at 6 months of age. No-spill sippy cups are generally not recommended. Spitting up and colic are parts of normal development in the otherwise thriving infant and do not require medical intervention.

Benefits of Breastfeeding

Infant Increased bonding with mother Immunologic protection Breast milk has anti-infective properties Decreased incidence and severity of diarrhea Decreased incidence of asthma, otitis media, bacterial meningitis, botulism, urinary tract infection Possible enhancement of cognitive development Decreased incidence of obesity in later childhood Maternal Increased bonding with infant Lessens maternal blood loss in the postpartum period Decreased risk of ovarian and premenopausal breast cancer Reduced incidence of pregnancy-induced, long-term obesity Possible delay of return of ovulation in some women Always ready; no mixing! Economic advantage

What Adolescents Need to Know About Tattooing

Infections occur as a result of nonsterile equipment used in the procedure Tattoos are open wounds predisposing to infection; sites require proper care, keep bandaged for the first 24 hours then wash with soap and warm water several times per day and apply antibiotic ointment or fragrance-free lotion three times a day for the first week Do not let the tattoo dry out. Do not expose it to direct sunlight until fully healed and then keep it protected from the sun with sunscreen Avoid pools, hot tubs, or long baths/showers until healed For most people a tattoo is permanent; new procedures for removal are painful and expensive

TABLE 1.3 Special Considerations Related to Informed Consent

Issue Definition Nursing Considerations Child not living with biologic or adoptive parents Child living: In foster care With potential adoptive parent With a relative Legally appointed guardian must provide consent. Verify authority and include documentation of legally appointed guardian in child's medical record. Parent consent after divorce Ability to give consent for healthcare rests with parent who has legal custody by divorce decree. Determine if the parents have joint custody or if there is sole custody by one parent. Even the parent with only physical custody may give consent for emergency care. Court involvement may be needed if there is joint legal custody but parents disagree on care. Consent for organ donation For a minor to donate, the parents must be aware of the risks and benefits and must provide emotional support to the child, and there should be a close relationship between the donor and recipient, if living-related donation is occurring. Potential donors should be referred to local organ procurement organization. Educate family about policies related to organ donation. Legal guardian or parent consents to organ donation. Consent for medical experimentation Requirements include consent of parents, assent of child, and a perceived benefit to the child. Comply with all federal regulations if federal funds are received. Refer to section on assent.

Most Dangerous Potential Poisons

Medicines (especially iron) Cleaning products Antifreeze, windshield washer solution Alcohol Pesticides Gasoline, kerosene, lamp oil, furniture polish Wild mushrooms

Appropriate Toys for Newborns and Infants

Newborn to 1 month Mobile with contrasting colors or patterns Unbreakable mirror Soft music via tape or music box Soft, brightly colored toys 1-4 months Bright mobile Unbreakable mirror Rattles Singing by parent or caregiver, varied music High-contrast patterns in books or images 4-7 months Fabric or board books Different types of music Easy-to-hold toys that do things or make noise (fancy rattles) Floating, squirting bath toys Soft dolls or animals 8-12 months Plastic cups, bowls, buckets Unbreakable mirror Large building blocks Stacking toys Busy boxes (with buttons or knobs that make things happen) Balls Dolls Board books with large pictures Toy telephone Push-pull toys (older infants)

The nurse is caring for a hospitalized 4-year-old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as:

Normal for this stage of growth and development.

TABLE 2.2 Types of Family Structures

Nuclear family Husband, wife, and children living in same household May include natural or adopted children Once considered the traditional family structure; now decreased due to trends in divorce rates or other social situations such as nonmarital childbearing Binuclear family Child who is member of two families due to joint custody; parenting is considered a joint venture Always works better when the interests of the child are put above the parents' needs and desires Single-parent family One parent responsible for care of children May result from death, divorce, desertion, birth outside marriage, or adoption Likely to encounter several challenges because of economic, social, and personal restraints; one person as homemaker, caregiver, and financial provider Commuter family Adults in the family living and working apart for professional or financial reasons, often leaving the daily care of children to one parent Similar to single-parent family Step or blended family Adults with children from previous marriages or from the new marriage May lead to family conflict due to different expectations for the child and adults; may have different views and practices related to child care and health Extended family Nuclear family and grandparents, cousins, aunts, and uncles Need to determine decision maker as well as primary caretaker of the children May be encouraged and supported by some cultures, such as Hispanic and Asian cultures Same-sex family (also called homosexual or gay/lesbian family) Adults of the same sex living together with or without children May face prejudice against those with different lifestyles Communal family Group of people living together to raise children and manage household; unrelated by blood or marriage May face prejudice against those with different lifestyles Need to determine the decision maker and caretaker of children Foster family A temporary family for children who are placed away from their parents to ensure their emotional and physical well-being May include foster family's children and other foster children in the home Foster children more likely to have unmet health needs and chronic health problems because they may have been living in a variety of settings Grandparents-as-parents families Grandparents raising their grandchildren if parents are unable to do so May increase the risk for physical, financial, and emotional stress on older adults May lead to confusion and emotional stress for child if biologic parents are in and out of the child's life Adolescent families Young parents still mastering the developmental tasks of their own childhood Greater risk to teenage girls for health problems during pregnancy and delivery of premature infants, leading to risk of subsequent health and developmental problems Probably still need support from their family related to financial, emotional, and school issues

1 Promotion of Reading in School-Age Children

Parents, read to and with your children Ask teachers and librarians for advice on books appropriate for your child Choose stories that the child can relate to if the child has difficulty reading Choose books with movement if the child has a short attention span Take advantage of all reading opportunities (cereal boxes, road signs) Provide choices for the child to select a book of interest Talk about the text and ask questions to improve understanding Keep a record of what the child is reading Visit a library, get a library card, and check out books Parents, demonstrate role modeling through reading books

ch 6 key points

Physical growth is slow and steady, with social and cognitive development progressing rapidly, during the school-age years of 6 to 12. Height increases approximately 6 to 7 cm (2.5 in) per year and weight gain is 3 to 3.5 kg (7 lb) per year. Boys are taller and heavier than girls during this time period (Feigelman, 2016a). With entrance into the school system, school-age children have the influences of peers and teachers. With the development of gross motor skills and involvement in sports at school and in the community, safety education and practices are required. Also, with the participation in cooperative sports, injuries occur. Increased independence leads to increased exposure to safety hazards. The school-age child develops the cognitive ability to classify objects and to identify relationships among objects. Dental care is very important to prevent dental caries, malocclusion, and other problems. In early school age, the first primary teeth will be lost. The onset of puberty may occur by the later school-age years. Erikson's (1963) developmental task for the age group is the development of a sense of industry. Peers are very important, especially peers of the same sex. School-age children usually have a best friend and belong to clubs. They have collections of nonvaluable items such as rocks, clips, and so forth. School-age children are capable of concrete operations, solving problems, and making decisions. They continue to need guidance, rules, and direction from parents. The school-age child develops a conscience and knows cultural and social values. He or she can understand and obey rules. The school-age child incorporates religious practices into his or her life, which may be a source of comfort during stressful times. The nurse's role includes educating parents and school-age children in promoting health and safety. Nurses should inform the school-age child about expected developmental changes in the body to promote self-esteem and self-confidence.

The mother of a 15-month-old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nurse's best response to this information?

Receptive language normally develops earlier than expressive language.

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

Promoting Breastfeeding

Sore nipples Prevention: encourage appropriate latch-on from the beginning Expose nipples to air between feedings Allow breast milk to dry on nipples Use aloe vera or vitamin E to help heal sore nipples May use medical-grade lanolin or preservative-free lanolin (Lansinoh) Engorgement Apply warm compresses or encourage the mother to take a warm shower prior to having the baby latch on (warmth encourages some of the milk to be released, allowing the breast to soften and making it easier for the infant to latch on) Poor sucking Feed on cue, not on a schedule Encourage the sleepy infant by stroking the feet, undressing, and rubbing the head Inadequate milk supply Decrease maternal stress Encourage adequate maternal diet and fluid intake Instruct working mothers to pump in order to keep up milk supply when away from infant Father feels left out Encourage father to participate in other aspects of care Mother worries about adequacy of breast milk If infant is voiding six times per day and gaining weight, then he or she is receiving enough milk and appropriate nutrition

Addressing Common Developmental Concerns

Television, Video Games, and the Internet Establish a consistent time limit for any media use and develop a Family Media Plan. Establish media-free times, such as meal time 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 help lines 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 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

BOX 2.1 Rules for Divorcing Parents

Tell your children about the divorce and the reasons for the divorce in terms that they can understand. Be sure that you and your spouse are present together when telling the children; tell all the children at the same time. Reassure your children that the divorce is not their fault. Repeat this as often as possible and as necessary. Inform the children well in advance of anyone moving out of the house (except when abuse is present or there are concerns for immediate safety). Clearly inform the children about the family structure after the divorce, such as who will live with whom and where; also discuss visitation clearly and honestly. Do not make your children be or act like adults. Seek support from other adults in your life. Do not discuss money or finances with your children. Minimize unpredictable schedules and maintain routines, rules, and discipline, and be consistent in this area. Never force or allow your children to take sides. Avoid belittling your former spouse when the children can hear. However, do not lie to cover up for irresponsible behavior by the other parent. Never put your children in the middle between you and your ex-spouse. Keep each parent involved in the child's life. Write letters, emails, phone calls, and text messages to continue communication. This shows the child they remain important to you even when they are with the other parent. Communicate directly with the other parent. Avoid making the child your messenger. Allow and assist the child to express his or her feelings about the divorce and offer support.

ch 5 key points

The preschool child grows at a slower rate and takes on a more slender and upright appearance than the toddler. The primary psychosocial task of the preschool period is developing a sense of initiative. Cognitive development moves from an egocentric approach to the world toward a more empathetic understanding of what happens outside of the self. The preschooler gains additional motor skills and displays significant refinement of fine motor abilities. Cognitive and language skills that develop in the preschool years help prepare the child for success in school. Dysfluency or hesitancy in speech is a normal finding in the preschool period and occurs as a result of the fast pace with which the preschooler is gaining language skills and vocabulary. The vocabulary of a preschooler increases to about 2,100 words, and the child speaks in full sentences with appropriate use of tense and prepositions. Appropriate growth and development should be maintained in the ill or hospitalized child. Recognizing concerns or delays in growth and development is essential so that the appropriate referrals may be made, and intervention can begin. The preschool child requires a well-balanced diet with fat content between 20% and 30% of calories consumed. Adequate physical activity and provision of a nutrient-dense diet (rather than foods high in fat and sugar) are the foundation for obesity prevention in the preschool child. Adequate dental care is important for the health of the primary teeth. Preschoolers need about 12 hours of sleep per day and benefit from a structured bedtime routine. Due to the active imagination of the preschooler, nightmares and night terrors may begin during this period. Safety and injury prevention remain a focus in the preschool years. Structure, appropriate limit setting, and consistency are the keys for effective discipline in the preschool period. Time-out is an effective disciplinary measure for preschoolers. Masturbation may occur as the preschooler discovers his or her body. If not excessive, it is considered a normal part of growth and development.

take note

Warning signs that may indicate problems with motor development include the following: arms and legs are stiff or floppy; child cannot support head at 3 to 4 months of age; child reaches with one hand only; child cannot sit with assistance at 6 months of age; child does not crawl by 12 months of age; child cannot stand supported by 12 months of age. Warning signs that may indicate problems with sensory development include the following: young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months. Warning signs that may indicate problems in language development are as follows: infant does not make sounds at 4 months of age; infant does not laugh or squeal by 6 months of age; infant does not babble by 8 months of age; infant does not use single words with meaning at 12 months of age (mama, dada). Warning signs of possible problems with social/emotional development include the following: child does not smile at people at 3 months of age; child refuses to cuddle; child does not seem to enjoy people; child shows no interest in peek-a-boo at 8 months of age.

nurse assisting with nutrition edu program for a group of parent of preschoolers which dietary guideline should nurse include

average intake should be 1800 calories per day

nurse is reinforcing teaching about health promotion with the parent of a 13 year old adolescent which of the following screenings should nurse recommend

body mass index weight scoliosis

school nurse examining cranial nerves of adolescent following a fall during football which should be expected when checking the trigeminal nerve

clenching teeth tightly detecting facial touches with eyes closed

nurse reinforcing teaching about dental care and teething to parent of 9 mo which statement indicate parent understand info

i should clean baby teeth with cool wet wash cloth

nurse in providers office preparing to administer immunizations to an 11 yr old which of the following immunizations should the nurse plan to administer

trivalent inactivated influenza meningococcal mcv4 tdap

nurse collecting data about a family which of the following should the nurse include

med history parents education level support systems and stressors

nurse is assisting parents of adolescents to develop skills to improve communication within the family nurse identifies authoritative style of parenting when she hears a parent make which statement

my son understands that a part of learning responsibility is helping with household chores

The nurse is caring for a hospitalized 30-month-old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as

normal for this stage of growth and development.

nurse is checking reflexes of a 6mo old which of the following should the nurse expect infant to exhibit

plantar grasp

nurse conducting a well baby visit with a 4 mo old which immunizations is the nurse planning to administer

polio (ipv) pneumococcal vaccine (pcv) rotavirus vaccine ( rv)

nurse is caring for an adolescent whose mother expresses concerns about her adolescent sleeping long hours on the weekend the nurse should inform the mother which of the following

rapid growth

nurse checking the vital signs of 3 yr old during well child visit which do you report to provider

resp 30/min

school nurse is preparing class about male puberty which of the following manifestations should the nurse identify as occurring first when sexual maturation begins

testicular enlargement

nurse is assisting with the collection of data for developmental screen on 18 mo old the nurse should expect toddler to perform which skill

throw ball overhead use spoon without rotation

teeth in babies

vast majority of newborns do not have teeth at birth, nor do they develop them in the first month of life. On average, the first primary teeth begin to erupt between the ages of 6 and 8 months. The primary teeth (also termed deciduous teeth) are lost later in childhood and will be replaced by the permanent teeth. The gums around the emerging tooth often swell. The lower central incisors are usually the first to appear, followed by the upper central incisors The average 12-month-old has four to eight teeth.

nurse is assisting with an in service for a group of parents about child safety during the school age years which information should the nurse include

wearing helmets when riding bicycles or skateboarding implementing firearm safety wearing seatbelts when riding in a vehicle