FALL 19 / UNIT 1 GROWTH & DEVELOPMENT
Adolescent male/female
-Final 20-25% of linear growth -Gain up to 50% of ideal adult body weight -Pubic hair then Axillary/acne 2 y later. -Formal Operational so abstract thinking. -concerns: obesity, anemia, anorexia/bulimia -#1 cause of death Motor Vehicle #2 Suicide.
•What immunizations does the child get at -2 months -4 months -6 months -12-15 months -4-6 years -11-12 years 16 years
Birth- Hep B 2/4/6 B Dr. Hip Hep B (2/6 Booster) DTap Diptheria, Tet, Pertussis Roto Hib haemopholus Influenza type B IPV-inactivated polio PCV Pneumococcal 12-15 mo MAD HPV MMR - live attenuated Hep A Dtap booster Varicella- live attenuated so compromised PCV Hib booster 4-6 y Never take a preschooler to the DMV MMR IPV DTap Varicella 11-12 Hurt My Toe HPV Meningiococcal (second dose at 16) TDap (stop tap dancing DTap) 16 Meningococcal booster
Piaget's stages of cognitive development
Birth-2: Sensorimotor. Uses reflexes and motor skills to learn about the world. Imitation and repetitive behaviors. Learns object permanence by about 8/9 mo. 2-7: Preoperational: symbolic thought. Egocentric, language skills and imaginative play. 7-11: Concrete operational. Thought patterns evolve and they begin to have empathy. Empathy is hard (concrete). 12 +: Fromal Operational thinking: Abstract thinking. Cant hypothesize and test. Draw logical conclusions. They become a rubik's cube
Age appropriate toys 1-4 mo
Bright mobile, rattles, singing, high-contrast patterns in books or images, unbreakable mirror
6-12 year olds
By age 6 knows right to left. Reads a clock by age 7. 20/20 vision. Permanent teeth (6y molars). 3-6lb/2" yrly.
Stage infant stools
Newborn's first stool is meconium and is the result of swallowing amniotic fluid in utero. Meconium is dark green to black and sticky. The first few days of life the stool becomes yellowish or tan. Formula-fed infant consistency of peanut butter, breastfed infants are looser and appear seedy. Newborns can have 8-10 a day or as little as 1-2, infrequent stooling is normal as long as it remains soft. After the first month the number might decrease. Call pc if the infant's stools are red, white, black; mucous-like; frequent and watery; frothy or foul smelling; or hard, dry, formed, or pellet-like; or if baby is vomiting.
NEWBORN, INFANT, TODDLER, PRESCHOOL, SCHOOL AGE, ADOLESCENT
Newborn: birth-1 mo Infant: 1 mo- 1 y Early Childhood (1-5) is Toddler: 1 y-3 y and Preschool: 4-5 Middle Childhood: School Age 7-11 Later Childhood: adolescence 12-20
What is copralalia?
Obscene and involuntary vocal utterances
age appropriate toys 8-12 mo
Plastic cups, bowls, buckets, large blocks, stacking toys, busy boxes, balls, dolls, board books with large pictures, toy phone, push-pull toys.
Fontanelles
Posterior 2mo Anterior closes by 18 mo
age changes in older adults (66+) associated w the nervous system?
Postural hypotension, cerebral atrophy, decreased cerebral function, and decreased nerve impulse conduction are age-related changes associated with the nervous system.
age-related changes in older adults associated w the nervous system?
Postural hypotension, cerebral atrophy, decreased cerebral function, and decreased nerve impulse conduction are age-related changes associated with the nervous system.
What are some eye-related changes in older adults?
Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.
What are the palmar and plantar grasp?
Primitive reflexes where the infant reflexively grasps with bottom of foot when plantar pressure is applied; same with hands when the palm is touched infant will instinctively grasp. Palmar is 4-6 mo and Plantar is 9 mo.
stomatitis
inflammation of the oral mucosa Stomatitis and blood dyscasia are examples of tissue and organ damage.
What's a DPOA?
A durable power of attorney (DPOA) for health care or healthcare proxy is the person the client designates to make medical decisions on the client's behalf when the client no longer can do so. It allows competent clients to identify exactly what life-sustaining measures they want to be implemented, avoided, or withdrawn and offers reassurance that others will carry out their wishes.
Which is also known as a proxy directive?
A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. The other options are incorrect.
What is a medical directive/living will?
A living will is a type of advance medical directive in which the individual, who is of sound mind, documents treatment preferences
What's a living will?
A living will is a written or printed statement describing a person's wishes concerning medical care and life-sustaining treatments that are wanted or unwanted in the event that a person is unable to personally make those decisions. Although a living will describes a person's wishes, it does not designate decision-making power to another person in the same was as a DPOA.
drug that helps in ADHD
Methylphenidate is effective in 70% to 80% of children with ADHD; it reduces hyperactivity, impulsivity, and mood lability and helps the child to pay attention more appropriately.
Skin cancer exam recommendations?
Monthly self exam.
Describe the Morro reflex
Morro is the startle reflex. Its the infant's response to lack of support/falling. Their arms extend and fingers form a C shape. Lasts to about 4 mo.
What primitive reflexes are present at birth?
Morro, Root and Suck, Tonic Neck, Plantar and Palmar Grasp, Step, and Babinski. Primitive reflexes diminish over the first few mo of life (except babinski goes to 12 mo) and are replaced w protective (postural) reflexes.
Infant's sensory preferences
Most important is the sense of touch. Even preemie responds to soothing stroking. Prefers soft sensations to course. Holding, stroking, rocking, cuddling makes them more alert when they are drowsy.
an expression of grief and associated behaviors.
Mourning
term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?
Mourning
What are the protective reflexes?
Neck righting, sideways parachute, forward parachute, backward parachute and they persist.
Child "loses" a developmental milestone-- ie. was able to sit without support, now cannot.
Needs immediate full evaluation.
What is neurotoxicity?
Neurotoxicity, sometimes referred to as central nervous system toxicity, is a drug's ability to harm or poison a nerve cell or nerve tissue. Signs and symptoms of neurotoxicity include drowsiness, auditory and visual disturbances, restlessness, nystagmus, and tonic-clonic seizures. Neurotoxicity can occur after exposure to drugs and other chemicals and gases.
4-6 year vaccinations
Never take a preschooler to the DMV. DTap, MMR, Varicella, possibly yearly flu
Language development
Newborn cry. 1-3 mo coos. 4-5 mo simple vowel sounds, laughs, responds to name & no. 6 mo yell. 7-10 mo babble, 9-12 meaning to mama dada and
TAKE NOTE! Risk factors for lack of social and emotional readiness for school include
insecure attachment in the early years, naternal depression, parental substance abuse, and low socioeconomic status. nurses should screen for these factors.
WHat are some stereotypical behaviors in autism spectrum disorder?
Stereotypic behavior incudes self-stimulating, nonfunctional, repetitive behaviors such as rocking, hand flapping, and head banging. Word repetition (echolalia) and pronoun reversal are communication difficulties.
Root and Suck primitive reflex
Stroke cheek will turn to that side, search with mouth: lasts to about 3 mo. Reflexive sucking when finger is placed in mouth: lasts around 2-5 mo.
What supplements do breastfed babies need?
iron and D
TAKE NOTE! Drinking excessive milk can lead to
iron deficiency. Ca in milk blocks iron absorption.
TAKE NOTE infants breathing pattern
irregular often. this is normal
TAKE NOTE! Spinach info AND Toddlers who consume a strictly vegan diet are at risk for deficiencies in Vit D, B12, and iron.
is a poor source of calcium because the calcium in it isn't bioavailable.
Where is head circ measured?
just above the eyebrows through the prominent part of the occiput
describe gait age 1, 2, 3,
learning to walk... 12-15 mo then toddler gait, legs planted wide apart, toes forward. Then at 3 they start heel to toe.
TAKE NOTE! mother's who are depressed...
may not be as sensitive to their children as other mothers. So... maternal depression puts child at risk for poor cognitive development.
Sight development
newborn is nearsighted and prefers objects 8-15 in away. Prefers the human face and might imitate expression, also black and white contrast objects. Eyes wander and occasionally cross. Color vision develops by 7 mo w distance and ability to track objects.
Sleep patterns of infants
newborns sleep average 20 h daily. 3 mo 7/8 h at night without waking and 3 naps daily. 4 mo capable of no night feeding and should sooth themselves back to sleep. 12 mo 8-12 h and 2 naps.
TAKE NOTE! Corporal punishment
not only causes physical and emotional pain, it also decreases learning capacity.
carseat safety w/ 1 mo. infant
position car seat so that baby is rear-facing Retainer clip at armpit level Harness comes through seat at or below shoulders Harness snug and flat Needs booster until age 8 or 80 lbs and should be in back seat.
What are idiosyncratic effects?
reactions that occur rarely and unpredictably among the population. It's unique to the individual's response, not the dose of the drug.
An example of impulsiveness in ADHD
risk taking behavior. Impulsiveness is the tendency to act on urges, notions, or desires without adequately considering the consequences. This is manifested by risk-taking behaviors and use of poor judgment, often leading to more than the usual bumps, lumps, and bruises. An inability to wait the client's turn and restlessness reflect hyperactivity. Difficulty completing a task reflects inattention. Inattentive behaviors include avoiding tasks that require mental effort, making careless mistakes, and being forgetful in daily activities.
principle of conservation
the ability to recognize that the physical properties of an object remain the same despite superficial changes in the object's appearance
How do we determine adjusted age in a premee?
Subtract the number of weeks premature from the infant's chronological age. Plot growth and dev parameters on adjusted age. 6 mo old born 8 weeks early: 6mo-2mo= 4 months adjusted age.
What is colostrum and why is it important?
"First milk" produced by the breasts for the first 2 to 4 days after birth. it is the breast milk that appears yellowish *important* b/c it is rich in immunoglobulins and is super easy for baby to digest. Mature breast milk has a slight bluish tint and appears thin.
Adolescent vitals
T P 60-90 R 12-16 BP Female 110/mid 60s Male low 120s/70
Vitals in School age 6-11
T P 65-110 R 18-30 BP upper 90s-100s/low 60s
Vitals: Toddler (12-36 mo)
T P 80-110 R 24-40 BP 90s/mid 50s
Vitals in infants
T: 99 P: 100-160 R: 30-60 BP 73/50 If Palpated #/P If Doppled #/D Use Brachial, Radial, Popliteal, Post Tib (inside)
MASTERY ALERT! parents to toddlers (nursing teaching)
Teach parents to make limited choices (two things) to assist with control over their environment. Advise aggressive behavior is normal, so don't blame the toddler, help them understand their behavior. Toddlers may bite, hit, grab, throw, scribble... . Guide them toward acceptable behavior.
What is tetragenicity?
Teratogenicity is when drugs that reach the developing fetus or embryo cause death or congenital defects, which can include skeletal and limb abnormalities, central nervous system alterations, heart defects, and the like.
Where is the point of maximal impulse (PMI) found in a 5-year-old child?
The 4th intercostal space The area of most intense cardiac pulsation, or point of maximal impulse (PMI), varies. <4y = 3rd and 4th intercostal space (ICS). 4 to 6 y = 4th ICS medial to the left midclavicular line. > 7 = 5th ICS lateral to the left midclavicular line. Heart sounds radiate and can be heard either to the right or left of the sternum but never directly over the sternum.
A nurse is counseling the parents of an adolescent client with oppositional defiant disorder (ODD). The parents state, "We've tried everything, what else are we supposed to do?" What is the mostlikely reason for the parents' voiced loss of hope? The parents may have not taught appropriate behavior to the adolescent. The adolescent may have limited sensitivity to reward and punishment. The adolescent may have been abused in childhood. The parents may have been pampering the adolescent too much.
The adolescent may have limited sensitivity to reward and punishment. The most likely reason for the parents' sense of loss of control and hope with their adolescent child who has a diagnosis of ODD is that the client has a limited ability to make associations between a behavior and the consequences of that behavior—both negative and positive. The parents likely did not neglect to teach the client appropriate behavior. Childhood abuse may be a predisposing factor for ODD. The parents likely did not pamper the client; however, problem behaviors may have been inadvertently reinforced in the home.
infant/child immunizaion sites
The anterolateral thigh is the appropriate site for the administration of an immunization for an infant. The deltoid and vastus lateralis are appropriate injection sites for an older child
Average weight of newborn? Describe weight trend for first month. To 12 mo?
The average weight of a newborn is 7.5 lb. w boys being slightly heavier. They lose roughly 10% of their body weight in week 1, but then regain their birth weight by 10-14 days. Double by 6mo, Triple by 12 mo.
Pharmaceuticals for IED (intermittent explosive disorder)
The client is likely to be prescribed antidepressant drugs, such as fluoxetine. The client may also be prescribed mood-stabilizing drugs, such as valproic acid and phenytoin. These drugs are used to reduce excessive irritability and anger impulses. The client is unlikely to be prescribed typical antipsychotic medication; atypical antipsychotic medications may be considered due to the effect on serotonin.
Tendencies of Toddlers
They are ritualistic (same cup/bowl). 1 T. per year age serving. Play is parallel and tactile. They like to imitate.
What are the directional growth/dev trends in infants and what are the sequential trends in development?
They grow Top down or Cephalocaudal (head to toe) and then Trunk to tips (proximodistal). Sequential trends are predictable patterns of development (sit, crawl, cruise, walk, run)
The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care? Suggestions that the family offer the client foods that are hot. Encouragement of the family to serve the client meat, especially beef. Advice for the family to have fruit juices readily available at the client's bedside. Arrangements for the client to eat meals while others are out of the home.
To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.
What is telegraphic speech?
Toddler only saying the needs like "Want cookie milk!"
The nurse is performing a physical exam on a 3-year-old boy. What method would the nurse use to perform the exam?
Toddler-Preschool: Start with head and work down to the child's toes. infants: Start w chest , then head to toes.
Gross and fine motor of toddler
Toddlers are a time of great growth and they gain great control over motor, cognitive & behavioral skills at a rapid rate. 15 mo scribbles & 2 cubes 18 mo runs clumsily (stairs w hand-holding), 3/4 cubes 24 mo Independent up & down stairs w 2 feet on each stair & turns pages of book 1 at a time.
TAKE NOTE! Toddlers and spanking
Toddlers under 18 mo of age should NEVER be spanked. They aren't capable of linking the spanking with the undesired behavior.
When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that the client is most likely exhibiting symptoms of what disorder?
Tourette's syndrome
What are some warning signs that might show a problem w motor develpment?
Trouble signs may be arms and legs are stiff or floppy; can't support head by at least 4 mo, reaching w only 1 hand; cannot sit w assistance at 6 mo, doesnt crawl by 12 mo, cannot stand supported by 12 mo.
T or F. Breastfed and bottle fed babies should both be fed on cue rather than on a schedule.
True.
True or False? Spitting up and colic are parts of normal development in the otherwise thriving infant and don't require medical intervention.
True.
All hospice care is palliative.
True. All hospice care is palliative but not all palliative care is hospice care. Palliative care is conceptually broader than hospice care and is an approach to care as well as a structured system for delivering care. Palliative care followed the development of hospice care. It does not begin when cure-focused treatment ends but is most helpful when provided along with disease-remitting treatment.
T or F? Child development is orderly, sequential, and predictable.
True. Development progresses in a Cephalocaudal and proximodistal way.
T or F. Cognitive development in infancy is sensorimotor.
True. Infants use their senses and progressing motor skills to master their environment (Piaget)
The infant is mastering the psychosocial task of....
Trust vs Mistrust
Temp earlobe under 3/over 3
Under 3 pinna down/ over 3 pinna up and back. No oral until at least over 6. Don't add a degree or subtract anymore, just state the way it was taken
Auscultate both pulse and respiratory rate
Until school age and go 1 full minute
The parents of a 2-year-old child complain to the nurse that their child is always dismantling toys, scribbling on the walls, and running all around the place and that it is very difficult to control the child's behavior. What is the most appropriate response from the nurse? A) "At this child's age, these behaviors are expected." B) "I will refer your child to the psychology clinic." C) "Therapy will help to calm your child." D) "Your child may develop violent behavior in the future.
"At this age, these behaviors are expected." Dismantling toys, scribbling on the walls, and running around the place are all normal behaviors for a child 2 years of age. The nurse should tell the parents to not to worry and that their child is perfectly normal.
When a person authorizes another to make medical decisions on his or her behalf, the person has written
a proxy directive
Adult immunizations
1 Tdap and booster q 10 y. 1 MMR (maybe) 1X yearly Flu Pneumonia Shingles (age 50)
Social Development of infant
1 mo reflexes. 2 mo smiling. 4 mo social baby. 6 mo recognize parents/fear strangers. 8 mo anxiety at parent leaving/responds to "no". 10 mo Object permanence, waves bye. 12 mo So Big & Peekaboo, emotions.
A nurse is assessing a 15-year-old adolescent with conduct disorder. Which appearance might the nurse see in the adolescent? The adolescent has poor physical hygiene. The adolescent appears terrified. The adolescent has lots of cuts on the face and body. The adolescent has lots of tattoos and body piercings.
Adolescents with conduct disorder appear normal for their age group but may have an extreme appearance, such as having tattoos and body piercings. They appear normal in terms of personal hygiene. These adolescents have no guilt associated with their behavior, thus they probably will not look terrified. The nurse is unlikely to observe changes associated with self-harm.
speech of toddler
15 mo understands simple commands. Asks by pointing 24 mo 300 words! Asks for food, toileting, drink
Speech at 12 mo
2 words w meaning (mama dada) but may say 3-5. Be careful on this question.
The 12 mo old babbles excessively and uses how many words that have meaning?
2-3 words with meaning
Head circumference of newborn?
35 cm (14 in) and is measured until about age 2--unless needed. Velocity (head circumference growth) slows slightly in 6-12 mo period. 10cm gain from birth to age 1. Chest circumference is also measured at birth.
With the absence of factors, vision screening begins at age
3
Social development trends of infants
6 mo stranger danger. 8 mo anxiety at parents leaving 10 mo object permanence (waves bye bye) 12 mo Patty-cake and Peekaboo (emotions/jealousy etc)
What age is a cup introduced?
6 mo, no spill sippy recommended.
What drug information is instrumental in determining nursing actions following drug administration?
Adverse effects. Becoming familiar with classifications of medications helps the nurse to recognize possible adverse effects clients may experience, providing a basis for implementing appropriate nursing actions should undesirable effects occur. The route of administration, body system involved, and protocols are more important to know before medication administration
Psychosocial stage of older adult
Age 66+ Ego integrity vs. despair Life review/reminiscing Retirement Driving Isolation
Vitals in Preschool
4-6 T P 70-110 R 22-34 BP 90s/mid 50s
BP shouldn't be taken during an assessment on any child younger than _____________.
Age three. Exceptions: history of prematurity, have congential heart defect, have a UTI, take any meds that influence BP or have increase intracranial pressure. Finally, for hospitalized children BP is taken according to hospital policy no matter what age
What age should food be introduced?
5 mo average and rice cereal first food. New foods should be introduced q 3-5 days.
TAKE NOTE! When introducing foods at
5nmo do not use cows milk (allergy) or fruit juice (sugar)
What are the 2, 4, and 6 mo vaccinations?
B DR. HIP B DTAP ROTO HIB IPV PCV (2,4,6 could B a RIP in DTaPs Hip). Roto, IPV, PCV, DTaP, Hib and Possible Single Hep B depending on date of initial. Rotovirus,
An adolescent client demonstrates callous and unemotional behavior in the absence of extreme aggressive behavior and mood disturbances. The client has a diagnosis of conduct disorder. Which treatment would be most effective for this client? Family therapy Group therapy Medication Individualized behavior therapy
An adolescent with conduct disorder would benefit most from individualized behavior therapy. These adolescents are usually not attached to their parents, thus family therapy is not useful for them. Group therapy will also not be beneficial for these clients, as they are uncomfortable socializing. The client here does not have extreme aggressive behavior and mood disturbances; therefore, it is unlikely that the client would be prescribed psychotropic drugs or mood stabilizers.
What is a drug "adverse affect"?
An adverse effect of drug therapy is a usually undesirable effect other than the intended therapeutic effect. It may occur even with normal drug dosing. Adverse effects may also occur independently of the dose and be unpredictable. The term adverse effect encompasses all nontherapeutic responses to drug therapy.
What's an allergic response to a drug?
An allergic response is an immune response where the body forms antibodies against the drug. It involves the release of histamine, which is responsible for symptoms of allergy—redness, itching, swelling, rash, and hives.
An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?
An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity
Before a nurse administers the MMR, a mom says, "My child had gelatin at day care and broke out in hives afterwards."
Anaphylactic reactions are believed to be associated with the neomycin or gelatin component of the vaccine. A child having hives after eating gelatin would alert the nurse to hold the vaccine and discuss with the physician.
Describe anaphylactic shock in Pharm
Anaphylactic shock occurs shortly after administration of a drug to which the client is sensitive. It may be life-threatening and must be treated immediately. The client may experience respiratory, cardiovascular, integumentary, and gastrointestinal symptoms.
health care visits through infancy often focus primarily on _______ _______.
Anticipatory guidance (educating parents and caregivers about what to expect in the next phase of development.)
Which medication classification is used in the treatment of tic disorders?
Antipsychotics. (risperidone is the drug of choice), alanzapine.
As a client approaches death, respirations become noisy. This is the result of which type physical event?
As death approaches, a client's reflexes become hypoactive. The jaw and facial muscles also relax. As the tongue falls to the back of the throat, respirations become noisy.
What is given in hospice care for help with alleviating symptoms associated with secretions?
Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions
Hearing tests for infants/children
Auditory brain stem response (ABR) test and the evoked otoacoustic emissions (EOAE) test are indicated for newborns. A child not screened for hearing at birth should be screened before 1 month of age. The Rinne and Weber tests are used with children 6 years and older. Tympanometry is appropriate for children beyond 7 months of age.
What is the average length of a newborn? What are the length/height growth trends and how measured?
Average 50cm (20 in) at birth. 1 in per mo for 6 mo. By 12 mo, length increases about 50%. Growth in "spurts" rather than gradually. Measure length in recumbent position (supine) to age 2 or 3 or until they can stand flat on feet.
Describe height/length trends in the first year
Average length at birth is 20". Height increases 1' mo X 6 mo. By the first year they have grown X 50% of their birth length.
Which assessment finding is considered normal in children? a) irregular respiratory rate and rhythm b) Split S2 and sinus arrhthmia c) decreased heart rate with crying d) genu varum past the age of 5 years
B) Infants and young children often display a split S2 hear sound, and it is very common for children to have sinus arrhythmea (in crease in the heart rate in relation to respirations. have the child hold their breath and listen. Sinus arrhythmia will convert to a regular rhythm when the breath is held. Innocent murmurs are most often heard at the 2nd or 4th intercostal space, and it's timeing is systolic. The innocent murmur is usually medium-pitched and musical. These also sometime disappear when the child changes position. The nurse would document Grade II/VI (quiet, soft, heard with each auscultation) systolic murmur heard at the 4th intercostal space. Document position. Any child w murmur should be referred to experienced practitioner for eval.
Age appropriate toys b-1mo
B-1 mo: Mobile black & white. Unbreakable mirror. Soft brightly colored toys.
Erikson's stages of psychosocial development
B-12mo Trust vs Mistrust. Goal: build trust. 1-3 Autonomy vs. Shame/doubt. Goal: Independence, simple choices, praise decision-making. 3-6 Preschool- Initiative vs Guilt. Goal: correct them in kind manner, not shameful. They are learning problem-solving. 7-11 School age: Industry vs Inferiority. learns how to do things well "industrious child". give small projects. 12-20 Adolescent: Identity vs Role confusion. Adjusts to life/body/person, value system, seeks vocation.
Crib safety
Babies only sleep on their backs (not side), slats distance between no wider than soda can (6 cm or less). No blakets, side rails always raised when parent not right there. No stuffed animals or blankets or pillows or bumper pads.
Describe the Babinski reflex
Babinski is the longest lasting of the Primitive reflexive in infants. It's when you stroke along the lateral aspect of the sole of the foot and across the plantar surface, the toes fan out and hyperextend. Lasts 12 mo. If this lasts long beyond 12 mo, it's a sign of abnormality-- definitely abnormal in an adult.
Recommended colorectal exam?
Begin after age 45. Might discontinue at 76
a period during which mourning for a loss take place.
Bereavement
A nurse is studying the medical records of a client with conduct disorder. The nurse finds that the client was prescribed lithium. What would be the most likely reason for prescribing this drug for this client? Risk of developing seizures The presence of aggression Predisposition to kleptomania Difficulty with decision-making skills
Clients with conduct disorder who are aggressive can sometimes be prescribed medications such as mood stabilizers that have antiaggression properties such as lithium. Lithium is also an antiseizure agent; however, the client history does not indicate this is part of the pathology. Lithium is not generally indicated for the treatment of kleptomania. Behavioral therapy and psychotherapy are required to improve decision-making abilities.
Which observation demonstrates the effective use of cognitive behavioral therapy with a client diagnosed with intermittent explosive disorder? "Do you usually have an explosive episode after a work day?" "Do you have any side effects from the antidepressant medication?" "Does anyone in your family have problems with alcohol use?" "Which member of your family makes you the most angry?"
Cognitive behavioral therapy focuses on helping the client recognize triggers or circumstances associated with the onset of the explosive episode to develop adaptive behaviors and prevent episodes from occurring. By asking the client if he tends to explode at the end of the work day, the nurse is helping the client identify the influence of work stress on the explosive behavior. The client must learn to understand the problem by developing personal responsibility for responses to triggers.
HEAD LAG
Complete head lag at 1 mo Partial head lag at 2 There should be almost none by 4 mo NO head lag by 5 mo!
What are gross motor skills and how do they develop?
Gross motor refers to skills that use large muscles, as opposed to Fine motor which require more intricacy. Head control, rolling, sitting, and walking. They develop Cephalocaudal (head to tail). 1 mo partial head lag begins 3 mo head to 45 degrees in prone. Slight head lag in pull-to-sit. 5 mo rolls both ways. 8 mo sits unsupported. 9 mo pull to stand/cruise. 12 mo walks.
Age 4
Growth 4-6 lb./3" yr. Birth length doubles (40"/40lb) Skip, hop, throw ball overhand, scissors. Copy a square. 1500 word vocab. Questioning is at its peak. Imaginary friend. Selfish, impatient. Can be physically and verbally aggressive. Exaggerates, boasts, tattles. May count but poor math concept.
Difference between Growth and Development
Growth: increase in # and size of cells Development: Advancement in level
what is a narrow margin of safety mean?
Measuring serum drug levels is useful when drugs with a narrow margin of safety are given because their therapeutic doses are close to their toxic doses.
Vocal: 1,2,3,4 mo
Cry, Coo, Babble, Laugh (coo rhymes w 2) and Babble before laughing.
A cytotoxic reaction to a drug is a ______________ reaction.
Cytotoxic reaction is an example of an allergic reaction to a drug
Documentation of vaccines include
Date administered. Name of Vacc. Lot # and exp date. Manufacturer's name. Site and route. Edition date of VIS given to parents. Name and address of facility & name of person giving vaccine.
screenings for ________ should be done every year after age 11.
Depression screenings.
Three drugs to stimulate appetite in end of life
Dexamethasone, megestrol, and dronabinol may be used to stimulate appetite in clients who are at the end of life.
What's the recommended Prostate exam schedule?
Digital exam yearly after age 50. And self-monthly testicular exam.
Common Med in older adult range (66+)
Donepezil (Aricept) 5-10mg at bedtime. Alzheimers/dementia. Rivastigmine (Exelon) Transdermal patch. Parkinson's dementia, mild-moderate Altzheimer's Galantamine (Razadyne) Delays progression of dementia
BP in age preschool and down
Doppler or Palpated BP and document #/D or #/P
Pharmacologic aspects of aging in older adults (66+)
During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen.
Physical changes prior to death
Earlier, a client with failing cardiac function exhibits a higher pulse as the body attempts to circulate oxygen. Next, cardiac output is decreased due to ineffective filling of the chambers, impairing circulation, and diminishing the heart's own oxygen supply. The heart rate and blood pressure then decrease. Peripheral circulation is impaired with the feet and ankles becoming pale and mottled.
What is echolalia?
Echolalia is the automatic repetition of vocalizations made by another person.
Which term is used to describe the personal feelings that accompany an anticipated or actual loss? Bereavement Grief Mourning Spirituality
Grief. Grief is defined as the personal feelings that accompany an anticipated or actual loss.
CONCEPT MASTERY ALERT: preschoolers are erratic eaters and will eat very well one day and then may eat very little the next.
FOOD JAGS (only eating ONE food item or a very small group of food items) are not co;mmon in the preschooler but are common in the toddler
age appropriate toys 4-7 mo
Fabric or board books, easy to hold toys that do things or make noise, bath toys, soft dolls or animals
What type of therapy is usually best for a child (vs adolescent) with conduct disorder?
Family therapy is most desirable to treat a 9-year-old child with conduct disorder. Interventions like sending the child to boot camp or incarceration can worsen the symptoms in the child. Unlike adolescents, school-aged children with conduct disorder do not usually require individualized behavioral therapy. Child- family therapy. Adolescent- individual therapy.
Physical changes in Middle age/Middle adult 40-65
Fatty tissue redistributed Skin drier Wrinkle lines appear on face Gray hair/baling cardiac output begins to decrease. Muscle mass, strength, and agility gradually decrease. Loss of calcium from bones fatigue increases, acute and chronic illness & recovery takes longer. visual acuity diminishes, especially near vision (presbyopia) hearing diminishes, (high-pitched sounds) presbycusis hormone production decreases, resulting in menopause or andropause.
What direction do fine motor skills develop as compared to gross motor skills?
Fine motor skills develop proximodistal (center to periphery. Infant first bats with the whole hand, eventually gross grasping, then finally capable of fine fingertip grasping. A 12 mo old can usually feed himself w a cup or spoon. Gross pincer grasp 8 mo. 10 mo pincer grasp (11 mo puts objects into container and takes em out) 12 mo old 2 block tower.
Erikson's Psychosocial Theory
First Yr- Trust Second Yr- Autonomy PreSchool 3-5- Initiative School Age 6-11- Industry Adolescent 12-20 Identity
Where might you see an abnormalty in the brain images of a child with ADHD?
Frontal lobe. Studies have proven that ADHD is associated with malfunction of the frontal lobe. Decreased metabolism and decreased perfusion to the frontal lobe are the physiological alterations known to cause ADHD.
Psychosocial development 40-64 (middle age/middle adult)
Generativity vs. stagnation time of increased personal freedome, economic stability, and social relationships. Establish and guide next generation, focus less on self. Increased awareness of one's own mortality.
When does the grasp vs/ pincer grasp develop?
Grasp is fine motor: Grasp is strong at 1 mo. Both hands at 4. Transfer at 7. Pincer at 10 mo.
MD schedule for infant/toddler/child/adolescent well visits
Health supervision visits for children without health problems and appropriate growth and development are recommended at birth, within the first week of life, by 1 month, then at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months (think milestones) , and then yearly until age 21.
The nurse is working with an adolescent to promote a healthy weight. Which goal would be appropriate for the nurse and adolescent to work towards? Limiting computer/TV time Weekly physical activity of 60 minutes Weighing on the scales weekly and recording Weight loss of 1 to 2 pounds per week on average
Healthy weight promotion is geared towards healthy habits and active lifestyles. Daily activity is recommended, not weekly. The focus should not be on specific weight-based goals. Linking the goals to weight-specific numbers leads to increased possibility of eating disorders, nutritional deficiencies and poor body image.
A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client? "Let's take this one day at a time; remember you have your daughter's dance recital next month." "You should seek a second medical opinion about your diagnosis." "I believe that you will fight hard to beat this and see your babies grow up." "I know another client with the same diagnosis who has been in remission for 10 years."
Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although the client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Responses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.
Methods of assessment restraint (infants/toddlers)
Hug or Supine Hold
Awareness concepts of Dying
In mutual pretense awareness, the client, the family, and the health care professionals are aware that the client is dying, but all pretend otherwise. In closed awareness, the client is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the client suspects what others know and attempts to find it out. In open awareness, all are aware that the client is dying and are able to openly acknowledge that reality.
A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give? "Why do you think that?" "Did someone tell you that you are dying?" "Tell me more about what's on your mind." "I am not at liberty to disclose that information."
In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind"). The nurse then needs to listen intently, ask additional questions for clarification, and provide reassurance only when it is realistic.
What are some normal age-related eye changes seen in older adults?
In the older adult, normal age-related changes include a sensitivity to glare, the need to hold objects, such as reading materials, far away from the face, slowed pupil dilation, and difficulty discerning blue from green.
Infant to Adolescent Pulse
Infant 100-160 Toddler 80-110 Preschool 70-110 School age 65-110 Adolescent 60-90
Respirations Infant-Adolescent
Infant 30-60 Toddler 24-40 Preschool 22-34 School age 18-30 Adolescent 12-16
A high school teacher has referred an adolescent to the school health nurse for repeated episodes of aggressive behavior and verbalizing profanities loudly at other students in the class. The adolescent can sometimes be apologetic. The nurse should suspect which disruptive behavior disorder? intermittent explosive disorder conduct disorder oppositional defiant disorder pyromania
Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts. The adolescent in this scenario is displaying the behaviors associated with this disorder. Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. Remorse or apology is not a characteristic associated with conduct disorder due to impaired ability to function in social, academic, or occupational settings. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures. In this case, the adolescent directs outbursts at peers. Pyromania is characterized by repeated, intentional fire-setting.
Erikson's theory 20-30s
Intimacy vs Isolation. Relationships/career
What is echokinesis?
Involuntarily Imitating someone else's movements. Often seen in Tourrette's.
Pain by culture:
Islam: Cleansing by God Hindu: Rebirth/Good Karma Christianity: Repentence
Difference between a medical directive and proxy directive?
Medical directive is the living will for treatment preferences Proxy Directive is for a medical proxy or person to make your decisions should you become unable to
When someone shows hyper-sensitivity to a drug...
It means they are excessively responsive to either the primary or secondary effects of a drug. Hypersensitivity occurs when clients are excessively responsive to either the primary or secondary effects of a drug. It also can occur if a client has an underlying condition (i.e., chronic renal failure) that makes the drug's effects especially unpleasant or dangerous, such as with a kidney problem or prostate cancer.
What is the Asymmetrical Tonic Neck Primitive Reflex?
Its the infant in fencing position. While on back, arm is out to whatever side the head is turned to and opposite extremities are flexed. Lasts to about 4 mo
18 mo vaccines
MAD HPV. MMR Hep A & B, DTAP Hib (Polio) IPV Varicella Possibly influenza (depends on time of year)
What happens with maternal iron stores?
Maternal iron stores are transferred to the fetus throughout the last trimester. Preemies can miss all or a portion of this transfer, putting them at risk for anemia compared to full term infants.
Why are IV solutions usually given at a slower rate to older adults?
Older adults usually have cardiac or renal disorders (impaired clearance etc)
TAKE NOTE! Baby formulas
Only formulas w iron fortified. Iron stores the infant rceived prenatally are depleted by 4 to 6 mo of age. NEVER use Cow's milk. no enough iron and too much sodium, protein, and minerals that may overload renal system.
What is ototoxicity? Which nerve?
Ototoxicity is damage to the eighth cranial nerve. It may or may not be reversible. Signs and symptoms of ototoxicity include tinnitus, which is a buzzing or ringing sound in the ear, and sensorineural hearing loss. Other signs and symptoms, particularly of vestibular toxicity, include light-headedness, vertigo, a spinning sensation from a seated position, and nausea and vomiting. Ibuprofren is one drug that can cause ototoxicity.
A nurse is counseling the parents of a child with oppositional defiant disorder (ODD). What does the nurse advise the parents for dealing with the maladaptive behavior of their child? The parents should scold their child. The parents should ignore the child's behavior. The parents should take the child to a psychotherapist. The parents should explain to the child the inappropriateness of the behavior.
Parental behavioral interventions are the mainstay of therapy for adolescents with ODD. Parents are instructed to ignore maladaptive behaviors instead of giving the behaviors negative attention. Positive behaviors should be rewarded with praise and reinforcers. The parents are asked not to deal with their child in a negative way, such as scolding or punishing. The child most likely will not require the help of a psychotherapist. The child may not be able to understand the inappropriateness of his or her behavior.
what's the recommended pap smear schedule?
Pelvic exam and pap smear q 3 y (age twenties) q 5 y (30 - 65)
high blood levels of lead require what treatment?
Pt must be treated with chelation therapy (removal of heavy metals from the body via chelating agents) either orally or intravenously.
For toilet training, assess for ______________________.
READINESS before FOUR! Physical, Psychological, Mental, Parental.
A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify? Risk for constipation related to the effects of an opioid Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug Caregiver role strain related to the need for around-the-clock pain control Impaired physical mobility related to sedative effects of the drug
Risk for constipation.
drug of choice for tic disorder
Risperidone is a drug of choice for tic disorders.
A nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent has been prescribed risperidone by the primary health care provider. What would be the most likely reason for the health care provider to prescribe this drug to the client?
Risperidone is given to those clients with conduct disorder whose behavior poses a threat to others.
Gross Motor overview yr 1
Rolls & sit supported 5/6 mo. Sits unsupported 8 Pulls up 9 Belly to sit 10 Cruising/Walking 12 mo
Age 5
Same 4-6 lb/3". Writes name. Begins to tie shoes. Catches. Rides bike w training wheels. Names coins, colors, days, months. Begins to develop empathy. More cooperative. Talks constantly. 2100 vocab.
For bilingual kids, toddlers mix the two languages in sentences, but by age 4, they have the ability to use both languages
Seperately.
A nurse is developing a plan of care for an adolescent with conduct disorder. What changes in behavior should the nurse expect to find in the client within the first 3 days if therapy is proceeding successfully? Select all that apply. The client will start developing relationships with peers. The client will verbalize feelings and emotions. The client will assess personal strengths and weaknesses. The client will show improvement in academic performance. The client will have learned strategies for solving the client's own problems.
The client will verbalize feelings and emotions. The client will have learned strategies for solving the client's own problems. The immediate goals of management of conduct disorder are that the client be able to verbalize feelings and emotions and learn strategies to solve problems. Changes like developing relationships with peers, being able to assess one's strengths and weaknesses, and improving academic performance are longer term goals of intervention. Remediation:
A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan? Each client experiences each of the stages. Typically, the stages occur in succession. The stages are applicable to any loss. Most clients reach acceptance by the time of death.
The five stages of dying describe the five emotional reactions applicable to the experience of any loss. Not every client or family member experiences every stage. Many clients never reach a stage of acceptance. Clients and family fluctutate on a sometimes daily basis in their emotional responses.
Describe vitals in the neonatal period
The neonatal period is birth to 28 days. BP 82/46 P 110-160 R 32-60 Head is 1/4 length of their body. Head circ= Chest circ. BEHAVIOR IS REFLEXIVE
Explain head lag and age development
The newborn has complete head lag the first month (cant control neck. Partial head lag is gone by 5 mo.
Why should you immediately ask about a person's reaction when they state they are allergic to a drug?
The nurse should ask additional questions of clients who state that they have a drug allergy to ascertain the exact nature of the response and whether or not it is a true drug allergy. This would be a priority over exploring alternatives or determining the client's pain tolerance.
To take ear temp in a three y old...
The nurse should pull the pinna of the ear down and back for a child younger than age 3 years to help straighten the ear canal. For a child older than age 3 years, the pinna is pulled up and back.
The nurse is assessing a child diagnosed with conduct disorder. Based on which behavior would this client be described as exhibiting the disorder at moderate intensity? Truancy Verbal bullying Cruelty to animals Attempted robbery
Verbal bullying is an example of a behavior seen in clients exhibiting a moderate intensity form of conduct disorder. Truancy is described as a behavior seen in a mild intensity form of the disorder. Cruelty to animals and attempted robbery are described as a behavior seen in a severe intensity form of conduct disorder.
Age three
Weight gain 4-6. Av 32 lb. Height 3" gain. Night time B&B control. Jump of bottom step & Stairs w alternating feet. Tower 9-10 blocks. Dress/undress and do buttons. Ride tricycle. 20/30 vision. 900 word vocab! Understands time. Magical thinking. Ability to separate from parent easier. Exploration of genitalia is common. A bit tyrannical at this age. Initiative/guilt
BMI Formula & Ranges
Weight lbX703/HxH 48lbX703/38X38= BMI = Weight (kg) / Height (m)2. Normal is < 25, obese > 28, morbid > 35
A 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia?
When a terminally ill client or the client's legal proxy requests palliative sedation, the use of pharmacologic agents to induce sedation or near sedation when symptoms have not responded to other management measures), the purpose is not to hasten the client's death but to relieve intractable symptoms. Palliative sedation may be controversial, but it is not illegal. Total sedation is rarely indicated in hospice care to provide comfort. Continuous pain assessments are not indicated at this stage; the client requires intervention/treatment.
What's the Step reflex (A Primitive Reflex)
When one foot is placed on a flat surface, the infant puts the other foot down as if to "step". (4-8 weeks).
While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate? "What makes you think that you might be dying?" "Tell me some more about what is on your mind." "You're just having a bit of a set-back. You'll be fine." "What has your physician told you about your condition?"
When responding to the client, the nurse needs to acknowledge the client's fears. Having the client tell the nurse what's on his or her mind acknowledges the client's feelings and opens the way for more discussion. Asking the client about what makes him or her think he or she is dying is probing and does not address the client's feelings or needs. Telling the client that he or she will be fine gives the client false reassurance and does not address his or her fears. Asking about what the physician has told the client redirects the conversation away from the client's feelings and is inappropriate.
blood dyscrasia (dis-KRAY-zee-ah)
any pathologic condition of the cellular elements of the blood reactions in pharm are examples of tissue and organ damage. Blood is a connective tissue.
How many wet diapers per day?
at least 6, but 8-10 is preferable.
What's up with drugs and grapefruit?
grapefruit contains a substance that strongly inhibits the metabolism of drugs normally metabolized by the cytochrome P450 CYP3A4 enzyme. This effect greatly increases the blood levels of some drugs (e.g., the widely used "statin" group of cholesterol-lowering drugs), and the effect lasts for several days. Clients who take medications metabolized by the CYP3A4 enzyme should be advised against eating grapefruit or drinking grapefruit juice.
Baby responds to their own name
by 6/7 mo
newborn sense of smell
by 7 days the newborn can tell his mom's breastmilk smell
Bruxism
grinding teeth especially during sleep
Dysfluency and hesitancy in speech is normal in preschool,
has to do with the fast pace they're aquiring new skills.
Colic
inconsolable crying that lasts 3h or longer per day. healthy infants cry about 3 h per day X 3-7 days per week, more prevalent in evenings. Typically colic resolves by 3 mo of age. We think colic is brought on by GI or neuro, temperment, or parenting style. Normal crying increases by 6 weeks and diminishes by 12.
TAKE NOTE! Warning signs with speech and dev in infant
doesnt make sounds by 4 mo, doesn't laugh or squeal by 6 mo, doesnt babble by 8mo, doenst use single words w meaning by 12 mo (mama, dada)
Malocclusion
upper or lower dental arches out of alignment
Weight/height trend to toddle
weight: 10% loss first week. 6mo double 12 mo triple Toddler: 2 1/2 X quadruple (7X4=28 lb) 4-6 lb year 3 " year 4 yr 40 lb/40" GROWTH IS STEP LIKE RATHER THAN LINEAR.
Pediatric Health supervision focuses on
wellness. It's proactive. promotes health. Growth & Development surveillance and screening, assessment (behavior too), immunizations, health promotion/anticipatory guidance. A pediatric Medical Home provides continuity of care from infancy through adolescence. It has a centralized database that contains all info about a child that pertains to their health status.
TAKE NOTE! bilingual kids might be delayed on first word but
will stay within milestone guidelines.
TAKE NOTE! warning signs that may indicate probs w sensory dev include the following:
young infant doesnt respond to loud noises. child doesn't focus on a near object; infant doesn't start to make sounds or babble by 4 mo, infant doesn't turn to locate sound at age 4 mo; infant crosses eyes most of the time at age 6 mo.
Bone density exam recommendations?
•Menopausal and postmenopausal women under age 65 with risk factors, or over age 65 •Men aged 50 to 69 with risk factors, or over age 70 •Fracture after age 50 •Height loss
