Peds Exam 1
A charge nurse is reviewing the expected growth and development of school-aged children with a group of staff nurses. Which of the following statements should the nurse include?
"A 6-year-old child should be able to count 13 coins." A 6-year-old child should be able to count 13 coins, identify morning and afternoon, and be able to identify right and left hands
The nurse is providing anticipatory guidance to a parent of an 8-year-old girl whose weight is 65 lb (29.5 kg) and height is 50.5 in (128.3 cm). Which statement by the parent demonstrates the need for further teaching?
"Based on my child's weight and height, I should be concerned my child is overweight." An 8-year-old girl needs between 1400 and 1600 calories per day. Based on the child's weight and height, the child has a body mass index (BMI) of 17.9 (around 75th percentile). To calculate BMI use [wt in lb/{ht in inches}x{ht in inches}] x703. This child is not in the overweight or obese category (>85th percentile is classified as overweight). An 8-year-old needs 1000 mg calcium per day. Children should be encouraged to fill half their plate with fruits and vegetables, to make half of their grains whole grains, and to choose lean proteins and calcium-rich foods.
A nurse is providing education for the family of a 6-month-old infant about ways to stimulate language development. Which of the following instructions should the nurse include?
"Explain what you are doing to the infant while providing care." The nurse should instruct the family that exposing the infant to expressive speech is the foundation for the development of expressive skills (the ability to make others understand needs and thoughts) and receptive skills (the ability to understand spoken words).
The parents of a 3-year-old toddler tell the nurse that their child constantly says "no" to everything and they are very frustrated. The parents ask the nurse what they should do. Which response(s) by the nurse are appropriate? Select all that apply.
"Have you tried using "time-outs" for negative behavior?" "Giving your toddler choices instead of posing 'yes' or 'no' questions may decrease the 'no' response." "This action is normal for this age. If measures to stop this behavior do not work, you should make the decision for your toddler to move on with the activity occurring." As the toddler separates from the parent and recognizes his or her own individuality and exerts autonomy, it is very common for the child to display negativism. Time-outs are helpful ways of disciplining for this age group. Offering choices, such as "Do you want the red or blue shirt?" lends to autonomy. If measures fail, the parent needs to calmly make choices for the toddler. Spanking is not recommended for any age. Asking the child to explain is not developmentally appropriate for a 3-year-old toddler.
A nurse is teaching the parent of an infant about injury prevention. Which of the following statements by the parent indicates an understanding of the teaching?
"I should make sure my baby's clothing does not have buttons." The nurse should instruct the parent to avoid clothing with buttons to reduce the risk of choking and aspiration.
A nurse is talking with the parent of a preschool-aged child who tells the nurse, "My child has suddenly become disinterested in certain foods." Which of the following statements should the nurse make?
"Keep a diary of the foods your child eats each day." The nurse should encourage the parent to keep a diary of the foods the child eats throughout the day for 1 week. This can help the parent realize that the child may be eating better than expected. Evidence suggests that children can self-regulate their caloric intake. When they eat less at a meal, they can compensate by eating more at another meal or by having a snack.
A nurse is providing teaching to the parent of a 2-year-old toddler about nutrition. Which of the following statements by the parent indicates an understanding of the teaching?
"My child should consume 1,000 calories per day."
A nurse is performing a developmental assessment on a 3-year-old child. Which of the following commands should the nurse expect the child to complete successfully?
"Put your shoes on."
A teen mom asks the discharge nurse if it is okay to sleep in bed with her baby. She says her mom always did it with her siblings and it seemed okay. How should the nurse respond?
"The baby can sleep in your room in an infant crib, but not in an adult bed." According to the 2016 recommendation by the American Academy of Pediatrics, infants should sleep in the same bedroom as the parents, but on a separate firm surface, such as a crib or bassinet, and never on a couch, armchair or adult bed, to decrease the risks of sleep-related deaths.
A nurse is talking with a parent of a preschooler. The parent reports that she struggles to get her child to go to bed at a consistent time. She explains that the child gets out of bed, enters his parents' room, and cries when they tell him to stay in his own bed. Which of the following instructions should the nurse give the parent?
"Use a stable, relaxing routine like a bath and story time before bed." Routines are reassuring to preschoolers because they allow them to anticipate their environment and adapt appropriately. These actions help the child settle down prior to bedtime and allow parental-child interaction prior to bed
A nurse is caring for a toddler. Which of the following objects should the nurse select from the playroom for this child during hospitalization?
10-piece wooden puzzle Age-appropriate toys for a toddler include puzzles, large crayons, blocks, picture books, push-pull toys, finger paints, modeling clay, and musical toys. These toys all allow manipulation and exploration and meet the child's developmental and diversional activity needs
The infant weighs 6 lb 8 oz (2,950 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 12 months?
19 lb 8 oz (8825 g) The average newborn weighs 7.5 lb (3400 g). The average newborn loses 10% of birth weight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,950 g) at birth and tripled that weight at 12 months, the infant should weigh 19 lb 8 oz (6.5 lb × 3 = 19.5 lb) or 8825 g.
Language development is rapid in the preschool years. At the age of 2 most children use about 50 to 100 words. By the time the child is 5 years of age, how many words do most children use?
2,000 words A 2 year old verbalizes about 50 to 100 words. By the age of 3 the child is using telegraphic speech. This means they can speak in short sentences containing only essential information. By the age of 5 preschoolers know and use about 2,000 words. By age 6 the child is making sentences that are adult-like in structure.
A nurse is providing teaching to the parents of an infant who is breastfeeding. When should the nurse instruct the parents to introduce solid foods in the infant's diet?
4-6 months of age
A nurse is assessing an infant who was born at 32 weeks gestation and is now 8 months old. Which of the following developmental ages should the nurse expect the infant to demonstrate?
6 months Because the infant was born 8 weeks prematurely, the nurse should use this data to determine that the infant's setback age is 6 months. Therefore, the nurse should expect the infant to have achieved the developmental milestones of a 6-month-old infant
The nurse is reviewing a group of medical records for compliance with recommended well-child care visits. Which finding would warrant further investigation?
A 13-year-old child who was last seen 2 years ago. 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, and then yearly until age 21.
A nurse is caring for a 4-month-old child who is hospitalized. Which of the following toys should the nurse provide for the child?
A plastic mirror A 4-month-old infant can recognize herself and will also attempt to play with "the baby in the mirror." A mirror is a bright object that provides appropriate visual stimulation for this age group. For the infant's safety, however, the mirror must be unbreakable
A nurse is conducting a health assessment for a 24-month-old toddler at the local health department. The nurse should expect which of the following findings? (Select all that apply.)
Ability to build a tower of 6 blocks, Slightly bowed or curved leg appearance The nurse should expect a 24-month-old toddler to be able to stack a short tower of 6 or 7 blocks. Additionally, a 24-month-old toddler will have a "pot-bellied" appearance; the legs should be slightly bowed to support the weight of the comparatively large trunk.
A nurse on a pediatric unit is planning care for a preschooler who will be having a surgical procedure in the morning. The child has been crying despite his parents' presence at his bedside. The nurse should add engaging the child in therapeutic play to the care plan to offer which of the following benefits?
Allow the child to manipulate toy medical equipment A major function of play therapy is making potentially unmanageable situations manageable through symbolic representation, which provides children with opportunities to learn to cope. A preschooler does not have the language development to express fear of the unfamiliar medical equipment in the hospital. By encouraging the child to touch the equipment, the nurse is helping decrease the child's fear and intimidation in a safe environment using age-appropriate vocabulary. The use of toys enables children to transfer anxieties, fears, fantasies, and guilt to objects rather than people
A nurse is providing teaching to the guardians of a 4-month-old infant on how to play with the infant. Which of the following play activities should the nurse suggest for this infant?
Allow the infant to splash in the bathtub The nurse should suggest allowing this 4-month-old infant to splash in the bathtub as a play activity. Splashing is appropriate for the developmental age of the infant and provides tactile stimulation. However, the nurse should emphasize and teach bath safety to prevent injury.
A nurse is providing anticipatory nutritional guidance for the caregivers of a 5-month-old infant. Which of the following points should the nurse include in the teaching?
Allow the infant to try finger foods, such as crackers, after 6 months of age. The nurse should instruct the caregivers that infants will acquire the coordination to begin self-feeding finger foods at around 6 months of age
Anatomic changes of a preschooler
Alveoli increase in number Always increase in size Eustachian tubes remain short & straight
A nurse is performing a physical assessment on a 6-month-old infant. Which of the following reflexes should the nurse expect to find?
Babinski The Babinski reflex, which is elicited by stroking the bottom of the foot and causing the toes to fan and the big toe to dorsiflex, should be present until the age of 1 year. Persistence of neonatal reflexes might indicate neurological deficits. The stepping reflex, in which the infant takes reflexive steps when placed on his or her feet in an upright position, disappears by the age of 4 weeks. The extrusion reflex, which causes the infant to spit out food placed on the tongue rather than moving it to the back of the mouth, is absent by the age of 4 months. The Moro reflex should disappear at the age of 3 to 4 months. It is an extension of the arms and flexion of the elbows in response to a sudden jarring, followed by flexion and adduction of the extremities.
A nurse is assessing a 6-year-old client at a well-child visit. Which of the following findings requires further assessment by the nurse?
Presence of sparse, fine pubic hair The development of sexual characteristics prior to the age of 9 years in boys and 8 years in girls is an indication of precocious puberty and requires further evaluation.
Newborn safety
Car safety Use proper restraint Never leave unattended in car Rear facing throughout infancy Always buckle Safety at home Crib with firm mattress Safety gates, outlet covers, dangerous items stored out of reach Choking prevention Crib is empty except baby ( no blankets or toys) Foods (no popcorn, nuts, carrot slices, grapes, hotdog pieces) No use of walkers ( can fall down stairs) Cabinet locks, choking prevention Water safety Can drown in even a small amount of water Never leave unattended in bath, pool, etc Dispose of any water or liquid from containers when done using
Conjugate vaccines
Chemically linking the bacterial cell wall polysaccharide portions with proteins Dramatically increases the immune response compared to presenting the polysaccharide portion alone Examples Hib (haemophilus influenzae type b)
Appropriate discipline of a school-age child
Children learn the natural & logical consequences of discipline Parents should teach children rules established by the family, values, & social rule of conduct Should be consistent, applied fairly & focus on the development of the child Positive acknowledgement of positive behaviors are more likely to encourage those positive behaviors & promote development This age child becomes aware of the cause & effect of his or her behavior Effective use of appropriate discipline can preserve the child's self-esteem & dignity
Appropriate discipline of an adolescent
Children learn the natural & logical consequences of discipline Parents should teach children rules established by the family, values, & social rules conduct Should be consistent, applied fairly & focus on the development of the child Positive acknowledgement of positive behaviors are more likely to encourage those positive behaviors & promote development This age child becomes aware of the cause & effect of his or her behavior Effective use of appropriate discipline can preserve the child's self-esteem & dignity
Toxoid vaccines
Contain protein products produced by bacteria called toxins Toxin is heat-treated to weaken its effect, but retains ability to produce an immune response Examples Diphtheria Tetanus
Inactivated vaccines
Contain whole dead organisms Are incapable of reducing, capable of producing an immune response Examples Hep A Flu Polio Rabies
A nurse is assessing the fine motor skill development of a 4-year-old child. The nurse should expect the child to be able to perform which of the following activities?
Copying a square The nurse should expect a 3-year-old child to have the fine motor ability to copy a circle. A 4-year-old child should have the ability to copy a square
A nurse is assessing a 4-year-old child's cognitive development during a well-child visit. Which of the following should the nurse expect the child to display?
Development of the superego This is the development of a conscience. Preschoolers begin to develop an understanding of right from wrong. While they might be unable to understand the "why" of acceptable vs unacceptable behaviors, they learn the concept through punishment and reward and the principles to which their parents adhere
A nurse is assessing an 18-month-old infant who is postoperative. Which of the following pain scales should the nurse use?
FLACC The nurse should use the FLACC pain scale to monitor the infant for pain. The FLACC scale monitors facial expression, leg movement, activity, cry, and consolability in children 2 months to 7 years of age
A nurse is assessing a 4-year-old child. The nurse should expect the child to be able to perform which of the following activities?
Fastening buttons on a shirt
Appropriate discipline of a toddler
Focus on limit setting, negotiation, techniques to assist the toddler to learn problem solving Realistic choices can be helpful Keep instructions simple Reinforce desirable behaviors Extinction & "time outs" for negative behaviors Time out can be used starting at 2.5-3 yr Extinction-useful fro 2-3 yrs Systematic ignoring of the undesired behavior Should only be used for non-dangerous unwanted behaviors
Preschooler Developmental Milestones
Gross Motor Preschooler is agile while standing, walking, running & jumping Can go up & down stairs & walk forward & backward easily Fine motor Capable of grasping utensils & crayons in an adult fashion Sensory Senses of smell & touch continue development during preschool years May have a less discriminating senses of taste than older children Visual acuity continues progression Should be equal bilaterally Typical 5-year old has an acuity of 20/40 or 20/30 Communication/Language Telegraphic speech- short sentences that contain only essential information (like charting) Age 2 uses 50-100 words By age 5 uses about 2,000 words By end of preschool period, child is using sentences that are adult like in structure May stutter; typically resolves by age 8 Certain sounds are harder than others to pronounce F, V, S, Z are mastered by 5 usually SH, L, TH, and R can take until age 6 or later Bilingual children may lag d/t learning 2 languages Social & Emotional Friendships- learn how to make & keep a friend; needs interactions w/friends; important social skill Social Skills Cooperation, sharing (of things & feelings), kindness, generosity, affection display, conversation, expression of feelings, helping others, making friends, strong emotions, developing sense of identity ( know they are boys or girls) Temperament-influenced by parent's expectation of child's behavior Fears- exhibits variety of fears, vivid imaginations, can experience a variety of fears Loud noises, barking dogs, imaginary monsters
Appropriate discipline of a newborn
Physical punishment should never be used in infancy Remaining calm, firm & consistent is needed Primary goal- teach limits to keep infant safe
A nurse is developing a health education program for the parents of school-aged females. Which of the following pieces of information regarding sexual maturation should the nurse include?
Higher body fat content is associated with earlier onset of menarche. The nurse should inform the parents that the onset of menarche is expected to occur around 10.5 to 15.5 years of age. Females who have a higher body fat content have been shown to have an earlier onset of menarche
A nurse is assessing the gross motor skills of a 4-year-old preschooler. The nurse should expect the preschooler to perform which of the following activities?
Hopping on 1 foot The nurse should expect a 4-year-old preschooler to hop on 1 foot.
Anatomic changes of an adolescent
Increase in diameter & length of lungs Respiratory volume & vital capacity increases
A nurse is providing teaching to the guardian of a child about bicycle safety. Which of the following pieces of information should the nurse include?
Instruct the child to walk the bike through intersections The child should walk the bike through intersections and crosswalks to decrease the risk of injury. The child should ride a bike with the flow of traffic to decrease the risk of injury. The child should ride a bike that is the appropriate size to prevent injuries. The balls of the child's feet should be on the ground when the child sits on the bicycle seat. The bike helmet should not obstruct the child's eyes or ears to decrease the risk of injury.
An infant is breastfed. When assessing the stools, which findings would be typical?
Less constipation than bottle-fed infants The first stool of the infant is meconium. It is the result of digestion of amniotic fluid and it is black-green color and sticky. Following that, in 1 to 2 days the infant's stools change to a yellowish-tan color. The stools of breastfed infants tend to be yellow-tan. They are looser in texture and appear "seedy." The stool of a bottle-fed baby has the consistency of peanut butter. The stools of breastfed babies generally have no odor since all milk is digested. Some babies will have a bowel movement with every feeding but it is small. Bottle-fed babies have less stools each day but they are larger and more likely to have an associated odor.
A nurse is teaching the parent of an infant about food allergens. Which of the following is the most common food allergy in children?
Milk
Live attenuated vaccines
Modified living organisms that are weakened Can produce an immune response but does not produce the complications of the illness Examples MMR (measles, mumps, & rubella) Varicella Rotavirus Smallpox Chickenpox Yellow fever
Anatomic changes of a newborn
Narrower nasal passages Larynx is more funnel shaped Trachea & chest wall more compliant Shorter/narrower bronchi & bronchioles Fewer alveoli Fast respiratory rate What does this mean? Higher risk for respiratory compromise Respiratory system does not reach adult levels of maturity until about 7 years of age Lack of IgA in mucosal lining of the upper respiratory tract also contributes to frequent infections Narrower nasal passages, takes less swelling to create respiratory distress Harder to clear secretions
A nurse is teaching the parent of an infant about home safety. Which of the following pieces of information should the nurse include? (Select all that apply.)
Position the car seat so it is rear-facing, Secure a safety gate at the top and bottom of the stairs, Maintain the water heater temperature at 49°C (120°F). Infants and children should remain in the rear-facing position in a car seat until the age of 2 years or until they reach the recommended height and weight per the manufacturer's guidelines. As the infant begins to crawl and becomes more mobile, the risk of falls increases. To prevent a burn injury, the temperature of the water heater should not exceed 49°C (120°F).
Adolescent Growth
Rapid physical growth in body size & proportions second only to growth in infancy
A nurse is talking with the parent of an infant during a well-child visit. The parent states, "My 6-year-old child started wetting the bed after we brought her baby sister home. She hasn't done that in over a year." This behavior by the sibling is an indication of which of the following defense mechanisms?
Regression The nurse should identify that the 6-year-old sibling's behavior is an indication of regression. With this defense mechanism, the individual reverts to a prior stage of development as a means of coping with stress.
A nurse is providing teaching about home safety to the parent of a 2-month-old infant. Which of the following information should the nurse include?
Remove bibs before the infant goes to sleep
A nurse is planning to implement relaxation strategies with a young child prior to a painful procedure. Which of the following actions should the nurse take?
Rock the child using long, rhythmic movements The nurse can implement relaxation strategies by sitting with the child in a well-supported position such as against the chest and rocking or swaying back and forth in long, wide movements.
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?
Sitting independently Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.
A nurse in a pediatric clinic is talking with the parent of a toddler who states that her child will not sit at the table to eat with the family. She asks the nurse for recommendations for "finger foods" for her child. Which of the following foods should the nurse suggest?
Slices of ripe banana Toddlers should have about 8 oz (1 cup) of fruit per day. Bananas are nutritious and, as long as they are soft, do not present a choking hazard for young children
A nurse is assessing a 4-year-old child for growth and developmental milestones during a well-child visit. Which of the following findings suggests a possible delay in development?
Speaking using 2- or 3-word sentences A 4-year-old child should be speaking in 4- to 5-word sentences. Speaking in 2- to 3-word sentences is typical of a 2-year-old child.
A nurse is assessing a 3-year-old child during a well-child examination. Which of the following findings should the nurse report to the provider?
The child cannot walk on tiptoe A child should be able to tiptoe by 30 months of age.
A nurse is preparing to assess a 3-month-old infant during a well-child visit. Which of the following observations should the nurse expect?
The infant looks at his hands Infants usually start to look at their hands while lying down or sitting between 12 to 20 weeks of age. Convergence on near objects is usually well established by 3 months of age. By 3 months of age, infants' hands should be mostly open, and they usually hold onto objects placed into their hands. Voluntary grasping of objects does not usually occur until 5 months of age. A crude pincer grasp usually develops by 8 to 9 months of age. Infants usually have a partial to slight head lag when pulled to a sitting position at 3 months. By 4 to 6 months, infants gain full head control. While some infants might independently roll from their back to their abdomen earlier than expected, a nurse would not expect an infant to be able to do this until 6 months of age
A nurse is assessing a 10-month-old infant at a well-infant checkup. Which of the following assessment findings should the nurse report to the provider?
The infant needs assistance to sit up An infant is expected to have the ability to sit up unsupported around 8 months of age. Therefore, the nurse should report this finding to the provider. Although infants develop at different rates, the infant may not begin walking independently until 13 months of age. Therefore, the nurse should identify this as an expected finding for a 10-month-old infant. The infant's Moro reflex is expected to disappear around 4 months of age. Therefore, the nurse should identify this as an expected finding for a 10-month-old infant. The infant's anterior fontanel is expected to close around 12 months of age. Therefore, the nurse should identify this as an expected finding for a 10-month-old infant.
A nurse in a provider's office enters an examination room to assess an 8-month-old infant for the first time. Which of the following reactions by the infant should the nurse expect?
The infant turns away when the nurse approaches. The nurse should expect an 8-month-old infant to have a heightened fear of strangers. The infant is expected to cling to her parent and turn away when approached by a stranger.
The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments?
The infant will most likely present with developmental skills consistent with a 6-month-old infant. When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age. The infant who was born at 32 weeks' gestation was 8 weeks (or 2 months) premature. To determine the adjusted age, the nurse subtracts 2 months from the chronological age of 8 months: 6 months
A nurse is assessing a 6-month-old infant at a well-child visit. Which of the following findings indicates the need for further assessment
The infant's legs remain crossed and extended when supine. Legs that are crossed and extended when supine is an unexpected finding and requires further assessment. At 6 months of age, the infant's legs flex at the knees when the infant is supine. Crossed and extended legs when supine is associated with cerebral palsy
A nurse is assessing a 30-month-old toddler during a well-child visit. Which of the following findings requires further assessment by the nurse?
The toddler's birth weight is tripled. The toddler's birth weight should triple by 12 months of age. By 30 months of age, the toddler's birth weight should be quadrupled
A nurse in a provider's office is observing children playing in the waiting room. The nurse should expect to identify parallel behavior in which of the following age groups?
Toddlers Toddlers demonstrate parallel play. Infants demonstrate solitary play. Preschoolers demonstrate associative play. School-age children demonstrate cooperative play.
A nurse is assessing a 6-month-old infant during a well-child visit. Which of the following motor activities should the nurse expect the infant to have achieved?
Turning from back to stomach A 6-month-old infant should be able to turn over completely, sit momentarily without support, and reach to be picked up
School-age children safety
Unintentional injuries are the leading cause of death in children between 1 and 14 yrs of age Car safety Ride in the rear seat Airbags make the front seat unsafe The seat belt needs to be low & flat over the hip bones & across the shoulder not the neck or face Pedestrian safety Every year, 40,000 children are injuries as pedestrians & 456 pedestrians children are killed Children under 10 should not be unsupervised pedestrians Bicycle & Sport safety Should wear a helmet, knee pads & elbow pads Head injuries d/t bicycle accidents have been shown to be reduced by 48-60% by wearing a well-fitted helmet Stress to parents the importance of appropriately sized bike; not buy one for the to grow into Concussion safety & protocols Fire safety Eager to help parents w/cooking & ironing; CNA be curious about fire, matches & fireworks Serious burns can occur from any exposure to fire Teach children what to do if their clothes catch on fire Water safety An adult should always supervise children when they are swimming to prevent water-related accidents Abuse in children An estimated 3.5 million reports of child abuse are made annually to child protective services in the US The abused are family, friends & strangers
Recombinant vaccines
Use genetically engineered organisms Hep B is produced by splicing a gene portion of the virus into a gene of a yeast cell Yeast cell can then produce hep b surface antigen to use for vaccine production Examples Hep B HPV
A nurse is providing education for a group of parents about toddler language development during a well-child visit. Which of the following findings should the parent expect in an 18-month-old toddler?
Vocabulary of 10 or more words
Newborn Growth
Weight Avg 3,400 g (7.5 lb) at birth May lose 5-10% of their body weight over the first week; back to birth weight by day 7-10 Double by 4-6 months Triples by 12 months Length Avg 50 cm (20in) at birth Increases by 50% by 12 months Head Circumference 35 cm (13.5 in) at birth Increases by about 10 cm by 12 months
Preschooler Growth
Weight Avg increase of 5lbs per year Loses baby fat, gains muscle Height Avg increase of 2.5 to 3 in per year Remember avg 4 year old is 40 inches tall and 40 lbs
Toddler Growth
Weight Increases steadily in spurts (slower rate than infant) Avg wgt gain= 3 to 5 lb (1.36-2.27kg) per year Length & height Increases steadily in spurts (slower rate than infant) Avg increase 3 in per year About ½ adult height by age 2 Head More proportional to body by age 3 Avg increase 1 in (2.54cm) between 1-2 years of age ad 0.5 in (1.27cm) per year until age 5
Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?
artificially acquired active immunity Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life.
A nurse is providing teaching to the guardian of an adolescent. The guardian reports that the adolescent sleeps about 10 hr on weekend nights. Which of the following responses should the nurse provide?
"Adolescents need more sleep due to rapid growth." The nurse should identify that sleeping 10 hours on weekend nights is an expected finding in adolescents, who need more sleep time than other age groups. Common reasons for the increased need for sleep include stress, busy schedules (e.g. extracurricular activities), and rapid physical growth
Anatomic changes of a toddler
Alveoli continues to increase in number Trachea & airways remain small compared to adult Tonsils & adenoids are relatively large Eustachian tubes are relatively short & straight Increases AOM (acute otitis media)
A nurse is observing the behavior of a 2-year-old child. Which of the following actions should the nurse expect to observe when the child is in an activity room with other toddlers?
Engaging in play near other children The nurse should identify that toddler play happens in parallel to that of other children. As socialization begins, the child plays alongside other children, not with them
Preschooler safety
Falls highest cause of non fatal injury Motor vehicle accidents & drowning responsible for most fatal injuries Prevent exposure to tobacco smoke Second hand smoke exposure is associated with increased ear infections, increased asthma symptoms, behavioral difficulties Household safety Handguns, matches, bodies of water, bicycle riding Education on injury prevention Teach preschoolers to stop at curb w/o a grown-up, never touch a gun, wear a helmet, smoke alarms in homes, water heater set to 120*F or less Never call medication and, have poison control number readily available (1-800-222-1222) Water safety/swimming education Great time to teach to swim as they can voluntarily hold their breath If you have a pool, adults should be CPR trained Never leave children unattended around water (even if they are strong swimmers) Children this age are cognitively able to absorb concrete information Car safety Make sure in correct seat based on hgt/wgt Fire department can check seats if needed As a nurse, never adjust a car seat unless specifically trained & told to do so
Toddler developmental milestones
Gross Motor Initial walking with "toddler" gait (unsteady, legs planted widely part, swaying from side to side) By 3 yrs old moves heel to toe, more typical gait Moves to walking well to running Pushing or pulling a toy Fine Motor Progresses from holding & pinching Manages utensils Holds crayon Strings a bead Works a puzzle Uses a touch screen Sensory Hearing intact since birth Visual acuity continues to improve May prefer certain smells May prefer certain textures (soft vs scratch clothes) Explore environment w/all 5 senses Lack of taste discrimination places the toddler at risk of accident ingestion Should be 20/50 to 20/40; depth perception improving Communication/Language Language development occurs rapidly during the toddler years Age, social interactions & types of language to which the toddler is exposed to influence the development Types of language Receptive- ability to understand what is being said or asked Echolalia- repetition of words & phrases w/o understanding (typical in toddlers under 30months) Telegraphic speech- speech that only contains the essential words to get the point across Early intervention & referral is essential for language & speech delays Bilingual- may mix languages from ages 1-2; Assessment of adequate language development is more complicated Emotional & social Emotional is focused on separation & individuation in toddlers Individuation- forming a sense of self, learning to control one's environment, leads to lability Egocentrism focus on self; sees everything that happens as it relates to the toddler
School-Age Developmental Milestones
Gross motor Coordination, balance & rhythm improve Often able to ride a two-wheeled bike, jump rope, dance, participate in variety of sports May become awkward as bodies growing faster than able to compensate Fine Motor Hand usage improves Eye-hand coordination & balance improve Can write, print words, sew or build models Can play musical instruments Myelinization of the central nervous system is reflected by refinement of the fine motor skills Child between 10-12 begins to exhibit manipulative skills comparable to adults Vision Problems Amblyopia- lazy eye; corrected w/glasses or patching Strabismus- malalignment of the eye muscles Deprivation d/t cataract formation in 1 eye (rare) Signs of vision impairment Eye rubbing, squinting Avoiding reading Frequent headaches Holding reading materials close Problems w/depth perception or hand-eye coordination Sports-related eye injuries & eye protection are important in this age group Communication/language Vocabulary expands to 8,000 to 14,000 words Culturally specific words are used Reading efficiency improves language skills More complex grammatical forms are used Development of metalinguistic awareness occurs Metaphors are beginning to be understood Emotional & social Temperament- easy & adaptable; the child that is slow to warm up; difficult & easily frustrated Self-esteem- face the process of self-evaluation from a framework of either self-confidence or self doubt Body image- may model themselves after parents, peers& person in movies or on tv; important for late school-ages to feel accepted by peers; can be lifelong effects from poor body image Fears- shift away from pretend things to things that can open to them in real life Peer relationship- peers influence perceptions of themselves; associate w/peers of the same sex; Learn to respect different point of views; may modify behavior to gain acceptance teacher & school influence- serves as means to transmit values of society & to establish peer relationships; system of awards & punishments administered by teachers affects the self-concept of children & influences their response to school Family influences- questioning of parents & the potential for parental conflict but continued to respect for family values; late school-age & preadolescent period the child may prefer to be in the company of peer
Newborn Developmental milestones
Gross motor Develop in cephalocaudal fashion (head to tail) Use large muscles (head control, rolling, sitting, walking) First head control, then ability to roll over, sit, crawl, pull to stand & then walk Warning Signs Arms & legs are stiff or floppy Child cannot support head at 3-4 months of age Child reaches with one hand only Child cannot sit with assistance at 6 months Not crawling by 12 months Unable to stand supported by 12 months Fine motor skills Develop in proximodistal fashion ( center outwards) Include maturation of hand & finger use Phenomenal increases in their gross & fine motor skills over the first 12 months of life Sensory Hearing should be developed at birth Smell develops rapidly (7 days can differentiate the smell of their mother's breast milk from another woman) Nearsighted 8-15 inches, prefer human face, likes sharp contracts (Black & white stripes), normal to wander and occasionally cross, binocular it's begins to develop at 6 weeks (well established by 4 months), full color vision by 7 months Prefer sweet taste to all others Prefer soft sensations to corse sensations Communication/Language 1-3 months: coos, other vocalizations , differentiated cries 4-5 months: simple vowel sounds, laughs, vocalizes in response to voice, responds to no & to name, raspberries 6 months: yelling and squealing begins 7-10 months: babbling begins progresses to strings w/o meaning, responds to simple commands 12 months: start placing meaning to "mama" & "dada" uses 2-3 recognizable words w/meaning, try to imitate words pay more attention to Social & Emotional Temperament Low to moderately active, regular & predictable Highly active, more intense & less adaptable An individual's nature Stranger anxiety Starts around 8 months of age May become clingy & whinny when approached by strangers Separation anxiety Starts later in infancy Comes after stranger anxiety
A nurse is preparing to administer recommended immunizations to a 2-month-old infant. Which of the following immunizations should the nurse plan to administer?
Haemophilus influenzae type B (Hib) and inactivated polio virus (IPV) The recommended immunizations for a 2-month-old infant include Hib and IPV. The Hib immunization series consists of 3 to 4 doses, depending on the immunization used. At minimum, it is administered at 2 months, 4 months, and 12 to 15 months of age. The IPV immunization series consists of 4 doses and is administered at 2 months, 4 months, 6 to 18 months, and 4 to 6 years of age
A nurse is performing a visual acuity screening for a school-aged child using the Snellen letter chart. Which of the following actions should the nurse take?
Have the child wear his glasses during the vision screening The nurse should assess the child's visual acuity while the child is wearing prescribed glasses.
Toddler safety
Increasing mobility REQUIRES increased vigilance Provide child proof environment Toddlers love to try to get hurt Keeping them safe takes lots of vigilance Use a safe car seat in back seat of the car Back seat, in proper car seat Rear facing until 2 Chest clip over chest Provide a safe home environment Avoid tobacco smoke exposure Guns in home Should be locked up in a safe (AAP advices against having guns) Safety gates (top & bottom of stairs) Pot handles turned inward Helmets when riding wheeled toy Prevent poison Toddlers will try to eat anything Keep everything locked up Button batteries, if swallowed, are medical emergency Magnets are medical emergency if swallowed Water safety ( careful observation) Very small volume of water needed (toilet, bucket, bathtub)
A nurse is planning care for a preschooler who is scheduled for a surgical procedure. The nurse should identify that the preschooler is in which of the following of Erikson's psychosocial stages of development?
Initiative vs. guilt A preschooler is in the developmental stage of initiative versus guilt. Preschoolers initiate play activities and experience a feeling of guilt if their efforts at independence receive a negative reaction from caregivers.
A nurse is performing a neurological examination on a 15-month-old toddler. Which of the following findings should the nurse expect?
Negative Babinski reflex The nurse should expect a negative Babinski reflex from a 15-month-old toddler because this reflex usually disappears around 12 months of age
Differentiating between night terrors and nightmares
Night terrors A short time after falling asleep, the child seems to awaken and is screaming Usually does not respond much to the parent's soothing, but he or she eventually stops screaming and goes back to sleep Often frightening for parents because the child does not seem to be responding to them One technique that may help to decrease the incidence of night terrors is to wake the child about 30-45 min into the sleep cycle If continued nightly for about a week, they cycle of night terrors may be broken Nightmares Often occur in preschool children as a result of the child's struggle to distinguish what is real from what is not When a child awakens from a night mare, he or she is often crying & may be able to recount what the dream was about Parents should validate the child's fear rather than discount it
A nurse is observing a mother who is playing peek-a-boo with her 8-month-old child. The mother asks if this game has any developmental significance. The nurse should reply that peek-a-boo helps develop which of the following concepts in the child?
Object permanence
Be familiar with primitive reflexes and protective reflexes
Primitive -subcortical involving whole body) Moro- with sudden extension of the head, the arms abduct & move upward & hands form a "C" Appears at birth Disappears at 4 months Root- when infant's cheek is stroked, the infant turns to that side, searching with mouth Appears at birth Disappears at 3 months Suck- reflexive sucking when nipple or finger is placed in infant's mouth Appears at birth Disappears at 2-5 months Asymmetric tonic Neck- while lying supine, extremities are extended on the side of the body to which the head is turned & opposite extremities are flexed (also called the "fencing" position) Appears at birth Disappears at 4 months Palmar grasp- infant reflexively grasps when palm is touched Appears at birth Disappears 4-6 months Plantar grasp- infant reflexively grasps with bottom of foot when pressure is applied to the plantar surface Appears at birth Disappears at 9 months Babinski- stroking along the lateral aspect of the sole & across the plantar surface results in fanning & hyperextension of the toes Appears at birth Disappears at 12 months Step- with one foot on a flat surface, the infant puts the other foot down as if to "step" Appears at birth Disappears at 4-8 weeks Protective - gross motor response. Prerequisite for appropriate motor development. Will remain for the rest of life once established. Neck righting- neck keeps head in upright position when body is tilted Appears at 4-6 months and Persists Parachute (sideways)- protective extension with the arms when tilted to the side in a supported sitting position Appears at 6 months and Persists Parachute (forward)- protective extension with the arms when held up in the air & moved forward. The infant reflexively reaches forward to catch himself or herself Appears 6-7 months and Persists Parachute (backward)- protective extension with the arms when tilted backward Appears at 9-10 months and Persists
Anatomic changes of a school age child
Respiratory rates decrease Respirations are diaphragmatic in nature
A nurse is assessing a 3-year-old preschooler. Which of the following developmental milestones should the nurse expect the preschooler to demonstrate?
Stacking 10 blocks The nurse should expect a 3-year-old preschooler to have the fine motor ability to stack 10 blocks. The nurse should expect a 3-year-old preschooler to have the ability to draw a circle but not print letters until age 5. The nurse should expect a 3-year-old preschooler to have the fine motor ability to put on shoes but not tie shoelaces until age 5. The nurse should expect a 3-year-old preschooler to have the language ability to use 3- to 4-word sentences. Seven-word sentences are not expected until age 5.
Adolescent safety
Unintentional injuries leading causes of death in adolescents MVC are leading cause of injury death followed by poisoning (unintentional OD) Impulsivity, inexperience & peer pressure may place the teen in a vulnerable situation Internet safety Teens are constantly connected Important for parents to know who they talk to, who is influencing them Motor vehicle safety Typically adolescent is opposed to authority & is interested in showing peers & others his or her independence Normal for teens to take risks Promote driver education, teach about the importance of wearing seatbelts, explain laws about teen driving & curfew Avoiding substance abuse Firearm safety Risks of dying from a firearm injury among 15-19 year olds have been increasing Water safety Drowning is a needless cause of death in adolescents Often a result in risk-taking behaviors
School-age Growth
Weight Increases wgt by avg of 7 lb per year Height Grows an average of 2.5 in per year Early on boys & girls are similar in hgt & wgt Later, girls may develop faster than boys in hgt & wgt