B234 Exam 2

Young child: roles-relationships pattern

- Family environment -- Provides sense of security - Increasing independence and maturity -- Begin to reduce parental authority/structure -- Broaden interests outside home --- Clubs, sports, gangs -- More responsibility in home and community --- Pets, chores, earn allowances - Learn socially accepted behaviors -- Limit-setting -- Nonviolent resolutions for conflict -- Behavioral contracts -- Positive reinforcement vs. punishment - Child abuse -- Victims: Increased risk of repeating cycle -- May occur with/without recognized risk factors -- Consider cultural factors in detecting abuse -- Sexual abuse

What happens with lymphoid tissue in 5-12 years?

- Grow rapidly (tonsils) - Stronger immune system

Young child: health perception health management pattern

- Health-perception -- Correlated with cognitive development (concrete operation) --- Germ theory, punishment theory, external forces -- Cultural influences --- Karma, "evil eye" - Facilitating health promotion -- Monitor/reinforce preventative practices -- Model health promoting behaviors -- Demonstrate/teach healthy behaviors at home and school

Adolescent: Activity-exercise pattern

- Increased strength/endurance - Teach importance of regular exercise - Preparticipation sports exam (Identify risks, assess health, promote healthy lifestyles)

Young child: values-beliefs pattern

- Kohlberg's theory -- Younger school-age: Preconventional --- Moral behavior based on self-interest -- Older school-age: Conventional --- Concern about group interests/values - Moral behavior problems -- Lying, stealing, cheating --- Common developmental behaviors --- Guidance needed to choose more socially acceptable ways to cope with stressors --- Consequences should be congruent with developmental understanding of the event

Young child: cognitive-perceptual pattern (cont.)

- Language—rapid development -- Capacity to imitate sounds -- Complex sentences; multiple meanings -- Reading --- Skills: Letter and sound recognition, combinations to form words -- Handwriting --- Skills: Hand-eye coordination, motor control, perceptual abilities --- Dyslexia: Reversal of letters and numbers in writing - Memory—improved ability -- Organizing, classifying, labeling facilitates retention - Intelligence -- Debate --- Inherent cognitive capacity vs. achieved level of performance vs. immeasurable -- Traditional intelligence test shortcomings --- Do not test all forms of intelligence --- Culturally insensitive --- May measure achievement, not ability -- Environmental factors affect achievement (e.g., SES, nutrition, sociocultural environmental stimuli) -- Achievement test results vs. intelligence test results - Learning disabilities (5%-10% of children) -- Attention-deficit/hyperactivity disorder (ADHD) --- Difficult to assess: varying symptoms in different settings wi

Adolescent: Health Perception-Health Management Pattern

- Less acute illness than younger children - Less chronic illness than adults - Negative health choices/outcomes (Sense of invincibility, adolescent experimentation, risk-taking behaviors) - Partnering approach in care (support autonomy, focus on strengths)

What is the treatment for type II diabetes mellitus?

- Medical nutrition therapy (MNT) -- Most critical/pivotal component of DM care -- Purpose: Delay/prevent complications -- MNT individualized—ongoing monitoring of metabolic parameters --- Tailored meal plan dependent on person's energy needs to determine number food choices --- Evaluate/adjust through outcome measures --- Referral to dietician/registered diabetes educator

Adolescent: Sleep-rest pattern

- Need at least 8 hours sleep per night - Risk of sleep deprivation (multiple activities and responsibilities - Nurses help adolescents cope with balancing responsibilities

Early recognition of PKU

- Newborn screen at 48hr of age - <24 hours needs repeat

Young child: nutritional-metabolic pattern

- Nutritional guidelines -- Well-balanced diet: 1200 to 1800 kcal/day - Factors influencing food intake -- Access to food: Lack of nutritious food, make own snacks -- Mass media influence: Billboards, TV -- Contemporary busy lifestyles: Skip meals, eat out - Nutritional education -- School programs -- Dietary guidelines - Overweight/obesity definition -- Obesity: BMI >95th percentile for age/gender or BMI >30 -- Overweight: BMI >85th but <95th percentile - Risk -- Increase risk for cardiovascular diseases, diabetes, sleep apnea -- Psychosocial: ridicule, discrimination

Young child: elimination pattern

- Physical ability -- Most: full bowel/bladder control

Adolescent: Cognitive-perceptual pattern

- Piaget's stage of formal operations -- Lays groundwork for abstract thinking -- Adolescent behaviors and characteristics (Introspection and egocentrism; Intolerance of "status quo") - Erikson's theory of psychosocial development—identity vs. role confusion -- Restaging of each previous stage development -- Threats to identity can result in delinquent behavior and mental health issues - Time orientation -- Ability for future orientation -- Able to delay immediate gratification - Language -- Increased cognitive skills and understanding language -- Receptive and expressive vocabulary increase -- Slang, electronic communication

Young child: cognitive-perceptual pattern

- Piaget: Concrete operations stage -- Learn by manipulating concrete objects; lack of abstract thinking -- Less egocentric—consider others' views -- Expanded conceptual understanding --- Conservation of substance --- Time -- Major operations --- Classifying and ordering - Vision—optimal function by age 6 Eye changes -- Δ from hyperopic (farsighted) to normal vision -- Vision screening needed to detect abnormalities - Vision problems (occur in 25% of school-age children) -- Myopia (nearsightedness) -- Astigmatism (uneven focusing) - Hearing -- Auditory acuity nearly complete by 7 years -- Hearing deficit cause: Chronic serous otitis media --- Periodic hearing evaluations -- Education on hearing protection - Sensory perception -- Learn simultaneously through many senses --- Auditory learners --- Kinesthetic learners --- Auditory, kinesthetic, and visual learners -- Increasing ability to differentiate detail

What is enuresis?

- Primary vs. secondary - Nocturnal vs. diurnal enuresis - Behavior management strategies; drug therapy

What is the Older Adults Nutrition Service Program?

- Provide older adults with nutritious meals - Meals on Wheels - Congregate feeding settings - Available for persons ≤60 years old, disabled, accompanying persons, volunteers - No income requirement - Donations accepted

Young child: coping-stress tolerance pattern

- Childhood stresses -- Multiple new stresses (School expectations, Peer relationships, Cultural differences, Bullying) -- May respond to stress with negative behavior - Coping strategies - Divorce -- Stressful—after-effects may result in juvenile behavior problems or require counseling -- School: Role of advocate for child - Depression-somatization -- Somatization: Transfer of feelings to physical problems -- Depression: Symptoms include anorexia, sleeplessness, lethargy, changed affect, aggressive behavior, crying, withdrawal -- Treatment: Individual/family counseling; medication

What is encopresis?

- Common complication of chronic constipation - Psychosocial component - Bowel management program and counseling recommended

Adolescent: Nutritional metabolic pattern

- Competing factors (Ideal body, Fast foods, soda pop, sweets, alcohol, Peer pressure, Activities requiring weight restriction, Increased needs with growth spurt) Dietary intake: way of gaining control, exerting independence

Adolescent: Elimination pattern

- Consistent with adults - Abnormal variation with eating disorders - Issues of privacy or self-protection

Young child: activity-exercise pattern

- Critical time to acquire and foster activity behaviors - Types of activities -- Group: Little League baseball, soccer -- Individual: Gymnastics, ballet -- Unorganized play: Bike riding, rollerblading - Play activities -- Promote social, personal, cognitive development -- Focus on fun, connections to peers and family

Adolescent: Sexuality-reproductive pattern

- Emergence of secondary sexual characteristics - Sexual experimentation (Heterosexual or same-sex activity, anticipatory guidance: sexual decisions, contraception, STI prevention) - Adolescent pregnancy (high risk in maternal/infant outcomes, educational and economic effects; anticipatory guidance: support and services for pregnant adolescents to facilitate positive outcomes)

Young child: self-perception self-concept pattern

- Erikson: Industry vs. inferiority -- Major task: Mastery of whatever the child is doing - Self-concept -- Self-esteem --- Belief that one is capable, significant, successful, worthy --- Family, peer, school influence -- Sense of control --- Internal vs. external locus of control --- Cultural and gender differences -- Body concept --- Develop understanding of internal body --- Physical differences (freckles, deformity, chronic illness) can cause anxiety, feelings of being threatened

Adolescent: Values-belief pattern

- Expanded understanding of good/bad - Kohlberg's theory of moral development (Begin transition to postconventional stage; idea of justice, universal principles) - Gilligan: moral development of females ("Good" involves self-sacrifice and caring for relationships in life; Learns balance between what is good for her and for others)

Adolescent: Self-perception Self-concept pattern

- Self-perception and body image (influenced by expectations from individual, peer, and societal) - Goal: develop healthy self-perception/healthy body image

Growth characteristics of 5-12 years

- Slower, steadier pace - Alternating "spurts" and minimal growth (5 cm (2 in.) per year height; 2 to 3 kg (4.4-6.6 lb) per year weight) - Differ by race, gender, genetics - Preadolescent growth spurt: Earlier in girls than boys - Menarche: Occurring earlier; related to genetics, sufficient body fat

Young child: sexuality-reproductive pattern

- Strong identification with parent of same gender -- Affects concepts of role and self-concept - Desire for knowledge of sexual function (puberty) -- Exploration of others' sexual organs -- Desire for privacy -- Discuss sexuality with peers - Sex education resources -- Health care agency short programs -- Age-appropriate books -- Nurse's role in school setting

What is the Supplemental Nutrition for Women, Infants, and Children (WIC)?

- Supplemental foods and nutrition education to low-income pregnant/postpartum women and at-risk children <5 yrs old - Nutritional risk and program availability determine who is served by program - Program outcomes: Lower Medicaid costs, longer gestation, higher birth weights, lower infant mortality rates

Teeth with 5-12 years

- Transition from deciduous to permanent teeth - Lose in same order they initially erupted; approx 4 teeth/year - Potential for dental caries, periodontal disease, malocclusion (dental and orthodontia implications)

Weight loss of no more than how much per week is appropriate for children with BMI 95th-99th percentiles?

1 pound

What are the 2 fats in the body?

1) Adipose 2) Blood lipids/cholesterol

5 health concerns and care issues of Arab Americans

1) Adult-onset diabetes mellitus 2) Coronary artery disease 3) Role of acculturation 4) Mental health 5) Teenage smoking

What are the 8 nonessential amino acids?

1) Alanine 2) Asparagine 3) Asparticacid 4) Glutamine 5) Glutamicacid 6) Glycine 7) Proline 8) Serine

Which 5 clients should be screened for iron deficiency anemia?

1) All children between 12 and 18 months 2) Any child who routinely drinks more than 24mL of milk per day 3) Mexican-american children ages 9-12 months 4) Preterm infants 5) Screen females ages 12-21 with known risk factors for iron-deficiency anemia

What are the 2 screenings to do at 1 year?

1) Anemia 2) Lead and TB (Selective)

What are 4 different types of eating disorders?

1) Anorexia nervosa 2) Bulimia nervosa 3) Binge eating disorder 4) Overweight and obesity

What are the 6 conditional amino acids?

1) Arginine 2) Camitine 3) Citrulline 4) Cysteine 5) Taurine 6) Tyrosine

Screen what 2 types of children?

1) At high risk 2) With known risk factors at ages 9-12 months and again 6 months later including: from families with low incomes, who are eligible for WIC, who are migrants or recently arrived refugees, who are Mexican American, preterm infants

What 2 screenings starts yearly at 3 years?

1) Blood pressure 2) Vision (do cover uncover earlier)

What 4 tests involving cancer should be done with adolescents?

1) Breast self-examination 2) Testicular examination 3) PAP test for cervical cancer 4) HPV vaccination to prevent 4 types HPV (precursor to cervical cancer, genital warts; recommended for adolescent/young women)

6 take away points from Bright Futures

1) Breastfeeding is preferred infant method 2) No cow's milk before age 1; after age 2 it should be low fat or fat free 3) Healthy eating is about balance, parents set the example 4) Screening with BMI for age starts at age 2; normal weight is between 5th and 85th percentile 5) Screen time should not exceed 2 hours a day

What two supplements are recommended for the elderly?

1) Calcium 2) Vitamin D

What 2 things should be promoted?

1) Car seat/bike safety 2) Home safety (smoke detectors, no guns or guns safely stored)

4 selected health-related cultural aspects for African Americans

1) Centered on family and religion 2) Family needs to be involved in care 3) Churches important in promoting health 4) Use traditional healing approaches

Screen what 2 types of children for anemia?

1) Children consuming a strict vegetarian diet without iron supplementation 2) Children with known risk factors for iron-deficiency anemia (low iron intake, special health care needs, previous diagnosis of iron-deficiency anemia) ((high dairy intake is a risk for anemia))

3 religions of Arab Americans

1) Christianity 2) Judaism 3) Islam

5 barriers to treatment for HIV/AIDS

1) Communication gap between health care professionals and at-risk populations 2) Socioeconomic factors such as poverty 3) Cultural values, stigma 4) Personal values and attitudes, behaviors 5) Political influences

What are 4 things recommended to encourage?

1) Daily reading 2) Family time, family traditions, family meals 3) Free play for physical activity daily 4) Brushing teeth with help

3 indicators for CHO excess

1) Dietary history > 60% CHO 2) BMI > 25% 3) Metabolic syndrome (insulin resistance)

2 barriers to care for native Americans

1) Difficult access to care 2) Underserved population

What are 2 habits to develop regarding activity?

1) Discourage television viewing 2) Encourage interactive activités (talking and reading together)

What are 4 food safety policies for formula?

1) Do not add cereal or other foods to infant formula 2) Discarding infant formula left in the bottle 3) Cover and refrigerating open containers of ready-to-feed or concentrated formula 4) Store powdered formula at room temperature

2 biological contaminants for food-borne illness

1) E. coli 0157:H7: damages intestines, hemolytic uremic syndrome—avoid undercooked meat, unpasteurized milk, unwashed foods 2) Salmonellosis: abdominal cramping, severe nausea/diarrhea—avoid uncooked eggs, undercooked meat, unpasteurized milk

What are 4 factors of diet while breastfeeding?

1) Eat a variety of healthy foods 2) Drink beverages such as milk or juice when thirsty (drink a glass of water at each feeding) 3) Limit consumption of beverages containing caffeine (coffee, tea, soft drinks) to 2 servings per day 3) Avoid alcohol 2 hours before breastfeeding (if mother drinks alcohol, no more than 8 oz wine, 12 oz beer, or 2 oz hard liquor should be consumed per day (less for small women))

7 fat functions

1) Energy source 2) Vehicle for fat soluble vitamins 3) Provides fullness 4) Insulates organs 5) Thermal regulates 6) Precursors for hormones 7) Build cell membranes

What are the 3 developmental theories?

1) Erikson 2) Piaget 3) Kolhberg

What are the 3 emerging populations?

1) Ethnic minorities 2) Homeless persons 3) Persons with HIV/AIDS

5 selected health-related cultural aspects

1) Family supersedes individual needs 2) Spiritual strength important 3) Hot and cold concept of disease 4) Disease attributed to supernatural or psychological causes 5) Folk remedies used in combination with Western medicine

What two supplements are recommended for pregnant women?

1) Folic acid 2) Iron

Five overarching guidelines from Dietary Guidelines

1) Follow a healthy eating pattern across the lifespan 2) Focus on variety, nutrient density, and amount 3) Limit calories from added sugars and saturated fats and reduce sodium intake 4) Shift to healthier food and beverage choices while considering cultural and personal preferences 5) Support healthy eating patterns for all

4 key elements of healthy eating patterns

1) Follow a healthy eating pattern across the lifespan 2. Focus on variety, nutrient density, and amount 3. Limit calories from added sugars, saturated fats, and reduce sodium intake 4) Shift to healthier food and beverage choices while considering cultural and personal preferences 5) Support healthy eating patterns for all

What is the School Breakfast Program (SBP)?

1) Having breakfast improves school performance 2) Follows same guidelines as lunch program

Gordon's functional health patterns (11)

1) Health perception-health management pattern 2) Nutritional-metabolic pattern 3) Elimination pattern 4) Activity-exercise pattern 5) Sleep-rest pattern 6) Cognitive-perceptual pattern 7) Self-perception-self-concept pattern 8) Roles-relationships pattern 9) Sexuality-reproductive pattern 10) Coping-stress tolerance pattern 11) Values-beliefs pattern

4 health concerns and care issues of Asian Americans/Pacific Islanders

1) Hesitancy to seek early diagnosis/screening 2) Higher rate of tuberculosis 3) Mental health problems due to adjustment issues 4) Lower rate of obesity, hypertension

5 health concerns and care issues for African Americans

1) Higher cancer deaths 2) HIV 3) Hypertension 4) Obesity 5) Mental health concerns

5 barriers to care for Latino/Hispanic

1) Highest uninsured rate of any US racial/ethnic group 2) Use/receive less preventative health care 3) Lack of interpreter services in health care 4) Lack culturally appropriate health care services 5) Reliance on folk systems of healing

What are the 9 essential amino acids?

1) Histidine 2) Isoleucine 3) Leucine 4) Lysine 5) Methionine 6) Phenylalanine 7) THreonine 8) Trytophan 9) Valine

What are the 6 Bright Future Vision and Goals?

1) Improve the nutrition status of infants, children, & adolescents. 2) Identify desired health and nutrition outcomes that result from positive nutrition status. 3) Set guidelines to help health professionals promote the nutrition status of infants, children,& adolescents. 4) Encourage partnerships among health professionals, families, and communities to promote the nutrition status of infants, children, & adolescents. 5) Describe the roles of health professionals in delivering nutrition services within the community. 6) Identify opportunities for coordination & collaboration between health professionals and the community.

2 things about diabetes type 2

1) Increasing prevalence 2) Risk increases with obesity, inactivity

What are 3 common harmful biological and chemical agents for adolescents?

1) Infection: Infectious mononucleosis, meningococcal, STIs; Need for immunizations, education on risk, safe sexual practices 2) Substance use and abuse: Chemical use increasing—use precursor to abuse 3) Tobacco use: Most start use in adolescence; Focus on preventing nonsmokers from starting; helping smoker to quit

3 background points for African Americans

1) Involuntary migration history 2) American slave system facilitated racism/alienation 3) Recent substantial progress; inequities remain

What are 6 health care barriers for diverse populations?

1) Lack of insurance 2) Availability of health care facilities/resources 3) Inadequate transportation 4) Complexity of health care system 5) Fragmentation of care 6) Attitudes of health care providers and incongruent beliefs between patients/providers

3 backgroun points for Latino/Hispanic

1) Largest ethnic group; relatively young population 2) Mexican, Puerto Rico, Cubans most common 3) Large diversity within Latino population

3 largest groups of Arab Americans

1) Lebanse 2) Syrians 3) Egyptians

What are the 3 most common cancers for the young children?

1) Leukemia 2) Cancers of brain/nervous system 3) Lymphomas

3 health concerns and care issues for native Americans

1) Linked to social and economic conditions 2) Smoking, substance abuse 3) Deaths: unintentional injuries, cirrhosis, homicide, suicide, pneumonia, diabetes

6 things about unsaturated fats

1) Liquid at room temperature 2) Plant origins 3) Become rancid quickly 4) Have a double carbon bond (one or more hydrogens could add to the fatty acid chain) 5) A double bond on a fatty acids causes the chain to bend or change shape 6) Has a health benefit

3 dietary managements of PKU

1) Lower protein 2) Frequent levels (keep PKU level <10) 3) No aspartame (nutrasweet/equal); made from aspartic acid and phenylalamine

4 things about trans fatty acids?

1) Made from unsaturated fats by commercially adding hydrogen at double-bond sites 2) Causes an unnatural bend in the fatty acid chain 3) Has a health detriment 4) Now must be listed on all food labels

3 things for motor skills development of ages 5-12

1) Maturated nervous system: brain hemisphere articulation 2) Lengthening long bones (risk of fractures, joint pain) 3) Muscle mass increase: potential for more complex fine and gross motor functions

4 immunization recommendations for late childhood/early adolescence

1) Meningococcal vaccination (age 11-12) 2) Hepatitis B series, if not completed in early childhood 3) Human papilloma virus (HPV) 4) Varicella (if no history of chickenpox)

Classification of CHO - 4 simple sugars

1) Monosaccharides 2) Disaccharides 3) Sugar alcohols 4) Intense sweeteners

For older infants (ages 4-6 months), signs of hunger include what 2 things?

1) Moving the head forward to reach the spoon 2) Swiping food toward the mouth

2 background points for native Americans

1) Native to North/South America for thousands of years 2) Experience minority group status; lower education and income levels compared to other groups

HIV/AIDS dietary recommendations (5)

1) Nutrient-dense, protein-rich, well-balanced 2) Vitamin and mineral supplement 3) Focus on food sanitation 4) Consider nutrition need for comorbidities 5) Avoid breast-feeding (vertical HIV transmission)

What are 2 other screenings for young children?

1) Oral health 2) Hearing

3 overview facts of persons with HIV/AIDS

1) Over 1 million persons in US affected 2) Affects all ethnic groups, sexual orientations 3) Adults over 50 years old fastest growing cohort

3 barriers to care for African Americans

1) Poverty 2) Lack of health insurance 3) Inadequate or unsafe environments

5 barriers to care with Asian Americans/Pacific Islanders

1) Poverty 2) Stress in intergenerational relationships 3) Cultural norms that prevent health care seeking 4) Loss of social networks 5) Poor access to services

Economics determinants of health for young children (2)

1) Poverty—22% of children live below poverty level (Homeless, depression, developmental delay, more disease) 2) Affluence—"latchkey children" (Less supervision, risk-taking behavior)

6 selected health-related cultural aspects

1) Present-oriented, take one day at a time 2) Value cooperation over competition 3) Share resources 4) Value families - form kinship systems 5) Believe health exists when person is in harmony with nature 6) Traditional health practices important (shaman)

What are the 3 components of the FDA's Food Protection Plan to monitor/prevent food contamination?

1) Prevention 2) Intervention 3) Response

3 HIV strategies

1) Prevention (most important) 2) Rapid diagnosis 3) Symptom management

What are the 5 types of malnutrition?

1) Protein deficiency or excess 2) Carbohydrate deficiency or excess 3) Essential fatty acid deficiency or excess 4) Vitamin deficiency or excess 5) Mineral deficiency or excess

4 functions of carbohydrates

1) Provide fuel (CHO is energy source for brain) 2) Spare body protein 3) Help prevent ketosis 4) Enhance learning and memory

Leglislation determinants of health for young children (2)

1) Public Law 94-142 Education for All Handicapped Children Act (Individualized educational plan (IEP)) 2) No Child Left Behind (2001)

For younger infants (up to age 3 months), signs of hunger include what 5 things?

1) Putting the hand to the mouth 2) Sucking 3) Rooting 4) Pre-cry facial grimaces 5) Fussing

What are 2 habits to avoid to prevent harming infant's teeth?

1) Putting the infant to sleep with a bottle or sippy cup 2) Allowing frequent and prolonged bottle-feeding or use of a sippy cup containing beverages high in sugar

6 barriers to care of Arab-Americans

1) Religious belief and practices 2) Cultural norms/modesty 3) Gender issues regarding providers 4) Communication difficulty 5) Folk remedies 6) Lack of culturally competent providers

3 selected health-related cultural aspects of Arab Americans

1) Role of religion 2) Importance of family; male-dominated family structure 3) Present-oriented

2 things about elevated blood pressure with 5-12 years

1) Screening for chronic conditions that begin in childhood 2) Goal: prevent long-term adult organ disease

What are the 5 types of fats we eat?

1) Small, medium or long chained 2) Saturated or unsaturated 3) Emulsified or nonemulsified fats 4) Visible or invisible fats 5) Simple or compound fats

6 things about saturated fats

1) Solid at room temperature 2) Animal origin or tropical oils (Coconut oil!) 3) Becomes rancid slowly 4) Products made with this fat have a longer shelf life 5) All of the carbons are attached to hydrogen 6) Unhealthy Fats - keep at 10% or less of total calorie intake

7 functions of protein

1) Source of Nitrogen 2) Provision of Structure Contractile proteins - In muscles Fibrous proteins - In bone, hair, nails, skin 3) Maintenance and Growth Anabolism/catabolism Positive/ negative nitrogen balance 4) Regulation of Body Processes Hormones - Insulin, growth hormone Enzymes - Sucrase, lipase Nucleoproteins that contain proteins - DNA, RNA 5) Immunity - Antibodies 6) Circulation - Albumin 7) Energy source - If CHO and fat intake inadequate

What are 2 other common harmful environmental processes for adolescents?

1) Sports injuries 2) Violence (unresolved fear: increase in violent behavior)

Classification of CHO - 3 complex sugars

1) Starch 2) Glycogen 3) Fiber

The nurse explains how parents influence healthy eating habits in children. Which 4 information statements should the nurse include in the discussion?

1) The family is the predominant influence on infants', children's, and adolescents' attitudes toward food 2) Parents provide the major it of food for younger children so they have control over their intake of junk food 3) It is important for parents to model healthy eating because children adopt their parents' food preferences 4) Families should engage children in helping prepare food

4 background points of Asian Americans/Pacific Islanders

1) Two waves of migration 2) Largest groups are Chinese, Koreans, and Filipinos 3) Diverse origins, cultures, lifestyles 4) Value education

Young children have fewer infections than the preschool child, but what are the 4 common infections?

1) Upper respiratory infections (viral) 2) Streptococcal infection, otitis media (bacterial) 3) Gastroenteritis (viral) 4) Scabies/lice (skin infestations)

5 selected health-related cultural aspects of Asian Americans/Pacific Islanders

1) Value of collectivism vs. individualism 2) Family most important social institution; respect for elders 3) Cultural value of passivity to avoid conflict 4) Taoism: foundation of Chinese medicine "achieving harmony" 5) Use of folk medicine/alternative treatment modalities common

What are the 2 populations at greatest risk for problems with nutrition?

1) Very young children 2) Elderly adults

Any three of what 5 conditions indicate a CHO excess?

1) Waist measurement of more than 40 inches for men and more than 35 inches for women 2) High levels of triglycerides (150 mg/dL or higher) 3) Low levels of HDL <40 mg/dL for men and < 50 mg/dL for women 4) High blood pressure (130/85 mm Hg or higher) 5) High fasting blood glucose levels 110 mg/dL or higher >126 mg diagnostic of diabetes

What are the 4 sanitary procedures for preparing formula?

1) Washing hands before preparing formula 2) Cleaning area where formula is prepared 3) Cleaning and disinfecting reusable bottles, caps, and nipples before each use 4) Washing and drying top of formula container before opening

Measure what 3 things to age 2?

1) Weight 2) Length 3) OFC

Health care delivery system determinants of health (2)

1) Well-child care: recommended every 2 years 2) State Children's Health Insurance Program (SCHIP)

What are serving sizes for 1 year of age and 2-3 years of age?

1/4 cup for 1 year 1/3 cup for 2-3 years

How prevalent is PKU in Europeans and Caucasians?

1/60 caucasions of northern European decent carry gene Occurs 1/10,000-20,000 caucasian births

Healthy eating patterns limit added sugars to less than what percent of calories per day?

10

Healthy eating patterns limit saturated fats to less than what percent of calories per day?

10

What percent of females have eating disorders?

10%

Age 1-2: what is sleep development?

11-14 hours per 24 hours (including naps) until age 3

Continue breastfeeding for how long?

12 months or as long as mother and child wish to continue

Screen males what ages for anemia?

12-18

Screen females what ages for anemia?

12-21

What is the mean age of menarche?

12.5 years

AAP recommends at least what age to ride ATVs to prevent injury?

16 years of age

What is healthy weight BMI for adults?

18.5-24.9

Exclusive breastfeeding is recommended for how many months?

1st 6 months continued breastfeeding until at least 1 year

Weight loss of no more than how much per week is appropriate for children with BMI >99th percentile?

2 pounds

What milk should be served to children age 2 and older?

2 servings of milk (two 8-oz cups) per day

Males begin puberty how much later than females?

2 years

Start using BMI for age at what age?

2 years

At what age should the nurse tell a family that a child typically should eat adult food serving sizes?

4

Limit juice consumption to what?

4-6 oz per day

What are toddlers (age 1-2) characterized by?

A growing sense of independence and sometimes by struggles over food and refusing to eat certain foods; they are developing fine motor skills, so eating is often messy

Which recommendation about weight management should the nurse make?

A medically supervised weight loss of no more than 2 lbs per week may be appropriate for children with BMI > the 99th percentile

For how long is exclusive breastfeeding recommended for?

A minimum of 4 months, but preferably for 6 months

What should breastfed and partially breastfed infants be given during the first few days of life?

A vitamin D supplement

What is the screening to do at 18 months?

Autism

What is the screening to do at 2 years?

BMI for age

What does thiamine (B1) deficiency do?

Beriberi a CV problem (but alcoholism can lead to Werncike-Korakoff a CNS problem)

What is early infancy?

Birth-6 months Most rapid changes occur during this stage

When is expected accelerated growth for boys and girls?

Boys at about age 12; girls at ages 9-11

If bottled water is preferred over community fluoridated water, what brand should be recommended?

Brand with fluoride added at a concentration of approximately 0.8-1.0 mg/L (ppm)

How do growth rates of exclusively breastfed infants differ from formula fed infants?

Breastfed infants grow more rapidly during the first half of the year but less rapidly during the second half

Age 2-3: what is fine motor development?

Builds 6 block tower by 3

When do children typically acquire fine motor skills?

By age 7 or 8 (can now tie their shoe laces and brush their teeth)

How should warmed fluids be tested?

By sprinkling drops on the wrist

Use what water to reduce dental cavities?

Community fluoridated water

What is one of the major elements in eliminating health disparities?

Cultural competency

What are conditionally and/or acquired essential amino acids?

Can become essential, depending on the biochemical needs of the body (N=6)

How many calories is 1 gram of carbs, protein, fat, and alcohol?

Carbohydrate: 4cal Protein: 4 cal Fat: 9 cal Alcohol: 7cal

Use what kind of water to make formula?

Fluoridated

What are incomplete proteins?

Food that lacks one or more of the essential amino acids Complementation: combining of incomplete proteins (grain and legume) so that all essential amino acids are supplied Vegetable sources of protein: legumes (peas, beans, lentils, peanuts)

What are essential amino acids?

Food that supplies all essential amino acids in sufficient quantity to maintain tissue and support growth

What are complete proteins?

Food that supplies all essential amino acids in sufficient quantity to maintain tissue and support growth Supply all 9 essential amino acids Meat, poultry, fish, eggs, milk, and cheese

What is low blood protein?

Hypoalbuminemia

Where does phenylalanine occurs?

In all protein foods

Infants usually increase their length by 50% when?

In the first year (rate of increase slows during second half of the year)

What is holism?

Incorporates family and support system in care; considers patient viewpoint

Saturated fat intake effects on blood lipids

Increased LDL and HDL

Transfats intake effects on blood lipids

Increased LDL, decreased HDL

What with caffeine does methylxanthines do?

Increases heart rate, blood pressure, and renal flow

Young child (ages 3-4)

Increasingly competent at self-feeding, but they still prefer eating with their hands rather than using utensils; they are becoming more interested in trying new foods and participating in family meals

What are middle adolescents (ages 15-17) characterized by?

Independence, experimentation, future-oriented thinking, and problem solving activities

Feed infant when he/she is hungry, which is typically when?

Initial weeks of life: 10-12 times/day Next several months: 8-12 times/day Thereafter: 6-12 times/day Feed infant more often during periods of rapid growth

What is marasmus?

Insufficient kilocalories and protein

What is common in children, especially children from families with low incomes?

Iron deficiency anemia

If not breastfeeding, use what?

Iron fortified formula for 1 year; no cow's milk before age 1

Screen all children at 12-18 months for what?

Iron-deficinecy anemia; consider screening older children drinking >24 mL milk/day

Rising phenylalamine levels can cause what?

Irreversible brain damage

Which parent statement about bottle-feeding reflects the need for more teaching?

It is recommended that I wean my child from the bottle by 2 years of age

A parent wants to know when a child can brush their teeth independently. What is the nurse's best response?

It takes until age 9 for children to be able to do a thorough job independently

When did MyPyramid change to MyPlate? What did it add?

June 2011 Added recommendations for physical exercise in addition to a more personalized, stepwise, and flexible approach

Feed infant on demand to stimulate what?

Lactation

What is underweight BMI for adults?

Less than 18.5

What is a moderate caffeine intake level?

Less than or equal to 300 mg/day

What milk should be served to children less than age 2?

Low-fat (1%) or fat-free milk

How does AIDS change with young children?

Lower risk; education starting at age 8 recommended

What are the 2 signs of puberty for males and females?

Males 1) Thinning scrotal sac 2) Enlargement of testes Females 1) Breast buds 2) Growth spurt

Health benefits of soluble fiber

May help lower cholesterol; may assist in lowering blood sugar levels; may promote satiety

Age 1-2: what is toileting development?

May show interest after 18 months (needs to be dry 2 hrs at a time)

What is Supplemental Nutrition Assistance Program (SNAP)?

Monthly allotment to help low-income families buy nutritious food

What is Kwashiorkor?

More kilocalories than in marasmus but insufficient protein

Age 2-3: what is toileting development?

Most children become potty trained

Age 4: what is cognitive and communication development?

Names 4 colors; 90% intelligible

Young children have risks of what 3 cancers from what?

Natural and human-made ionizing radiation give risk of breast and thyroid cancer, leukemia

Should bottles or food in contains or jars be microwaved?

No

During middle school, do muscle-building activities (weight lifting) build muscle mass?

No; they can be harmful, muscle strength can be improved with appropriate physical activities

Sources of soluble fiber

Oatmeal, oat bran, barley, apples, oranges, broccoli, and some dry beans

What are nonessential amino acids?

Ordinarily can be built by the body in sufficient quantities to meet its need (N=8)

The nurse provides information to a family about physical activity. Which client statement reflects the need for more teaching?

Our 8 year old can begin lifting weights

What is Tanner staging?

Sexual maturity rating

For how long should the vitamin D supplementation be given?

Should continue unless the infant is weaned and is consuming at least 1 L per day or 1 qt per day of vitamin D-fortified formula

Serve children ages 4 and older what portion sizes?

Similar to those eaten by older family members

What toothpaste should be used for children ages 1-2?

Small smear of fluoridated tooth paste

Age 1-2: what is social development?

Solitary play, removes clothes

What glands are involved with acne?

Sweat and sebaceous glands are clogged/inflamed

What are the symptoms and 2 effects of Turner syndrome? (Female: X0)

Symptoms Short stature, webbed neck, low-set ears, lack of sexual development, cardiac/renal anomalies, learning disabilities Effects 1) Hormonal therapy 2) Infertile

What are the symptoms and 2 effects of Klinefelter syndrome? (Male: XXY)

Symptoms Tall, thin, lack of sexual development, gynecomastia, learning/behavior problems Effects 1) Hormonal therapy 2) Sterile

How are toddlers with food?

Unpredictable and tend to be leery of new foods and may refuse to eat them

Vitamin D supplements for what infants?

Until they are taking 32 oz formula/day

Age 2-3: what is cognitive and communication development?

Use 3 word sentences, understand rules, use pronouns

What toothpaste should be used for ages >2?

Use a pea-sized amount of fluoridated toothpaste

Food exchange system

Vegetables= 25 calories and 5 grams of carbohydrate. Fat-Free and Very Low-Fat Milk = 12grams of carbohydrate, 8 grams of protein/ 90 calories Very Lean Protein=have 35 calories/1 gram of fat Fruits= 15 grams of carbohydrate/ 60 calories. Lean Protein= 55 calories/ 2-3 grams of fat Medium-Fat Proteins = 75 calories/5 grams of fat Starches= 15 grams of carbohydrate/ 80 calories per serving. Fats contain 45 calories/ 5 grams of fat

What milk should be served to children ages 1-2?

Whole milk (serve reduced 2% milk if obesity is of concern or if there is a family history of obesity, dyslipidemia, or cardiovascular disease)

Is spitting up a little breast milk or formula at each feeding normal?

Yes

Feed infants until when?

They are full

What are late adolescents (ages 18-21) characterized by?

Time of important personal and vocational decisions and refined abilities to reason logically and solve problems

What does transcultural nursing (Leininger 2002) do?

Transforms health care for diverse populations

How much of amino acids enter pool daily? How much from diet?

340g 90 from diet

What is the most severely affected population with HIV/AIDS?

African Americans

Which parent statement about milk would indicate the nurse should clarify misconceptions?

After the age of 2, it is best to give my child 2% milk

What is Erikson's developmental theory?

Age 1-3: Autonomy vs. shame/doubt Age 3-6: Initiative vs. guilt

Avoid low-iron milk (cow's, goat's, soy), even in infant cereal until when?

Age 12

Wean child from bottle by when?

Age 12 to 14 months

Children quadruple their birth weight by when?

Age 2

Iron supplements are recommended by when?

Age 4 months

What is Piaget's developmental theory?

Age birth-2: Sensory-motor Pre-operational

In classic PKU, levels may range from what?

6 to 80 mg/dl, but are usually greater than 30 mg/dl

What is middle infancy?

6-9 months Growth slows but is still rapid

Engage in how many minutes of physical activity/day?

60 minutes or more

What percent of females and what percent of males participate in "fad" dieting?

62% of females and 20% of males

Children in middle childhood gain an average of how much weight and height per year?

7 lbs; 2.5 inches

Age 1-2: what is the growth rate?

8 oz/month 3-5 in/year

What BMI is overweight and needs further screening?

85th-94th percentile

What is late infancy?

9-12 months Growth slows, but infants' maturation and purposeful activity allows them to eat a wider variety of foods

Under what BMI for children should weight loss not occur?

95th percentile

What BMI is underweight?

<5th percentile

If greater than what degree, refer for scoliosis?

>15 degrees (more common in females)

What BMI is considered obese and needs in-depth medical assessment?

>95th percentile

Age 4: what is social development?

Associative play

How should discipline occur?

Discipline with time out at age 1/use distractions and praise positive behaviors whenever possible

Age 1-2: what is diet development?

3 meals a day with 2-3 snacks; 2-3 cups cow milk

Age 2-3: what is diet development?

3 meals per day with 2-3 snacks; 2-3 cups cow milk

Age 4: what is diet development?

3 meals per day with 2-3 snacks; 2-3 cups cow milk

Age 1-2: what is cognitive and communication development?

3 word minimum by 18 months; combines 2 words by age 2

What is obese BMI for adults?

30.0 or greater

Age 4: what is fine motor development?

Draws person with 3 parts and builds 8 block tower at age 4; uses scissors; copies a circle

When do males experience major growth spurts and increases in muscle mass?

During middle adolescence

Young child: sleep-rest pattern

- 8 to 12 hours of sleep/night - Fewer difficulties with going to bed - Sleeping arrangements -- Culturally influenced: Own bed vs. bed sharing - Sleep disturbances: Sleepwalking and sleep talking -- Disorders of arousal: Immaturity of nervous system; most outgrow with CNS maturation -- Consider safety, relaxation techniques, sleep preparation consistency

Adolescent: Coping-stress tolerance pattern

- Ability to cope tested in adolescence - Depression: Major depressive and dysthymic disorders; Depressed/irritable mood or diminished interest and pleasure; Assess for s/s depression; refer for treatment

What is mad cow disease?

- Bovine spongiform encephalopathy (BSE) - From unsafe meat-producing practices - Infectious protein-like particle (prion) causes fatal neurological degeneration -- Humans—Creutzfeldt-Jakob disease -- Incurable

Adolescent: Roles-relationships pattern

- Changing roles—stressful family time: increasing independence for adolescent, parents try to learn to "let go" - Positive strategies: willingness to listen, ongoing affection for and acceptance of teen, negotiation of limits - Peer groups: moving from child in family to member of group, strong influence on adolescent

What are the 3 principles of Bright Futures?

1. Nutrition must be integrated into the lives of infants, children, adolescents, and families. 2. Good nutrition requires balance. 3. An element of joy enhances nutrition, health, and well-being.

Help children what ages gradually decrease fat intake?

2-5

Children ages 2-8 and above 9 need to drink how much low-fat or fat-free milk per day to consume the equivalent dairy?

2-8: 2 cups 9 and older: 3 cups Supplement 400 units Vitamin D if low intake

Motor vehicle accidents are how much more likely to occur with adolescents than with any other age group?

20 times; inexperience, drugs/ETOH, distracted driving

Healthy eating patterns limit sodium to less than how many mg per day?

2300 mg Adults with pre-hypertension and hypertension should limit their intake to less than 1500 mg per day

What is overweight BMI for adults?

25-29.9

How many people are affected by type II diabetes mellitus in the US?

25.8 million in 2010

Recommended fiber intake for females 19-30

28g

Age 4: what is growth development?

3-5 lbs/year 1.5-2.5 in/year

Age 2-3: what is growth rate?

3-5 lbs/year 3-5 in/year

Recommended fiber intake for males 19-30

33.5g

Loss of how much body protein is likely to be fatal?

30% (CHO needed to prevent ketosis and loss of muscle mass)

When do body systems reach adult level function?

5-12 years

Between ages 2 and 5, children gain an average of how much weight and how much height per year?

4.5 and 6.5 lbs 2.5 and 3.5 inches

Provide a vitamin D supplement of how much and for who?

400 IU per day for children who do not obtain through diet

What percent is below poverty line?

46.2 million; 15.1% 1/6 receive food assistance yearly

What is normal blood phenylalanine level?

About 1 mg/dl

What are early adolescents (ages 11-14) characterized by?

Adolescents are characterized by pubertal changes and a growing capacity for abstract thought, although concrete and oriented toward the present

What are emancipated minors?

Adolescents permitted to accept responsibility for certain health/illness decisions, separated from family

How should screen time/TV work?

Avoid screen time before age 2; limit screen time to 1-2 hrs/day after age 2; no TV in bedroom

Monounsaturated fats effects on blood lipids

Decreases LDL, increases HDL

Polyunsaturated fats effects on blood lipids

Decreases LDL, increases HDL (very high intakes may be associated with prostate cancer)

What do individuals with PKU lack?

Enzyme phenylalamine hydroxylase; can't convert phenylalamine to tyrosine

What is vitamin toxicity? What vitamins are at highest risk?

Excessive use of supplements Highest risk are fat soluble vitamins (A, D, E, K)

Obesity prevalence has risen by how much among children ages 2-5?

From 5% to more than 12%

As toddlers' eating skills develop, how do they progress?

From eating soft pieces of food to eating foods with more texture

When were three majors waves of Arab Americans?

From late 1800s to 1960s

Give breastfed infants what before age 6 months if the mother is what?

Give vitamin B12 if the mother is vitamin B12 deficient (vegan, undernourished, does not take vitamin B12 supplements)

What is the most efficient energy source?

Glucose (if CHO is deficient >12 hours, fats and protein are back up sources

What does iodine deficiency lead to?

Goiter

What is National School Lunch Program (NSLP)?

Help schools provide balanced, low-cost/free lunches Cost related to family income; free if <130% poverty level

Health concerns and care issues of Latino/Hispanic

Higher incidence of stomach cancer, diabetes mellitus, cardiovascular disease, HIV

Age 4: what is gross motor development?

Hops and balances on each foot

Age 2-3: what is social development?

Parallel play, names friend, takes off clothes

For young children, who is the strongest relationship outside family?

Peers

Who uses the food exchange system?

People who count carbs; especially those doing tight control over their diabetes (1 unit of insulin can approximately cover 1 carb exchange (12-15 grams))

What are sojourners?

People who stay for a specific time then return to home country

What is fatalistic orientation?

Perception that the person has no control over his or her life African and Asian Americans have this perception; leads to lower participation in screening programs

What is a phytochemical?

Plant compounds with health benefits

There is an increased focus on what type of cancers with adolescents?

Reproductive

What is Kolhberg's developmental theory?

Preconventional 4-7

Out of primary and secondary sexual characteristics, which are essential for reproduction?

Primary

Health benefits of insoluble fiber

Promotes regularity; may reduce risk of some forms of cancer; may reduce risk of diverticular disease

What is Phenylkenoruria (PKU)?

Protein excess Autosomal recessive amino acid pathology

What is used for energy of brain and spinal cord if no glucose?

Protein; other systems can use fat

What are the growth patterns of infants?

Regain birth weight by 7 days Double birth weight by age 4-6 months Triple birth weight by age 1

Salt and cholesterol limits

Salt: <6g/day (DASH diet) Cholesterol: <300 mg/day (200 mg if at risk for cardiovascular disease)

Provide children ages 2-3 what portion sizes?

Same number of servings as children ages 4 and older, but with smaller portions (about 2/3 of serving)

Age 1-2: what is fine motor development?

Scribbles by 18 months; builds tower of 4 blocks by 2

What can vitamin C deficiency lead to?

Scurvy

Subjective (5) and Objective (2) symptoms of CHO deficiency

Subjective 1) Fatigue 2) Muscle aches 3) Problems concentrating 4) Nausea/loss of appetite 5) Lightheadedness Objective 1) Fruity breath/ketones in urine 2) Very rapid weight loss

What should be limited?

Sugary beverages

What recommendation should the nurse give a family about appropriate beverages?

Sugary drinks are a major contributor to childhood obesity

What is the third leading cause of death in 15-19 year olds?

Suicide; recognition of warning signs and prevention essential

What is the vitamin rule?

Supplements should not exceed 150% of RDI without specific medical indicate and supervisions

Sources of insoluble fiber

Wheat bran, corn bran, vegetables, nuts, fruit skins, and some dry beans contain soluble fiber

What vitamin deficiency is worldwide a leading cause of blindness?

Vitamin A

Are vitamins organic? Are minerals?

Vitamins are; minerals are not

Age 2-3: what is gross motor development?

Walk up steps by 2; throws ball overhead by 3

Age 1-2: what is gross motor development?

Walks independently by 15 months