QUIZ 2 PEDIATRICS CHAPETRS 18,19,20
The school nurse is planning a program for girls about the physical changes of puberty. Toward what age girl should this program be directed?
10 RATIONALE: Because puberty can occur in girls as early as age 10 years, instruction must be given by that age.
When planning an activity for a 3-year-old, the nurse bases the plan on the average attention span of?
15 Minutes RATIONALE: The average attention span of the preschooler is about 15 minutes.
Major Developmental Tasks for the Adolescent Child?
1. Establish identity 2. Separation from family 3. Initiate intimacy 4. Develop career choices for economic independence
Major Development tasks for the Pre-school Age? (Age 3-6)
1. Preparation to enter school 2. Development of associative-type play 3. Control of bodily functions 4. Acceptance of separation 5. Increase in communication skills 6. Increase in memory 7. Increase in attention span
Egocentrism?
A type of thinking in which children have difficulty seeing any point of view other than their own
A 13-year-old girl tells the nurse she is concerned because she has not had her first menstrual period. What is the best initial response from the nurse?
Age of first menstrual cycle varies. RATIONALE: Puberty is easily recognized in girls by the onset of menstruation. The first menstrual period is called the menarche. It commonly occurs about age 12 or 13 years, but this varies. It may occur as early as age 10 years or as late as age 15 years.
Which statement best describes the 3-year-old child?
Helpful, wants to assist with chores RATIONALE: Three-year-old children are helpful and can assist in simple household chores.
Risk of Latchkey Children?
Increased risk for accidents: Mischief or immature judgment, more trouble often risk of feeling isolated and alone Studies show more likely to use alcohol/illegal drugs
What does adolescent acne result from?
Oily Skin RATIONALE: Adolescent acne is the result of overactive sweat glands and oily skin.
To what is the restlessness seen in the adolescent considered to be attributed? (Select all that apply.)
-Drive to be accepted by society as an individual -Urge for independence -Establishment of a personal identity -Intense libido
Adolescent Pregnancy?
4 out of every 10 girls become pregnant each year. Most pregnancies unintended, 40% end in abortion. Father involved older (>20 years old). Sexual experiment occurs 50%. Use of birth control is recommended
A parent asked the nurse, At what age are children capable of assuming more responsibility for personal belongings? What is the nurses best response based on knowledge of growth and development?
9 Years RATIONALE: The 9-year-old is dependable and assumes more responsibility for personal belongings.
What foods would be a healthy choice for an adolescent who just finished playing in a strenuous sports game?
A bagel and skim milk RATIONALEL: A bagel provides a rapid supply of carbohydrates to the muscles, and skim milk provides a slow release of carbohydrates to the muscles.
The nurse is planning care of an adolescent. What psychosocial task does the nurse understand is important for the adolescent to develop?
A sense of identity RATIONALE: Psychosocial milestones that must be accomplished during adolescence include the five Isimage of self, identity, independence, interpersonal relationships, and intellectual maturity.
Parents of a 5-year-old child tell the nurse they are concerned about their childs speech development by stating, No one can understand him but us. What clinical classification of speech disorder does the nurse suspect?
Articulation disorder RATIONALE: When parents are the only people to understand their preschool child, an articulation disorder is suspected.
The nurse is planning a safety program for high school students. To what will the nurse relay that most accidental deaths in adolescence are related?
Automobiles RATIONALE: The chief safety hazard for the adolescent is automobiles.
Characteristics of The 11 and 12 year-old Children?
Before onset of puberty: complete disorganization: Intense, observant, all knowing, energetic, meddlesome, argumentative, critical of own work, appears in constant tension, will ignore constant verbal nagging Begin to see and understand other points of view Primary task of the middle years of childhood is developing social competence Enjoy as team players (team loyalty), best friend period Preadolescence: preoccupied with bodies Look forward to menses and wearing first bra, aware of opposite sex but ignore them Body Hormones begin to influence physical growth, poor posture Girls 'tomboyish' preoccupied with physical activities and anxieties, less concerned with appearance Wants unreasonable independence, rebellious about routines, wide mood swings Hero worship prevails, enjoy reading mysteries and love stories, sports, dancing, talking on phone Masturbation increases
What fear is unique to the preschool period?
Bodily harm RATIONALE: The fear of bodily harm, particularly the loss of body parts, is unique to this stage.
Latchkey Children?
Children left unsupervised after school Parents away from home or at work with no extended family to care for them
Gynecomastia?
Development of breast tissue in males Boys should report increased enlargement and tenderness of the breast to rule out breast cancer
The gradual transfer of behavioral control from the parent to the child is accomplished through?
Discipline RATIONALE: Through discipline the parent gradually gives up behavior self-control to the child.
A girl tells the nurse that she and her best friend belong to the popular clique. She states, I love Katy Perry, and I want to be a singer. The nurse recognizes the girls statement as characteristic of what time period?
Early adolescence RATIONALE: Cliques of unisex friends, having a best friend, and hero worship are characteristics of the early adolescent.
The nurse is assessing a 13-year-old boy. With what do physical changes in the pubertal male begin?
Enlargement of testicles RATIONALE: In boys, pubertal changes begin with enlargement of the testicles and internal structures.
List three pubertal changes that begin to appear in females and males during the School Age Stage (Age 6-12)?
Females: 1. Budding of breast 2. Appearance of pubic hair 3. Menarche Males: 1. Enlargement of testicles with increased looseness of the scrotum 2. Appearance of pubic hair
How does the nurse characterize the play of 5-year-old children?
Following rules RATIONALE: The 5-year-old wants to play by the rules but cannot accept losing. The rules may be very strict or change as the game progresses.
At what stage is the adolescent considered to be, according to Freuds theory?
Genital RATIONALE: Freud describes the adolescent period as genital.
The school nurse is educating high school students about guidelines to be followed when participating in sports. Which statement by a student alerts the nurse of the need for further information?
I drink large amounts of fluid when working out. RATIONALE: Fluids lost by sweat must be replaced by drinking small amounts of fluid during a workout. Thirst is one guide for intake. Caffeine and alcohol deplete body water and are to be avoided. Carbohydrates that provide both energy and other nutrients are best for athletes. Protective gear should be worn by all team players in any contact sport.
The nurse using the PACE interview guide for persons at risk for substance abuse arrives at a score of 2 for an adolescent patient. How would the nurse interpret this score?
Indication for referral for counseling RATIONALE: The PACE guide recommends that a score of 2 or higher would suggest the need for a referral for counseling about substance abuse.
What does an adolescents peer group serve as related to development?
Initial separation from family RATIONALE: Being a member of a peer group and communicating with and seeking approval from this group are hallmarks of the first separation from the family.
A 4-year-old child insists he has more money with a nickel than his father has with a dime. What is this perception, as described in Piagets theory?
Intuition RATIONALE: The intuitive stage, as described by Piaget, is prelogical thinking that is based on the outside appearance of objects. A nickel is larger than a dime and therefore more valuable
What can the nurse suggests as a good dietary source of zinc for an adolescent who is a vegetarian?
Nuts RATIONALE: Zinc is essential for growth and sexual maturation in adolescence. Good vegetable sources include nuts, legumes, and wheat germ.
A parent confides in the school nurse that her 8-year-old twins argue and bicker constantly. What is the best response by the nurse?
Offer reassurance that such behavior is normal for 8-year-olds. RATIONALE: Argumentative and competitive behavior is normal in 8-year-olds.
Child Abduction?
Parents' greatest fears in raising children Number of children abducted by non-family member is smaller than the number taken by non-custodial family member. Risk for death is higher with a non-family member Topic of strangers should be discussed with the child Child should learn to deal with strangers with confidence rather than with fear and avoidance There are commercial devices that parents can use to track their children, such as ionKids monitors or Wherify watch, Life 360
Stage of Freud's Psychosexual Development for the School Age Child?
Period of sexual latency Romantic love for parent of opposite sex diminishes. Identifies with parent of the same sex Gender identity: Sex organs immature, interest in gender difference progresses Gender role development: Influenced by parents and attitudes of family members. Teachers directly foster stereotyping in school assignment and tasks
Physical Growth of the School Age Child (Age 6-12)?
Physical Growth: Slow, steady growth Average weight gain: 2.5 to 3.2 kg (5.5 to 7lbs) per year Average increase in height: 5.0 cm (2 inches) per year Head circumference: Increases from 20 to 21 in. (2 to 3cm) between 5 and 12 years Brain: Adult size Myelinization within the brain is complete by 7 years: refine of motor coordination Visual acuity: 20/20 vision Dentition: Loss of primary teeth begins at about 6 yrs 6-year old molars (1st permanent teeth) erupt Language skills: Speaks in full sentences
A 13-year-old girl tells the school nurse that she is getting fat, especially in her hips and legs. What understanding by the nurse would best guide the response?
Puberty is often preceded by fat deposits in these areas. RATIONALE: Secondary sexual characteristics become apparent before menarche. Fat is deposited in the hips, thighs, and breasts, causing them to enlarge.
Characteristics of The Seven year-old Child?
Quieter age; not looking for trouble, good sense of humor Acquire "crush" on friend of opposite sex Increasingly independent. Active play important Play with same sex, boys tease girls, play realistic toys, enjoy bike, jump rope, tag, table games Know months, seasons of year, tell time, concept of arithmetic, know value of money Problem: "Stealing" if need is not met, distribute loot to buy friendship
Vital Signs for a School Age Child (Age 6-12)?
Respiratory rate: 18 to 20 breaths/min Pulse Rate: 85 to 100 bpm Blood pressure: 90-108/60-68
Average Vital Signs for the Pre-school Age? (Age 3-6)
Respiratory rate: 20 breaths/min Pulse rate: 90 to 110 bpm Blood Pressure: 85-90/60mm Hg
Stage of Erikson's Psychosocial Development for the School Age Child (Age 6-12)?
Sense of Industry vs. Sense of Inferiority: Industry: Stage of accomplishment: develop skills and participate in socially useful work Interested exploration and adventure Likes to accomplish and produce, develops confidence, competitiveness is common Sense of inferiority (lack of worth): Incapable of assuming responsibilities associated with developing sense of accomplishment (unable to master specific skill). Sometimes, the cause is that parents sets high goals that are unachievable Fears of ridicule by peers and teachers over school-related issues are common. Some children manifest nervous behaviors to deal with the stress, such as nail biting
A parent comments that her adolescent daughter seems to be daydreaming a lot. What does the nurse understand this behavior to indicate regarding their daughter?
She is mentally preparing for real situations. RATIONALE: Daydreaming allows adolescents to act out in their imaginations what will be said or done in certain situations. This helps them to prepare for and cope with interactions with others.
Who becomes and important role model during the School Age Stage?
Teacher
When planning to answer a 16-year-old girls questions about menstruation, the nurse must consider cognitive development. What is developed during adolescence according to Piaget?
The ability to consider hypothetical situations RATIONALE: According to Piaget, in the formal operations stage adolescents have the ability to think abstractly.
Artificialism?
The belief of the preoperational child that all objects are made by people
The parents of an 8-year-old tell the nurse the child wakes the household crying out during his frequent nightmares. What is the nurses most helpful response to explain nightmares?
They are a normal extension of the childs fear of mutilation. RATIONALE: The nightmares experienced by an 8-year-old are an extension of their characteristic fear of mutilation.
A preschool-age child is asked, Why do trees have leaves? Which response would be an example of animism?
To hide behind when they are scared. RATIONALE: Animism describes the tendency of preschool children to attribute human characteristics to nonhuman objects.
Bad Language for a Pre-school Age Child?
•Bad language is inevitable •Child delights in attention, and it does not matter, whether this attention is good or bad •Swearing at this age is not particularly meaningful •Children are merely imitating what they hear and it does not have any real significance to them
Cognitive Development for the Pre-school Age?
•Major Task: Readiness for school and scholastic learning •Increase development of language and symbols •Believe they have magical powers •Piaget's theory of Cognitive Development •Preoperational phase (2 to 7 years old) •Two stages: 1.Pre-conceptual stage (2-4 years) 2.Perceptual (Intuitive) thought stage (4-7 years)
The nurse is assessing a school-age child. What will the nurse expect in regard to physical development of this child?
Gain of 5 to 7 pounds per year RATIONALE: During the school-age period, the average weight gain per year is generally 5.5 to 7 pounds.
Moral Development for a Pre-school Child?
•Major tasks: Learn right and wrong •develop superego or conscience •Kohlberg's theory of Moral development: •Pre-conventional level: Obedience and punishment driven is the beginning of morality •if an action is wrong, there is punishment. •Cultural influences: •Parenting styles, language development, mastery of sounds, dietary preferences and moral values influence child development. Preschooler aware of skin color and racial differences
Characteristics of The Four-year old Child?
•More aggressive physically and verbally, feel superior, very independent. Obeys parents because of set limits •Angry when others attempt to take their possessions. •Mood swings, selfish, impatient. Likes to show off, takes pride in accomplishments •Enjoy music; like marching songs and simple instruments to shake or bang •Boisterous, may begin to swear if they are around children or adults who use profanity •Understands time better, height, width, count •Vocabulary 1500 words •Associative play, imaginary and imitative •Sexual exploration and curiosity
Characteristics of The Five-Year old Child?
•More responsible, patient, and finish what was started •Less fearful because the world is controlled by authorities. "Live by the rules" •Talks constantly, vocabulary 2000 words •Watch television with better comprehension (1 hr/day TV) •Gets along with parents, strongly identifies with parent of same sex, play and talk to a best friend •Rides tricycle with better speed and dexterity •Can name the days of the week, prints their first name •Associative play, play computer games
What type of relationships are the preferred social interactions for the school-age child?
Same-sex peer groups RATIONALE: The preferred social interaction of the school-age child is in same-sex peer groups or cliques.
General Characteristics of height for the Pre-school Age? (Age 3-6)
•Height: Increase of 7.6cm (3 in) in the legs giving posturally erect appearance •3 yrs: 95 cm (37.2 in.) •4 yrs: 103 cm (40.5 in.) •5 yrs: 110 cm (43.2 in.) •Length at birth doubled at 4 years
Which major developmental tasks will the nurse expect a child to accomplish by the end of the preschool years? (Select all that apply.)
-Acceptance of separation -Increased communication skills -Control of bodily functions RATIONALE: The major tasks of the preschool child include preparation to enter school, development of a cooperative type of play, control of body functions, acceptance of separation, and increase in communication skills, memory, and attention span. Appetite remains inconsistent.
The school nurse is preparing an educational program for new teachers regarding school-age children. What information is accurate for the nurse to include? (Select all that apply.)
-Participation in group activity increases -Thinking is logical -Understand cause and effect Rationale: Piaget refers to the thought processes of the school age period as concrete operations. Concrete operations involve logical thinking and an understanding of cause and effect. The egocentric view of the preschool child is replaced by the ability to understand the point of view of another person. Between 6 and 12 years of age, children prefer friends of their own sex and usually prefer the company of their friends to that of their brothers and sisters.
Different ways parent's can reduce Jealousy and Sibling Rivalry?
1. Prepare young children for the arrival of new baby, settle the older child to large bed before infant is born 2. Remind older child they can do things that new baby cannot 3. If child tends to hit infant, separate both children, the child that caused the injury need as much attention as the victim 4. Children are assured they are loved and told they are not allowed to injure others
What are the 2 types of Enuresis?
1.Primary: Bed wetting in a child who has never been dry 2.Secondary: Recurrence of bed wetting in a child who has been dry for a period of 1 year or more •Diurnal (daytime) enuresis less common than nocturnal (nighttime). Common in boys than girls, genetic influence •Approximately, 92% of children achieve daytime dryness by 5 years of age. •Most children who bedwet may overcome the problem between 6 and 10 years old
Gross and Fine Motor Development for the Pre-school Age?
3 years: •Walking, running, goes up and down stairs, stands on one foot for few seconds, walks on tip toe, rides tricycle •Builds tower 9-10, copies a circle, names what has been drawn 4 years: •Skips and hops on one foot, walks backward •Throws and catches ball reliably •Use scissors, lace shoes, copies a square 5 years: •Skips and hops alternate feet, jumps rope, skates with good balance, jumps on height of 12", lands on toes •Tie shoelaces, copies a diamond, print few letters
Characteristics of Late Adolescence 17- 20 years?
Achieves greater independence, chooses a vocation, participates in society Body image and gender role definition nearly secured, stability of self-esteem Peer group recedes in importance Emotional and physical separation from parents, finds an identity, finds a mate Develops own morality Completes physical and emotional maturity
Adolescent Period (12-18)?
Adolescent: Begins with appearance of secondary sex characteristics and ends with cessation of growth and emotional maturity Divided into three periods: Early, Middle, late adolescence
Sleep and Exercise for the Adolescent Child?
Adolescents: 8 hours generally suggested Crankiness, frustration, impatience, accident proneness, and other such behaviors indicate lack of sleep Teenagers need to sleep on firm mattress, preferably in their own room Adolescents do not have to participate actively in sports; they can easily exercise by taking a brisk walk, riding a bike, or swimming Although many teenagers are not athletes, they can benefit from a less sedentary lifestyle
The parent of a 3 -year-old child tells the nurse, My daughter points instead of speaking whenever she wants me to get something for her, but she understands me when I ask her to do something. Based on the parents comment, what does the nurse suspect?
An expressive language delay RATIONALE: An expressive language delay is suspected when the child understands spoken language but is not talking.
Animism?
Belief that inanimate objects, such as plants and stones, or natural events, like thunderstorms and earthquakes, have a discrete spirit and conscious life.
A 4-year-old child tells the nurse she will not eat peas because they are green. Of what is this an example?
Centering RATIONALE: The tendency to concentrate on a single outstanding characteristic of an object while excluding other features is known as centering.
Which stage of cognitive development is a 9-year-old child in according to Piaget?
Concrete Operations RATIONALE: School-age children are in the concrete operations stage of cognitive development.
Type of Play for the School Age Child? (Age 6-12)
Cooperative play: Usually same sex group •Understands concepts of cooperation and compromise: Fair play vs Competition •Enjoys quiet activities. Starts collections of play board games or card games; read books, TV, computer and video games •Rules and ritual dominate play, knowing rules provides sense of belonging •Involved in sports: athletic activities- swimming, hiking, bicycling, skating. Organized sports can develop skill, teamwork and fitness
Cognitive Development Piaget: for the Adolescent Child?
Early adolescents: Concrete phase of thinking, take things literally, often unrealistic Stage of formal operations Middle adolescents: Abstract thinking •Capable of scientific reasoning. Able to view problems comprehensively, has longer attention span Older adolescents: See situation from many viewpoints Failure to develop formal thoughts is connected to the failure to develop a high level of moral reasoning
Characteristics of The Six year-old Child?
Energetic, always on the go. Bossy, sometimes rude Unable to finish tasks. Brief attention span Sensitive to criticism. Conscience is active, difficulty in making decisions Experiment with language. Vocabulary 2500 words Physical changes: loss of the temporary teeth, 6-year molars erupt Play with same sex. Fears: body mutilation Need physical examination and preschool immunizations
Break down the 2 stages involved in The Preoperational phase ( 2 to 7 years old) of Piaget's theory?
First Stage: Pre-conceptual stage (2-4 years) A. Symbolic functioning: Use symbols (words or pictures) B. Egocentrism: Do not see other point of view C. Pre-causal thinking: Own views explain cause-and-effect relationships: •Animism: Inanimate objects capable of action •Artificialism: World and everything in it created by people Second Stage: Perceptual (Intuitive) thought stage: 4-7 years. •Pre-logical thinking: Wants to know, why things are what they are? Based on outside appearances •Characteristics: Centering- concentrate on single outstanding characteristics of an object while excluding its other features
Psychosexual Development (Freud) for the Adolescent Child?
Genital stage: Self-love (narcissism) diminishes; love for others (altruism) develops. The adolescent begins to love others and peers Maturity has developed that sets the stage for adult development
What is the best suggestion by the nurse for an appropriate toy for a hospitalized 6-year-old boy?
Handheld video game RATIONALE: The 6-year-old child can perform numerous feats that require muscle coordination. At this age, the handheld video game will offer nonaggressive competition.
The school nurse is preserving a tooth that was knocked out on the school playground. What will the nurse be especially careful to do?
Handle the tooth only by the crown. RATIONALE: When a permanent tooth is avulsed, the tooth should be picked up by the crown to prevent any further damage to the root and placed in milk until the child can be examined by a dentist.
Centering?
In Piaget's conservation tasks, the preoperational child's tendency to fix on the most visually striking feature of a substance and not take other dimensions into account.
Health Examinations for the School Age Child? (Age 6-12)
School nurse determines health care requirements Physical examination: in spring before school admission Booster immunizations, dental check up completed If inattentive at school, screened for: 1. Vision or hearing deficits 2. Language or learning disabilities Scoliosis: Screen school-aged children by examining for lateral curvature of spine before and during growth spurts
What should the nurse keep in mind when planning to teach a class on nutrition to fourth-grade students?
School-age children think logically and concretely. RATIONALE: Piaget refers to the thought process of this period as concrete operations, which involves logical thinking and an understanding of cause and effect.
Symbolic Functioning?
Seen in the play of children who pretend that an empty box is a fort. They create a mental image to stand for something that is not there.
Enuresis?
Involuntary urination after the age at which the bladder control should have been established
A 13-year-old boy states, The girls in my class tower over me. What would be the nurses most informative response?
It may seem that way because girls have a growth spurt 2 years earlier than boys. RATIONALE: Although the age for growth spurts during puberty varies, growth spurts occur 2 years earlier for girls than for boys.
Timing the Time Out for Pre-school Age Child?
Last 1 minute per year of age: 1. Sit for 5 minutes in a chair or corner is one consequence of inappropriate behavior 2. Child sitting in a chair facing a corner 3. No interaction/eye contact during time out period 4. Used a timer buzzer. If child start to interact, the time goes back to zero 5. Do not use child's room or soft comfortable chair (child will fall sleep or engage in another activity) 6. Time out is preceded by short (no longer than 10 words) explanation of the reason why time out is necessary •Consistency: key to help child learn acceptable behavior (must exist between parents)
Puberty?
Maturational, hormonal and growth processes that occurs when reproductive organs begin to function and secondary characteristics develop Earlier for girls than boys Three Stages: 1. Prepubescence: 2 years before puberty when developing changes 2. Puberty: sexual maturity achieved (1st menstrual flow in girls, less obvious in boys) 3. Postpubescence: 1-2 year following puberty when skeletal growth is completed, reproductive functions established
Characteristics of Middle Adolescence: 14-17 years?
Modifies self-image, very self-centered, increased narcissism, rich fantasy life Major conflicts over independence and control. Separate from parents (except financially) Identify own values Define self (self concept, strength and weaknesses Strong need for identity to affirm self image. Acceptance by peers extremely important. Partakes in peer groups, conforms to values, fads Has increased heterosexual interest, communicates with opposite sex, may form 'love' relationships
Emotional needs for the Adolescent Child? (Age 12-18)
Need assistance with getting in touch with their feelings and sorting out confused feelings Adults provide confidential accepting atmosphere to foster quality communication Common Fears: Threat to body image, injury or death, being different, loss of control, being left out or socially isolated, separation from peer group
Nutrition need for the Adolescent Child?
Nutritional requirements peak during years of maximum growth: age 12 in girls, 2 years later in boys Appetite increases "always hungry". Stomach too small to meet increased caloric and protein requirements of the rapid growth spurt Inadequate diet: retard growth and delay sexual maturation Increased need include: 1. Calcium: Skeletal growth 2. Iron: Increases muscle mass and blood cell development 3. Zinc: Develops skeletal, muscle tissue and sexual maturation Concern over body image: Leads to eating disorders, anorexia nervosa, bulimia (predominantly girls, boys may also be affected)
Characteristics of Early adolescence: 11-14 years?
Preoccupied with body changes. Tends to compare own body to others. Early and late developers have anxiety regarding fear of rejection Conformity with group norms. Fantasy life, daydreams, crushes are all normal, need help in the role play of varying social situation. Intense daydreaming Prone to mood swings, temper outbursts, name calling. Strong desire to remain dependent with parents while trying to detach Need limits and consistent discipline
Dental Care for the Adolescent Child?
Risk for dental caries: inadequate dental maintenance, frequent snacks on sucrose-containing candies and beverages. When dental hygiene is neglected, period of greatest tooth decay in the permanent teeth is from ages 12 to 18 years Poor oral hygiene: inadequate brushing, flossing, and rinsing, particularly after meals fosters accumulation of plaque and food debris Missing, aching or decayed teeth contribute to poor nutrition and low self-esteem Healthy white teeth contribute to popularity and sex appeal
Kohlberg's Moral Development for the School Age Child?
Rules are basis for moral judgments. Must be followed to please others Understand what is right and what is wrong. As a result, the child develops a conscience Instrumental exchange: (I'll help you if you help me"). makes the best deal. Does not consider elements of loyalty, gratitude, or justice in making decisions
Physical Development: Girls Age 12-18?
•Changes occur 6 mos. to 2 years before in boys •Puberty: onset of menses (menarche) occurs age 12-13 yrs (early as 10 or late as 15 years). •Small bud of breast tissue (thelarche): earliest sign •Fat deposits enlarge hips, thighs and breast. External genitalia grows. Hair develop in pubic and underarms •Growth spurt: age 9.5 and 14.5 yrs, gain 2-8 in. height, and 15 to 55lbs. in weight •American Cancer Society recommends breast exam routinely performed after age 20 years. •Puberty is good time to begin teaching self-breast exam Sport bras available for girls who are active in sports
General Characteristics of the Adolescent Child?
Transition between childhood and adulthood •Surge toward independence more pronounced •Difficult to get along with parents (represents authority) •If they submit to authority, they feel humiliated and childish •Bodies rapidly changing, experience intense sexual drives •Final 20% of mature height that is achieved during adolescence is the "growth spurt". •Usually occurs by 18 years of age
Which is an example of associative play?
Two children playing house, one playing the role of the dad and the other playing the mom RATIONALE: Associative play allows the preschoolers to use their enlarged vocabulary in play with other children to carry on conversations and describe scenarios for each to play.
Divorce?
Unless divorce is handled carefully, the impact on this age group can have serious consequences Younger school-age children: openly show their grief Older school-aged children: keep their feelings inside while experiencing deterioration in school performance and peer relationships Children are allowed to express their emotions, and counseling may help them work through their feelings
Physical Development for the Pre-school Age? (Age 3-6)
Visual acuity: •20/40 at 3 years •20/30 at 4 years •Dentition: all 20 primary teeth erupted •Hand preference: develops at age 3 years •Most bodily systems matured, gait resembles an adult
Characteristics of The Eight year-old Child?
Wants to do everything, creative, enjoy group activities (boy scouts, brownies) Play alone longer than 7 year-olds Likes to be considered important, particularly by adults, likes to argue. Teach child to express anger in an acceptable manner Arms and hands grow faster than rest of body Understands special events Enjoys competitive sports but a poor loser Likes to be the hero or heroine of their favorite program
A 3-year-old child, while playing with his favorite toy in the playroom of the pediatric unit, is approached by another child who also wants to play with the same toy. What behavior will the nurse anticipate from this child?
Will become angry and a physical response might ensue RATIONALE: The 3-year-old child is egocentric and likely will become angry when others attempt to take his or her possessions.
A parent is concerned about her children's reaction should their grandmother die. What understanding will guide the nurses response?
Young children often understand that other people die, but do not equate it with themselves. RATIONALE: Between 3 and 4 years of age, the child becomes curious about death and dying. They may realize that others die, but they do not relate death to themselves.
Masturbation for the Pre-school Age Child?
•Common in both sexes in preschool •Child experiences pleasurable sensations → repetitions of behavior •Harmless if child is outgoing, sociable and not preoccupied with the activity •Rule out cause such as rashes, penile or vaginal irritations •Punitive reactions are discouraged, harmful to the child. Assure parents this behavior is normal •If 'compulsive or excessive' or 'interferes with normal activities' or 'acting out sexual intercourse' with other children, possibility of sexual abuse should be explored Parents and children may need counseling
Stage of Piaget's Cognitive Development for the School Age Child (Age 6-12)?
•Concrete operations: School Age Child (Age 6-12) •School-aged child thinks and reasons in concrete terms •See things from another point of view •Able to solve problems •Masters symbols •Uses memory of past experiences to evaluate and interpret the present •Capable of abstract reasoning but thought is still limited to own experience •Concentrate on more than one aspect of a situation at a time (days, season) •Understands cause and effect Develops concept of time and space: understands causality Develop classification skills. They collect things Master arithmetic and reading Comprehends ideas of conservation and reversibility: Conservation: Recognize two equal quantities regardless of form (permanence of mass and volume) Reversibility: Think in either direction. Understands simple analogies
The American Cancer society recommends for boys Age 12-18?
•Examine testes during or after hot bath/shower •Each testicle is examined with index and middle finger of both hands on underside and the thumbs on top of the testicle. •Normal for one testicle to be larger than the other •Testicles are gently rolled between thumb and fingers Testicular and scrotal self-exam once a month per American Cancer society •Report any lump, pain or discomfort immediately or if symptoms last as long as 2 weeks •Scrotal support device (jockstrap) for sport events •Good personal hygiene
Parenting for the Adolescent Child?
•Adolescence: one of greatest parenting challenges. •Goal of parents: raise children to be independent and responsible •Some parents: -Unsure of opinions and hesitate to exert authority -Refuse to "let go" or change own beliefs to accommodate today's youth •Adolescents may: -Need time alone (privacy) to separate themselves from family to search for identity. -Need to talk about fears -Need assistance to sort out confused feelings -Need a confidential, accepting atmosphere that will promote quality communications
Development of Play for the Pre-school Child?
•Associative play: Playing the game but not working together •Characteristic of play: imitative, imaginative, magical •Dolls, dollhouses, telephone, construction sets, trucks •Cars, planes, hand puppets, handicraft sets, musical toys, large puzzles •Pretend doctors, teachers, nurses, firefighters •Imaginary playmates: common and normal and serve many purposes, such as relief from loneliness, mastery of feats, and provision of a "scapegoat" •Important to well and sick child's physical, mental, emotional, and social development
Language Development for the Pre-school Age?
•3 years: Vocabulary of 300- 800 words, 3-word sentence, repeat 3 numbers, use plurals, name familiar objects, ask many questions •4 years: Vocabulary of 1500 words, 4-5 word sentences, knows simple songs, may use offensive word without understanding meaning, use past tense •5 years: Vocabulary of 2000 words, 6-8 word sentences with pronouns, name > 4 colors, knows names of days, weeks, months, use future tense
Common Problems of Adolescence?
•Accidents leading cause of death: automobile, sports injuries, firearms accidents •Drug and alcohol: serious problems Substance abuse: Leading contributor to MVA fatalities Best weapon against drug is education •If 2 or more letters in PACE are problem areas, adolescent is high risk for drug abuse, require referral P - Parents, peers, and pot A - Alcohol, automobiles C - Cigarettes E - Education
Characteristics of The Three-year old Child?
•Helpful, assists in simple household chores •Obtains articles on request and return to proper places •Helps dress and undress self, uses toilet, and washes hands •Eats independently with improved table manners •Talks in longer sentences, expresses thoughts and imaginative. Talks to toys, and imitates what is seen about them •Parallel and associative play are typical, cooperative play for short period •Attempts to please parents. Less jealous of siblings •Knows own sex •Identify self with parent of opposite sex. Romantic attachment to parent of opposite sex: Oedipal complex in boys, Elektra complex in girls •Fears: more fears due to increased intelligence (recognize potential dangers), memory development and graded independence •Fear of bodily harm, loss of body parts (mutilation) •Fear of animals, dark, strangers •Night wandering is typical •Masturbation: common to reassure self that they are alright. •Sensitive feelings: are easily hurt
Thumb sucking for a Pre-school Age child?
•Instinctual behavioral pattern. Considered normal. •Comforting measure. Not necessarily mean child is insecure •Non-nutritive sucking (thumb or pacifier) has benefits: •Increased weight gain, decreased crying, self consoling ability, increased organized behavior •Pacifier causes fewer dental problems than rigid finger/ fingers. Should be safe constructed pacifier. Cleanliness is essential •Most children give up the habit when they reach school age. May regress during periods of stress or fatigue •Finger or thumb sucking: will not cause detrimental effect on teeth if discontinued before permanent teeth erupt
Jealousy and Sibling Rivalry for a Pre-school Age Child?
•Jealousy: Normal response to actual, supposed, or threatened loss of affection •Jealousy of new sibling strongest under 5 years of age: •may become aggressive: bite or pinch or revert to regression( thumbsucking, bedwetting) •Aggressiveness: Seen when child is made to share toys
Spiritual Development for a Pre-school Child?
•Learn religious beliefs and practices from what they observe in the home. •Concept of God is concrete: Understand simple Bible stories, take prayers literally •Spiritual development: Strongly linked to development of conscience •Concept of death: •Death and dying: Acquaint self with death through objects (flower dies, animal killed) •Parents should reassure child that people do not generally die until they lived a long time •Parents should encourage questions, help accept truth without fear
Physical Development: Boys? (Age 12-18)
•Luteinizing hormone (LH) maintains testosterone levels. LH increases during sleep 1-2 yrs before puberty •Puberty begins in boys with hormonal changes between 10 and 13 years of age: 1. Enlargement of testicles (first sign) 2. Pigmentation of scrotum, elongation and widening of penis. Age 17 to 21: adult genitalia is attained 3. Shoulders widen, pectoral muscles enlarge 4. Downy hair on upper lip, axillary, facial 5. Pubic hair grows, along with body odor, voice changes •Growth spurt around age10.5 to 16 yrs, gain 12 inches in height and 15 to 65 lbs. in weight, slows in late teens Production of sperm begins between ages 13-14 yrs Erections and nocturnal emissions takes place: •Physiologic reflex to ejaculate semen buildup, natural and normal, occurs during sleep (child should not feel guilty, needs to understand this is not enuresis)
Psychosocial Development: Erikson for Adolescent Age Child? (Age 12-18)
•Major task: Identity versus Role -confusion •Desire for freedom and independence •Emancipation: to establish identity. •If unable to master identity: -Bewildered, depressed, rigid, cling to the conformity of the peer group long after the need is passed -Experiences low self-esteem and alienation •Parents ambivalent about letting go: -Disagreements about car, money, chores, school grades, choice of friends, smoking, sex, use of drugs -Parents should set limits, expect to be challenged but not exceeded
Nutrition for Pre-school Age Child?
•Nutritional requirements similar to toddlers •Influenced by other's food habits and willing to try new foods •Involve children in preparing meals •Small portions, give nutritious snacks •Quality of food more important than quantity •Still with strong food preferences •Diet should continue to emphasize milk, vegetables and fruits
Freud: Psycho-sexual Development for a Pre-school Child Age 3-6?
•Phallic Stage (3 to 6 years): Aware of own bodies, aware of gender (boy/girl; male/female). •Focus on genital area as source of pleasure •Two Psychosexual Complexes: 1. Oedipal complex: Children manifest erotically tinged desires for their opposite-sex parent, accompanied by feelings of hostility toward their same-sex parent 2. Electra complex: Conflict during phallic stage in which girls supposedly love their fathers romantically and want to eliminate their mothers as rivals. Sexual Curiosity: Be honest, give accurate information at child's level, use correct terminology, provide sex education at the time child asks question (readiness to learn)
Erickson's Stage of Psychosocial Development for a Pre-School Child Age 3-6?
•Sense of Initiative vs. Sense of Guilt (4 to 5 yrs old): •Stage of Initiative: Begin and complete own actions for a purpose •Try new activities with sense of accomplishments and satisfaction. Prepare for leadership and achievement roles in the future. Activities initiated include risk-taking behaviors. •Guilt: When initiative does not produce desired results or when initiative is criticized or punished •Think they overstepped limits of capability. Guilty for not having behaved appropriately •Feelings of guilt→ leads to anxiety and fear. Can be carried over later in life and affect abilities to make decisions or solve problems
Therapeutic Play and other play aspects for the Pre-school Child?
•Therapeutic Play: •Play and toys have therapeutic value: •Retrain muscles, improve hand-eye coordination •Help children crawl and walk (push-pull toys) •Play Therapy: •Therapist obtains better understanding of child's struggles, fears, resentments, and feelings toward self and others •Art Therapy: •Express their feelings through drawings, clay, and other media
General Characteristics of weight for the Pre-school Age? (Age 3-6)
•Weight: Average weight gain per year: about 2.3kg (5lbs): •3 yrs: 14.6kg (32lbs) •4 yrs: 16.7kg (36.2 lbs) •5 yrs: 18.7kg (41lbs) •Doubled 1st year weight by 5 yrs of age
