Exam Review - Memo Essentials

3 m

holds hand in front face

Fine Motor Skills - 2 months

holds head up while prone

Gross motor skill- 2 months

improving head control

15-18 m

increasing words and begins word phrases. Points to body parts when asked.

12-13 m

jabbering

4-5 m

laughs and expresses delight

12 m

makes simple marks on paper with pencil

Developmental Milestone

observed performance of a specific behavior - smile, sitting up, walking, saying first word

Nutritional (3-5), preschool

picky eaters continue with schedules meals and snacks Offer variety of foods Many kids with calcium and iron deeficiency. Calcium ( rich in dairy, broccoli, and oranges). Iron is rich in beans, meats, and fortified cereals.

10 m

pincer grasp

5 year

prints first name asks what a word means participates in long conversations

10-11 m

pulls to standing, cruises

language development - birth

respond to sound

2 year

right or left handed; undresses partially; scribbles

5 months

rolls back to front

4 months

rolls front to back

12-15 m

self feeds; finger food; holds spoon

The school nurse is discussing various topics with a group of adolescent girls. One of the girls states, "I just want to be pretty and to look like everyone else." The nurse recognizes that the girl's feelings about herself and her body relate to the development of:

self-esteem. Body image is closely related to self-esteem. Seeing one's body as attractive and functional contributes to a positive sense of self-esteem. During adolescence, the desire not to be different can extend to feelings about one's body and can cause adolescents to feel that their bodies are inadequate even though they are actually healthy and attractive.

Developmental Task

set of skills and competencies unique to each developmental stage, where children must accomplish or master to interact with their environment. EX) trust vs mistrust

4 year

sing songs or say poem from memory asks many questions 75% of speech understandable

7-8 m

sits independently

2-3 m

smiles and coos

18 m

stacks 4 cubes; removes shoes and socks

11-12 m

stands alone, first steps

5 year

swings , skips, and climbs well

3 year

talks mostly in 3-5 + words + sentences can say name + identify sex, and age uses pronouns and plurals

Development - toddler

temper tantrums (controlling their tempers is NOT one of them but YES negatism) & egocentrism management of temper tantrums- decrease stimulation, time out for 1 min for each year of age Sleeps 12 hrs + 1-2 naps focused on separation and individualism identifies boundaries power struggles needs security item potty training 18-24 months ( 28 months day time bowel and bladder training). 30 months full set of teeth provide routine - ritualism!

Infant vital signs

temperature: most accurate and safe: temporal artery HR; apical, count while infant is calm or sleeping. 130-160 in a newborn to 90-100 in a 12 month old RR: 30-60 in a newborn. 20-30 in a 12 month old. Listen mid-axillary. Pulse ox in toe for infant. Finger for older child.

Infant oral health

tooth eruption begins around 6-8 months. lower than upper. can be painful, does not cause fever

6 m

tripod sits

11-12 m

two words other than mama/dada

9-10 m

understands no

6-12 year

vocabulary expands, reading and listening skills improve

12 m

walks forward

12-15 m

walks independently

2 year

walks up steps alone, runs, kicks a ball

18 m

walks up steps with assistance

6-12 year

writing; musical instruments; constructing

Developmental Theories

Freud - psychoanalytic Erickson- psychosocial Piaget - cogntive Kohlberg- moral development

Growth: toddler (1-3 years)

Gains average 5 lbs / 5 inches If head circumference grow appropriate stop at age 2; if not continue until age 3 Upright height 2-18 Recumbent length until 2 yo BMI at 2 y/o

Growth: Preschool (3-5 years)

Gains average of 4.5 / growth 2-3.5 Physical growth becomes slower Lean and more upright appearance Increased strength

Nutritional: Adolescence (13-17)

Girls: 2000 kcal/day. Include folate Boys: 2400-2800 kcal/day.

adolescence vaccine

HPV, mengicoccpl

Types of Play

Infant (0-1) - solitary play - play on their own Toddler (1-3) - parallel play - engaged in the same activity, but with minimal interaction Preschooler (3-5): associative play - sharing toys and some interaction but not organized or consistent enough. Dramatic / pretend / pretend play. Rough and tumble play, medical play. School Age (6-12)- cooperative play/ team play/ skill development. competition.

Nursing Interventions

Infant - cluster care, specific play time, skin-skin Toddlers- routines, redirect attention, give small choices, provide quite and calm, comfort objects preschooler - routines and rituals, setting consistent limits, age-appropriate toys, allow participation in simple tasks, socialize with other children in play rooms, praise good behaviors, give choices, go from noninvasive to invasive, do not lie, say no ouchies to reassure nothing harmful School age- increased awareness of surroundings, time reference is important, behaviors may not match feelings, choices are important Adolescent - need to know normal growth and development. need to know normal growth and development.

Fluid status

It is easier for infants and children to get dehydrated because most of their fluid is extracellular, meaning they do not have fluid reserve in their cells to move into.

Dehydration s/s

Mild ( less than 5% weight loss): irritable / fussy, slightly sunken fontanelles, pink mucous membrane, HR slight elevation, BP slight decreased, Cap refill 2-3, labs normal, slightly decreased in wet diapers. o2 sats 95-100. Moderate: (5-10% loss): sleepy/lethargic, sunken fontanelles, pale mucous membranes, tachy, hypotension, decreased weight, cap refill 3-4, labs slightly changed, fewer wet diapers or trips to the bathroom, o2 sats 90-95 Severe: (10 or more %): stuporous, very sunken fontanelles, dry pale mucous membranes, profound tachy and hypo (responsive to fluid boluses), decreased weight, cap refill 5+, concentrated labs, little to no wet diapers or UO. O2 less than 90.

Adolescents additional

Need depression screening annually 12-21. Screen tobacco use annually 11-21. Developmental surveillance yearly 11-21. Assess need for anemia, dyslipidemia, sti and hiv annually. Immunizations / booster.

Hearing

Newborns hearing screen before they leave the hospital. *** identification of hearing loss is crucial by 6 months ** Preferably when sleeping; they will hear clicks. If continue to fail at age 2-3 months refer. Universal screening at 4,5,6,8,10 Risk assessment performed at 7,9,11-21 Measures hearing through hz and decibles. frequency and loudness. Wears headphones in quiet room follow instructions for noises.

Normal Urine Output number

Normal Urine Output: Infants: 2 ml/kg/hr Children: 0.5-1 ml/kg/hr Adolescents and Adults: 40-80 ml/hr

While evaluating the development of a 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which developmental phenomena has this

Object permanence By 10 months, an infant looks under a towel or around a corner for a concealed object (beginning of object permanence, or become aware an object out of sight still exists).

CRIES

Physiological used for infants greater than or equal to 38 weeks of gestation up to 6 months. - crying, oxy req, changes in vital signs, facial expression, and sleep state. - maximal score of 10 is possible. greater than 4, further pain assessment. analgesic for greater than 6.

Piaget Theory

Sensorimotor Stage: Birth to 18-24 months Pre-operational: 2-7 years Concrete Operational: 7-11 years Formal Operational = 12+

Growth milestones - infant

Should be back to birth weight by 10-14 days old Weight doubles by 4-5 months Weight Triples by one year HC increases rapidly during 1-6 months due to head growth. Posterior fontanelle closes 2-3 months Anterior closes 12-18 months Focus on HC (until 2 year), hegight, and weight Assess laying down until 2 years old Reflexes precursor to brains development Presence or absence of some reflexes could indicate issues with brain development

Growth: School age (6-12 years)

Starts with loss of childhood teeth and ends with start of puberty. Height and weight slower but steady. Caloric needs decrease decreased Organ growth matures Grow 1-2 inches per year Gains 3-5 pounds per year Early school age and girls similar in height and weight Later school age most girls surpass busy in height and weight Puberty characterized by development of secondary characteristics

When caring for a child with a cognitive impairment, what is a primary factor for the nurse to consider regarding the approach for interaction with the child?

The developmental stage is based on developmental tasks achieved.

palmar grasp reflex

disappears at 3-4 months

8 month

finger feeding

A 10 year old child weighs 73 pounds. The doctor orders a medication, Augmentin. The safe dose for Augmentin is 25mg/kg/day divided q.12hours. How many mg of Augmentin can the child receive per dose?

415 mg.

Numeric Scale

8 and up

Adolescents

8.5-10 hrs of sleep Invincible Sexual development and relationships

Obesity Numbers

95 and up - Obesity 85-95 - Overweight Under 5 - Underweight 5-84 % - Normal

Infant crying

first way to communicate needs several hours a day during first month; peaks at 6 weeks Decreases as infant learns other ways to communicate. Emergence of fears and anxiety - peaks around 8 monghs. Separation anxiety begins around 8-9 months and peaks around 14-18 months

5 m

graps rattle

7 month

hand to hand object trasfer

D-Tap / T-dap

has different concentration Child is over 7 - D comes first

According to Piaget, one basic concept that a child will learn during the first year is that:

he is separate from his parents. Part of learning permanence is learning where body boundaries begin or end or that the child is separate from parents.

ACE

Adverse Childhood Experiences (ACE) - related to childhood trauma and the risk for future health problems. Trauma informed care- recognizes the prevalence of trauma and ACEs and its effects on health

The mother of a 6-month-old infant asks the nurse at a community health center what she should do about her baby, who always wants to put everything in his mouth. What would be an appropriate response by the nurse, based on Freud's theory?

"Babies at this age explore and enjoy their world with their mouths." According to Freud, infants ages 0 to 18 months use their mouths as the major source of gratification and exploration. Pleasure is experienced from eating, biting, chewing, and sucking.

A mother reports to the nurse that her 4-year-old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother?

"Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development." They enjoy games using imitation and they mimic exactly what they see parents do. It is a normal part of their development.

The nurse enters her client's room and finds the infant on a pillow with a bottle propped up while the mother is dressing. What statement should the nurse make?

"You should always hold your baby for feedings instead of propping the bottles." Infants are at risk for aspiration of milk and for otitis media.

8-9 m

"dada, mama"

Dehydration calculation

% weight kiss = (present weight- original weight) / (original weight)

Sensorimotor (birth to 18-24 months)

- Development of cognitive abilities, object permanence ( pee-kaa-boo, about 8 months ), self-recognition, differed imitation, and representational play. - Learns through senses and actions.

Formal Operational ( 12 and up)

- Entirely freed from physical and perceptual constraints. - deals with abstract ideas ( ex: describing characteristics of respect) Logically test hypotheses. Uses Concepts but DOES NOT imply emotional maturity - Form an argument without having to think in terms of specific examples. - Emergence of scientific thinking, formulating abstract theories, and hypotheses. - Identifies healthy relationships

HTN screening

- Universal hypertension starts at 3 Auscultation preferred not manual. - Right arm preferred, needs to be confirmed on 3 separate visits for Dx - Have child sit quietly for 5 min with feet on floor before. But not realistic. - If elevated, repeat manually. Use appropriate size cuff if not could not be off ( too large falsely low, too small falsely high). Cuff should be 40% mid upper arm circumference and should encircle 80-100 of arm. Under 13- normal is less than 90% ( SBP or DBP) for age, gender, and height. Prehypertneison/elevated: 90-95% for age gender and height. HTN greater than 95% for age, gender, and health. - Stage 1: 95-99% + 5 mm Hg - Stage 2: Greater than 99% + 5 mmHg Over 13 - same as adult. - Normal: less than 120/80 - Elevated: 120-129/ <80 - Stage 1 : 130-139/80-89 - Stage 2: 140/90

Concrete operational (7-11 years old)

- begin to think ( REASON- conceptual thinking ) logically about concrete events. - classification of object - concept of conservation - mentally reverse things. Clay changing shape. - Less egocentric and begins to think about how others think and feel. -During this stage, children learn by manipulating concrete or tangible objects and can classify articles according to two or more characteristics. - A child in this stage would best learn the procedure by handling the equipment and having it demonstrated on a teddy bear or doll.

Erickson Stages

0-1.5 - infant - Trust vs Mistrust - hope - infant is uncertain about the world. 1.5-3 - toddler- autonomy vs shame -will - terrible 2s - sense of personal control. 3-5 - preschooler - initiative vs guilt - "purpose"- wonder their roles are. Asks many questions - curious (gender differences) and eager to please- smart and curious "3s" 5-12: school childhood- industry vs inferiority - competency / confidence 12-18: adolescent - identity vs role confusion- fidelity / who you are / goal: fit in

Causes of Dehydration:

1) fever. loses 7 ml/kg/24 hrs for each degree in temperature 2) bleeding 3) v/d 4) third spacing. fluid in interstitial places pleural cavity or pericardium 5) insensible loss: sweating, increasing metabolic demand, increased RR

12-month-old child weighing 11 lb has an order for gentamycin sulfate 13 mg IM q 36 hour. The pharmacy has 20 mg/2 mL on hand. How may milliliters would the infant receive, and what is the best site for the injection?

1.3 mL; vastus lateralis

Fluid requirements for infants less than 10 kg

100 cc / kg/ 24 hrs

Nutritional milestones - infant

110-120 kcal / kg / day Skin - Skin First 6 months: BM/ formula sole source of nutrition. Breast feeding infants should receive 400 IU vitamin D starting at 2 weeks. 6 months and can sit in a highchair with good head control, opens mouth in response to food, absence of tongue extrusion reflex - mix cereal with BM, formula, or water - pureed, smashed fruits, veggies, and meats - introduce sippy cup. 8 months: finger foods. - cookie, banana, peas, pasta, veggies, fruit, meat all cutinto small sized pieces. Cut rapes in half to precent obstruction of airway. Don't avoid allergens and give diverse foods. Introduce during 4-12 months. AVOID - honey (infant botulism), cows milk, fruit juices. Aspiration risk: nuts, popcorn, hotdogs, small hard/foods

Nutritional: toddler(1-3 y.o.)

12-15 months: wean from bottle Should use cup, spoon, self feed, finger foods Move to cows milk at 12 months- limit milk to 16-24 ounce a day. Limit juice to 4 oz per day Offer 3 meals and 2 snacks per day 1/4 of adult portions

2 year

2-3 word phrases. 50 word ++

vision for 3 year

20/40

vision for 2 year

20/50

Faces Scale

3-8

School aged (6-12)

Explore environment beyond family Parents influences are still primary Peer approval Same sex friendships Formalized groups clubs or sports Bullying Gang violence Body concept /image

The nurse at an elementary school is explaining the concept of industry versus inferiority to a group of nursing students. What is part of this stage of Erikson's theory?

A sense of competence, mastery, and worth Erikson states that school-agers receive satisfaction from developing new skills and successfully using them to accomplish goals (industry). Failing (without adult support) or being unable to meet expectations that are set too high can result in feelings of inferiority. Lacking the ability for abstract thought is a cognitive skill and part of Piaget's theory, as is the principle of conservation. The conventional stage belongs to Kohlberg's theory of moral development.

Vision

All health supervision visits. Neonate (1-28 days) : red reflex ( if not oncology), fixate on object to midline, 10-12 inches **** Infant (1 month- 1 year) : follow object to midline. 2 months- follow object 180 degree Up to 3 yo: focuses and tracks object, report squinting and bumping into things. 3-5. 20/40. assess with shape chart. Greater than 6: 20/30. assess with letter chart. Report if not at these recommend guidelines or if there is 2-line difference between eyes.

FLACC

Behavioral Younger toddler Non-verbal or preverbal pts Score each subset 0-2 Face, Legs, Activity, Cry, Consolability

Growth milestones - adolescents (12-18)

Boys: Growth spurts 10.5-18 years old Gain 15-65 lbs Grow 4-12 inches Puberty: enlargement of testicles, penis, pubic hair 13.5, nocturnal emissions 14, hair under arms, voices changes, acne at 15. Girls: Growth spurt 9-14 years old Gain 15-55 bs Grow 2-8 inches Puberty: Breast development, pubic hair, underarm hair, menarche (period) 10-16. - Body image and ideal body - Looking for adult roles models to determine who they want to be.

Infant vaccination

COVID-19 vac for infants above 6 months. Boosters are recommended for 5 years and older. MMR, VZV (varicella), and Hep A - not given until at least 1 year. RV- rota virus Hep B - Hepatitis B Hib - Haemophilus influenza type b PCV 13- Pneumococcus IPV - Inactivated Polio vaccine Flu - Influenza (from 6 months)

Nutritional: (6-12), school aged

Calroic needs diminish. but need well balanced diet. They have adult teeth- oral health is importanr.

preschool (3-5)

Can expect "tall tales" - telling unrealistic stories. Curious and eager to please. sleeps 11-12 hrs graduates eliminates naps nightmare start around 3 start seeing dentist thumb sucking needs to stop by age 4 for dentition Brush teeth with fluoride am and pm

Additional Screening

Check lead levels at 12 and 24 months (1,2 years) Dyslipidemia: 6,8,20 Anemia, TB, and fluoride supplement: assess need for annually 5-10. Lead exposure 5, 6

Vaccines

Chemo and immunocompromised pts: no live vaccines Early childhood vacc - low grade fever as response (immunity) - redness / soreness at injection site - tiring /fussy/irritable

A nurse is teaching a 7-year old diabetic child who is in Piaget's concrete operational stage about insulin injections. Based on Piaget's theory, what would be the nurse's best method of preparation for this child?

Demonstrate the procedure on a teddy bear. During this stage, children learn by manipulating concrete or tangible objects and can classify articles according to two or more characteristics. A child in this stage would best learn the procedure by handling the equipment and having it demonstrated on a teddy bear or doll.

The mother of a toddler observes the child play next to another child but not with the child. What should the nurse explain to the mother about this type of play behavior?

This is parallel play and is expected. All during the toddler period, children play beside children next to them, not with them. This side-by-side play called parallel play is not unfriendly but is a normal developmental sequence that occurs during the toddler period

Safety

Toddlers: use screen over 15 spf. Preschoolers (3-5): emphasize street safety 3-7, more frequently involved in peds struck, devise fire escape and teach the children. Lead screening. Lead toxicity = greater 3.5 mcg/dl. Adolescents - mva/mvc leading cause of death. limit distractions. think "invincible."

Pre-operational Stage (2-7 years)

Using Brooms to fly - magical thinking- what they SEE - perceptual thinking - Acquire the ability to internally represent the world through language and mental imagery. - Young children can think about thinks symbolically. Animals / sounds. - Thinking is how the world looks.

Vaccine

Vastus lateralis - largest muscle in infants and small children. 0.5 ml for infants (1 month-1year) 1 ml for toddler (1-3 year) 2 ml for preschool (3-5 year). Use 5/8 to 1 inch. 23-25 gauge. Mild reaction: Redness or swelling in the injection site

Vision / Hearing Assessment

Vision - Infant: presence of blink reflex and pupil constriction to light are indications of newborn vision. Red reflex Can focus on objects between 8 (20 cm) - 15 inches including mother's face during feeding. Difficult to measure during infancy, between 20/150 to 20/400. Very nearsighted. - Adolescents. Determine if they need yearly screening. Hearing: - Infant: Better high than low frequency sounds. Responsive to baby talk. Will stop an activity around 2 months at sound of voice, turn head in attempt to locate sound. Newborn infant screen. Monitor for chronic ear infection.

4 year

alternates feet when going downstairs; hops; catches a ball

3 year

alternates feet when going up stairs, pedals a tricycle

5-6 m

babbles

9 m

bangs objects together

4 m

bats at objects

6-12 years

bike riding, jumping rope, swimming, ball game skills, refinement of motor skills

The nurse at a health fair is teaching about the various changes of puberty. Which sequence of events will be best for the nurse to present when illustrating pubertal changes in females?

breast budding, appearance of pubic hair, menarche Secondary sexual characteristics develop in an orderly sequence with variance in the timing for individuals. Breast budding in the female is usually the first physical sign noted, and occurs between the ages of 10 and 12 years on average. Appearance of pubic hair usually occurs just before menarche, the first menstrual period. From the onset to the start of menarche is typically 2 years.

Formalized Screening Tests for Preschooler

height, weight, BMI obtained at each well child visit and plotted on ages 2 thru 18 growth chart blood pressure beginning at age 3 conduct formalized visual acuity test at age 3. conduct formalized hearing screen at age 3

BMI

compared height and weight - that correlates with body fat

3 year

copies a circle, undresses completely, dresses partially, unbuttons

4 year

copies a square; dresses completely

5 year

copies a triangle; ties shoes; prints letter

9 m

creeps or crawls