NUR 101 Quiz 9 Unit 13: growth and development

Which vaccination is recommended at birth?

hep b

During a home visit, the nurse observes a mother prepare a bottle of skim milk for an 18-month-old child. Which nursing diagnosis should the nurse use to base instruction for this mother?

imbalanced nutrition

According to Erikson, school age is developing?

industry/ successful mastery of enjoyable activities

What is the greatest accomplishment that school age children do when they start school?

learn to read

Which vaccinations for 16 - 18?

meningococcal, HPV x3 series, flu/influenza

A 16 year old who is having sex thinks what?

pregnancy will not happen to her

Dressing in toddlers

-Encourage caregiver to let child change themselves -Roomy clothing, easy buttons, large zippers, and Velcro

Bathing in toddlers

-Set a regular time for each day for a bath- helps give the toddler a sense of security and may have helpthe toddler quiet down before bedtime -Avoid bubble bath, especially for girls (bladder infections)

meningococcal

10 years old

MMR

12 - 15 months

HPV

9 - 14 years old 6 - 12 months after

infants physical development

-Birth weight doubles by 6 months of age, triples by 1 year -Increases approximately 6 inches by 6 months of age (1 in per month) by 1 year- height has increased 10-12 inches -Head at birth- average is 35 cm 1 year-average is 47 cm o Anterior fontanel- closes by 12-18 months o Posterior- closes by 2-3 months o First deciduous teeth erupt between 6-8 months, 6-8 teeth present by 1 year Cardiovascular o Auscultate apical puse for 1 full minute o Normal HR: § 90 asleep § 170 awake o Rate slows with maturity · Respiratory o Abdominal breathing movements o Normal RR during infancy: 30-60 breaths per minute o Slows with maturity o Close proximity of trachea to bronchi o Lumen of trachea and bronchi are small o Rib cage is less flexible o Eustachian tube (in ear drum) is straight and wide- Higher risk for middle ear infection

Fine motor skills in infants

-Birth-4 Weeks: grasp reflex present; hands flexed -6 Weeks: hands open; holds head up when prone -10-12 Weeks: grasp reflex absent; pulls on clothes and blanket but does not reach for them; pumps arms, shoulders, and head from prone position -16 Weeks: grasps objects with 2 hands; hand-eye coordination beginning -20 Weeks: holds one object while looking for another one; grasps objects voluntarily and brings them to mouth -24 Weeks: can hold a bottle; tries to retrieve a dropped article -28 Weeks: holds cup; transfers objects from one hand to the other -32 Weeks: Pincer grasp (using thumb and index finger) develops; adjusts body position to be able to reach for an object; may stand up while holding on -40 Weeks- 1 Year: holds tools with one hand and works on it with another; puts toy in box after demonstration; stacks blocks, holds crayon to scribble on paper

communicating with family/caregivers

-View caregivers as the experts in the care of the child and you as their consultant -Offer anticipatory guidance to help prepare them for the future

The nurse is assessing an 11-year-old girl. Which assessment finding(s) should the nurse expect? Select all that apply. -presence of pubic hair -enlarged breast buds -coarse pubic hair -enlarged areolas -increased genitalia pigmentation -secondary mound formed of areola and nipple

-presence of pubic hair -enlarged breast buds -enlarged areolas -increased genitalia pigmentation

A nurse is teaching parents of a 2-year-old child about discipline and limit setting. When describing the use of "time-out," the nurse would inform the parents that the maximum duration of time-out should be how many minutes per each year of age?

1 minute

Tdap

11 years old, routine every 7 years

varicella

12 - 15 months

Which vaccinations are recommended at 2, 4, 6 months old?

hep b, DTAP/tdap, HIB, IPV, PCV, RV, and flu at 6 months. wait for MMR and varicella

What vaccinations are given to a one year old?

hep b, dTAP, Tdap, HIB, IPV, PCV, RV, MMR, varicella, Hep A

proximodistal

midline to periphery (ability to control arms before fingers)

Motor skills in infants

· Birth-4 Weeks: catches and holds objects in sight that cross visual field (tracking someone walking by); can turn head from side to side when prone; body in a flexed position when prone; moves extremities in a crawling fashion when prone · 6 Weeks: tries to raise shoulders and arms when stimulated; smiles to familiar voices; less flexion when prone · 10-12 Weeks: Moro reflex absent (startle reflex); symmetric body positioning · 16 Weeks: plays with hands; brings objects to mouth; balances head and body for short periods in sitting position · 20 Weeks: able to roll over (easier to roll from belly to back) and sit up while learning forward · 24 Weeks: Tonic neck reflex disappears; sits alone; rolls over and back to abdomen · 28 Weeks: reaches without visual guidance; can lift head up when in a supine position · 32 Weeks: crawls around; pulls toy toward self · 40 Weeks- 1 Year: stands alone; beings to walk; can change self from prone to sitting to standing position

Nutrition in toddlers

· Growth rate slows · Physiologic anorexia- child may want and need less food than before · Strong drive for independence and autonomy · Food jags are common- the desire for only one kind of food · Keep serving sizes small · Give preferred food with 1 to 2 other foods on plate

factors on growth and development

· Prenatal Factors- mother's health, nutrition, and behaviors during pregnancy · Genetics- sex, race, height, weight, temperament, etc. · Nutrition · Environment · Family structures- family size, parent-child relationships, etc. · Cultural background · Socioeconomic status of family

What can a 3 year old do?

ride a bike, balance on one foot, can say 300 words

The nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding?

"I can expect my infant to be able to raise the head up when on the stomach within the next month."

The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?

"I will grow an average of 2.5 in (6.5 cm) per year."

Psychosocial development in school aged children

- industry VS inferiority - build self confidence - sense of right vs wrong - understanding conversion (change in shape doesn't mean change in mass) - decentration (understand several problems of a situation) - reversibility (can think in either direction) - classification

Accident prevention

- no drinking/ texting while driving - safe sex - prevention and testing of STDs - substance abuse - tattoo and piercing safety - self exams of breasts and testes

A mother who is vegan, when asked about the nutritional intake of her 18-month-old, tells the nurse not to worry because she is providing plenty of protein to her daughter. "And," she says, "I avoid giving her fats." Which of the following would be the most appropriate response for the nurse to give this mother?

"Your child needs fat in the diet at this age, as it is needed for myelination of spinal nerves."

A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time, even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?

"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school."

Psychosocial development

- Initiative VS Guilt - magical thinking (may have imaginary friends) - sexual curiosity - imitative play, dramatic play, cooperative play, associative, solitary, onlooker, unoccupied behavior

Accident and infection prevention

- Seat belt use - Bicycle safety helmet - Street safety - Stranger, fire, and swimming safety - cover mouth - correct disposal of tissues - wipe front to back - hand hygiene - do not share personal items

Psychosocial development in adolescents

- identity VS role confusion - confused by changes in body - rollercoaster of emotions - sexual identity and orientation - peer pressure - body image

Dental care in toddlers

-Bacteria forms plaque on teeth because of the presence of sugar in foods -By 2 years of age, a toddler can be taught to brush his or her teeth by imitating the example of adults -By 2 years of age, the first visit to the dentist should occur

Toilet training in toddlers

-Can be started when urethral and anal sphincters have developed enough so the toddler can control them (usually occurs at age 18-24 months) -Perfection should not be expected -Leave the toddler on the potty chair for a short period of time -Teach hand washing -Empty potty chair after the child has resumed playing -Caregivers should ignore occasional lapses -The toddler should not be teased

Sleep in toddlers

-Daily need for 12-14 hours of sleep in the first year of toddlerhood (decrease to 10-12 hours by 3 years of age) -Bedtime rituals provide structure and security

In teaching school-aged children and their parents, what facts would be valuable for the nurse to emphasize? Select all that apply. -School-age children require 8 to 10 hours of sleep each night. -Dental checkups are recommended twice a year. -Children need to learn about human reproduction at home. -Education about the unhealthy aspects of tobacco and alcohol should begin in elementary school. -For nutritional recommendations, a good resource for parents is choosemyplate.gov.

-Dental checkups are recommended twice a year. -Education about the unhealthy aspects of tobacco and alcohol should begin in elementary school. -For nutritional recommendations, a good resource for parents is choosemyplate.gov.

rotavirus

1st dose- 2 months 2nd dose- 4 months

DTap

1st dose- 2 months 2nd dose- 4 months 3rd dose- 6 months

Haemophilus influenzae

1st dose- 2 months 2nd dose- 4 months 3rd dose- 6 months

pneumococcal conjugate PCV13

1st dose- 2 months 2nd dose- 4 months 3rd dose- 6 months

inactivated poliovirus

1st dose- 2 months 2nd dose- 4 months 3rd dose- 6 months to 15 months

hep b

1st dose- birth 2nd dose- 1 to 2 months 3rd dose- 6 to 15 months

In working with infants, the nurse would expect the posterior fontanel to be closed in an infant who is which age?

3 months

A nurse is obtaining a weight on a 7-year-old who weighed 8 pounds (3632 g) at birth. How much does the nurse anticipate that he should weigh now?

56 pounds (25.5 kg)

A nurse is preparing a class for a group of parents of school-age children about language development and problems with speech articulation, specifically difficulty pronouncing specific letters. The nurse would inform the parents that a referral for initiating speech therapy may be necessary for these problems after which which age?

8 years

Assessment in infants

Cardiovascular o Auscultate apical puse for 1 full minute o Normal HR: 90 asleep, 170 awake o Rate slows with maturity o Abdominal breathing movements o Normal RR during infancy: 30-60 breaths per minute o Slows with maturity o Close proximity of trachea to bronchi o Lumen of trachea and bronchi are small o Rib cage is less flexible o Eustachian tube (in ear drum) is straight and wide- Higher risk for middle ear infection

A client is concerned that the new baby is going to have a weight problem growing up because other family members are obese. How should the nurse respond to this client?

Do not restrict fatty foods until the age of 2 years.

A trend with growth and development of the infant is that development is proximodistal. This means:

Growth progresses from gross motor movements to fine motor movements.

An 8-year-old male child is being seen for a well-child visit. His weight at his visit last year was 50 lb (22.7 kg) and his height was 47 in (119 cm). If he is developing normally, which finding will the nurse expect to note this year?

Height 49.5 in (124 cm)

Teething in infants

Infant may have swollen gums and be restless or fussy o Interventions- cold teething rings, OTC teething gels, acetaminophen or ibuprofen o Clean teeth with a cool, wet washcloth

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years.

Which milestone would the nurse expect an infant to accomplish by 8 months of age?

Sitting without support

The nurse is visiting a mother who has a 3-month-old infant. Which anticipatory guidance information should the nurse provide to the mother at this time?

The child should be able to turn over onto the back around age 4 months.

During a physical assessment, a 15-year-old male expresses concern about being short in height. When responding to the client, the nurse would incorporate an understanding of which information about growth?

The epiphyseal lines of long bones close at about 18 to 20 years of age in males.

The nurse is conducting a physical examination of an 8-month-old infant. Which observation may be cause for concern about the infant's neurologic development?

The infant displays an asymmetric tonic neck reflex (fencing reflex). The tonic neck reflex normally disappears by between 4 and 7 months

The nurse is providing anticipatory guidance and education to the parents of child entering into the preschool age group. What information would the nurse include in the teaching?

The preschool-age child's physical growth will slow compared to previous years.

A nurse is examining a 17-year-old adolescent in the emergency room who is being disruptive in the waiting area. On assessment, the nurse finds dilated pupils, and the teen is talking very fast. Which of the following drugs does the nurse suspect the teen may be abusing?

amphetamines

What happens to an 8 year old's motor coordination when they get older?

motor coordination improves

What happens to an 18 month old's head?

anterior fontanel closes

influenza

as early as 6 months, annually after that

The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response?

as soon as the first tooth erupts

According to Erikson, the toddler is developing what?

autonomy/shame, doubt trying out independence

What can a 5 year old do?

can jump rope, swim, skate, can say 2100 words

How do babies learn?

cognitive learning through sensory input and movement

According to Piaget, school age is developing?

concrete operations, set realistic goals

The school-age child develops the ability to recognize that if a block of clay is in a round ball and then is flattened, the shape changes but not the amount of clay. What understanding has this child developed?

conservation

What can a baby do at three months?

creeping (normal locomotion both arms and legs move with the abdomen parallel to the floor)

What vaccinations for 3-5 years old?

dTap, Tdap, polio, MMR, varicella

Which vaccinations are recommended before starting school?

dTap, Tdap, polio, MMR, varicella

According to Erikson, adolescence is developing?

establishing identity

What is a toddler able to do from 1- 3 years?

feed self (with spoon at 24 months), walk, talk, go to the bathroom by 2 years (control of bowel and bladder is almost complete by 2)

Snack and foods for a toddler

finger foods, soft foods, foods that are the same size diameter of the trachea need to be divided into fourths, always offer new foods by themselves to note any allergies

According to Piaget, adolescence is developing?

formal operations

Normal age of puberty for boys and girls?

girls: 10 - 12 boys: 13

How do school aged kids play together?

group play and teams is the major way that a child at this age learns

cephalocaudal

head and neck control is developed before control of the rest of the body

Which characteristic of the adolescent should the nurse consider abnormal? Select all that apply. epiphyseal plates closed heart rate 84 bpm growth of 4 to 8 inches (10 to 20 cm) in males third molars erupting at age 13 apocrine glands functioning

heart rate 84 bpm third molars erupting at age 13

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?

nocturnal emissions

communicating with young children

o Allow family to hold the young child o Do not rush; use short sentences, positive and concrete explanations, and familiar and nonthreatening terms o Play a game/ allow them to explore equipment they will encounter

communicating with school aged children

o Interested in knowing the "why" and "how" of things- answer questions with concrete responses

communication with infants

o Respond to sensory cues only o Sensory play activities (convey safety and comfort)- massaging the infant, stretching arms and legs, looking at a colorful or moving object, playing peek-a-boo

communicating with adolescents

o Show genuine interest in them; build rapport with conversation about friends, school, hobbies, and family o Discuss confidentiality of information- it may be appropriate to interview adolescent alone o Be open-minded and nonjudgmental

Accident prevention in toddlers

o Toddlers should always be secured in a car seat when in a motor vehicle o Supervision is needed when near motor vehicles and/or streets o Supervision is needed near any body of water (bathtub, pool, pond, etc.) o Cover electrical wall outlets o Keep matches and hot liquids out of reach o Turn handles of pots and pans toward back of stove o Turn thermostat on water heater down to 120 degrees o Store toxic substances out of reach and in child-proof containers o Use safety latches or locks on drawers and cabinets

8 stages of psychosocial development (Erikson)

o Trust vs. Mistrust- (0-1 Year) o Autonomy vs. shame and doubt- (1-3 Years) o Initiative vs. Guilt- (3-6 Years) o Industry vs. Inferiority- (6-12 Years) o Identity vs. role confusion- (12-18 Years)* o Intimacy vs. Isolation- (Early Adulthood) o Generativity vs. self-absorption- (Young and Middle Adulthood) o Ego integrity vs. Despair- (Old Age)

How do toddlers play with each other?

parallel play

What can a baby do at 1 to 2 months? What closes on their head

partial head lag (ability to hold head on their own, not a strong hold) posterior fontanelle closes

A pediatric nurse caring for children of all ages knows that children learn about themselves, the environment, and relationships best through:

play

A 17-year-old girl has come to the clinic to get a rubella immunization that is required by the college she plans to attend. Before administering this immunization, the child should have which screening or test?

pregnancy test

What precautions should the parents be aware of with a toddler?

safety, choking, hot dogs, small pieces in mouth, pulling things over on themselves

A nurse is providing anticipatory guidance to the parents of an 8-year-old child, explaining that when the child returns next year for a well check-up, the child will likely undergo which screening?

scoliosis

According to Erikson, preschool age is developing what?

sense of initiative

According to Erikson, the infant is developing what?

sensing trust (fear is at 6 months)

According to Piaget, the toddler is developing what?

sensorimotor (ratify hunger, sucking)

What can a 4 year old do?

skip, hop on one foot, use scissors, color, can say 1500 words, dressing up clothes, imaginary thinking

What vaccinations for 11-12?

tetanus, Tdap due to cuts and injuries

Which drug can affect the fetus teeth?

tetracycline

If a pre-school age child sees you pour his liquid medicine from a tall, thin glass into a short, wide one, he will probably reason that:

the amount of medicine is less (the glass is not as full).

What can a baby do at 5 - 6 month? What happens in their mouths?

they can sit with support, not crawling, cannot turn over (at 4 months can roll from back to side), able to introduce solid food, teeth erupt at 6 months (first deciduous teeth are called incisors)

What can a baby do at 7 months?

transfer objects from one hand to another

Pneumococcal polysaccharide

two years old

What can a baby do at 12 months of age? How much should they weigh?

use push toys to begin walking, birth weight doubles by 6 months and triples in 1 year

Describe an infant's fine motor skills

using fingers and hand grasping (pincer grasp)

Describe an infant's gross motor skills

using legs and bigger muscles

Denver developmental screening test

· 4 Categories: · Personal-social skills · Fine motor adaptive skills · Language skills · Gross motor skills · Purpose is to identify children who are unable to perform at a comparable level to their age mates · Low score indicates need for further investigation—may be at risk for developmental delay · NOT an intelligence test

Adolescent physical development 13- 18

· Adult-like contours occur · Primary sex organs enlarge · Secondary sexual characteristics appear · Hormones increase · Females: breast development occurs, pubic hair appears, menstruation and ovulation occur · Males: penis, testes, and scrotum reach adult size and shape, pubic hair appears, voice deepens, muscle strength and coordination occur

Nutrition in adolescents

· Appetite increase, eats more frequently · Food choices influenced by peers · Skip meals, snack on foods that provide empty calories, eat fast food · Diets are deficient in calcium, iron, zinc, folic acid, vitamins A, D, B6 · Experiment with food fads and diets · Culture influences food choices and habits, choice to follow a vegetarian diet

Physical development in toddlers

· Average weight gain is 5-10 pounds per year · Average height increase is 3 inches per year · Fine Motor Skills o Increasing manual dexterity o 15 months- can drop pellet into bottle, throw object o Eating with spoon mastered by 24 months · Gross Motor Skills o 12- 15 months- able to stand and take a few independent steps o 18 months- walks alone, gait may be unsteady o 24 months- runs well with little falling; throws and kicks a ball; walks up and down stairs one step at a time o 36 months- balances on 1 foot, jumps in place, pedals a tricycle

Nutrition in infants

· Breast milk, infant formula, or a combination of both is the sole source of nutrition for the first 6 months of life but is needed until 1 year of age · Some infants have intolerance to milk (intestinal bleeding, allergies or other reactions)—milk substitutes...soybean mixtures · Many begin to introduce solid foods at 4-6 months of life · Introduce solid foods one at a time over a 5-7-day period to observe for allergies · Order of introduction is no longer considered important: iron-fortified infant cereal (rice cereal), plain strained fruits, plain strained vegetables, plain strained meats · Appropriate finger-foods- ripe bananas, toast strips, graham crackers, noodles, and peeled chunks of apples, peaches, or pears · Gradually wean to a cup at 1 year of age

Preadolescent physical development 10 - 12

· Females o Marked by a growth spurt o Menarche- beginning of menstruation o Pelvis broadens o Axillary and pubic hair develop o Hormone levels change · Males o Grow at a slower, steadier rate than females o Scrotum and testes enlarge o Pubic hair develops o Production of sperm

Physical development in school aged children

· Slow and steady growth · Weight increases 5 to 6 pounds each year · Height increases 2.5 inches each year · Skeletal growth · Growth mostly occurs in the long bones · Ossification- Cartilage is replaced by bone at the epiphyses (growth centers at the end of long bones and at the wrists) · By 10 years of age- spine is straighter, abdomen is flatter, and body is generally more slender · Dentition- At about age 6, the child starts to lose the deciduous teeth and permanent teeth appear

Physical development in preschoolers

· Slowed growth rate · Weight increases 3 to 5 pounds each year · Height increases 2.5 inches · Most skeletal growth occurs in feet and legs · Gross and fine motor skills: o 3 Years- can ride tricycle, broad jump, walk on tiptoe, balance on one foot o 4 Years- can hop on one foot, skip, and use scissors o 5 Years- can throw and catch a ball, jump rope, walk backwards, and begin to swim and skate o Fine motor increases in manipulation, such as drawing & being able to dress themselves · Dentition: o Deciduous teeth (baby teeth) have completely emerged at the beginning of the preschool period o Deciduous teeth begin to be replaced by permanent teeth by the end of the preschool period · Vision: o By age 6 a normal child has 20/20 vision