Erickson stages:
trust vs mistrust
birth to 1 year
establishing trust in people providing care.
Erickson stages:
Autonomy versus shame and doubt
1-3 years
The toddler's sense of autonomy or independence is shown by controlling body excretions:
saying no when asked to do something, and directing motor activity.
Children who are consistently criticized for expressions of autonomy or for lack of control:
for example, during toilet training�will develop a sense of shame about themselves and doubt in their abilities
Erickson stages: initiative vs guilt
3-6 years
The young child is exposed to more people outside of the family and therefore initiates new activities and considers new ideas.
This interest in exploring the world creates a child who is involved and busy. The child learners to assume new responsibilities and becomes aware of guiding principles for actions.
Erickson stages: industry vs inferiority
6-12 years
The middle years of childhood are characterized by development of new interests and by a focus on intellectual or cognitive pursuits.
The child takes pride in accomplishments in sports, school, home and community
Erickson stages: Identity versus role confusion
12-18 years
In adolescence, as the body matures and thought processes become more complex, a new sense of identity or self is established.
The adolescent tries out roles and examines what fits best for the self and family/society expectations
Erickson stages: intimacy vs isolation
As we enter young adulthood in our early 20s, we also enter Erikson's stage known as intimacy vs. isolation.
During this stage, young adults face the challenge of forming close relationships with others.
Erickson stages: generative vs stagnation
Generativity refers to "making your mark" on the world through caring for others as well as creating and accomplishing things that make the world a better place.
Stagnation refers to the failure to find a way to contribute. These individuals may feel disconnected or uninvolved with their community and with society as a whole.
Erickson stages: integrity vs despair
The integrity versus despair stage begins as the aging adult begins to tackle the problem of his or her mortality.
The onset of this stage is often triggered by life events such as retirement, the loss of a spouse, the loss of friends and acquaintances, facing a terminal illness and other changes to major roles in life.
o Infant (birth-1 year)
� When a baby is offered nothing by mouth, offer a pacifier if not contraindicated. After painful procedures, offer a baby a bottle or a pacifier or have the mother breastfeed.
� Hold the hospitalized baby often. Offer comfort after painful procedures. Meet the baby's needs for food and hygiene.
� Encourage parents to room in.
o Infant (birth-1 year) nursing applications
� When a baby is offered nothing by mouth, offer a pacifier if not contraindicated. After painful procedures, offer a baby a bottle or a pacifier or have the mother breastfeed.
� Hold the hospitalized baby often. Offer comfort after painful procedures. Meet the baby's needs for food and hygiene.
� Encourage parents to room in.
o Toddler (1-3 years)
� Fear intrusive procedures
� Respect the child's routine
� Expect regression (bed-wetting)
� During hospitalization separation from parents is the greatest threat to a toddler.
� Continue the child's normal patterns of elimination in the hospital.
� Do not begin toilet training during illness or hospitalization.
o Preschooler (3-6 years)
� Be alert for children who appear more comfortable with male or female nurses and attempt to accommodate them
� Encourage parental involvement in care.
� Plan for playtime and offer a variety of materials from which to choose
� Offer medical equipment for play to lessen anxiety about strange objects
� Assess children's concerns as expressed through their drawings.
� Accept the child's choices and expressions of feelings.
� Preschoolers think he/she caused the illness or injury because they were "bad"
� Fear of body mutilation by procedures is common. Band-aids are very helpful.
� Allow child to handle medical equipment or models when preparing for a procedure
o School-agers
� Very concerned with body integrity
� Fear loss of control over their bodies
� Privacy and modesty are important
� May need more support from parents than they are able to admit
� Peers are becoming more important
� Allow child to make choices if possible
o Adolescent
� Major concern is about a change in body image
� Teaching should always focus on the hear and now....not future thinkers
� Some assessment questions should be asked without parents present.
� Encourage them to share a room with another teen when hospitalized if possible
freud: conservatism
two buckets of water one bigger than the other with the same amount of water
the kid will pick the bigger one.
freud: object permanence
Object permanence means knowing that an object still exists, even if it is hidden. It requires the ability to form a mental representation (i.e. a schema) of the object.
when does birth length double?
4 years
when does the child sit unsupported
8 months
when does a child achieve 50% of adult height?
2 years
when does a child throw a ball overhand ?
18 months
when does a child speak two-to three-word sentences?
2 years
when does a child uses scissors
4 years
when does a child can tie his shoes
5 years
girl's growth spurt during adolescence ?
Begins earlier than boys
as early as 10 years
what is common in toddlers?
temper tantrums
they are considered normal and average behaviors
adolescence is a time when
the child build rebellion against family values and form his or her identity.
what is normal knowledge of growth and development is used for?
evaluation of interventions and therapy
what behavior would indicate that thyroid hormone therapy for a 4 month old is effective ?
you must know milestone that are accomplished b a 4 month old.
ex: steady head control
which will indicate that replacement therapy is adequate for growth.
toddlers milestones:
birth to weight quadruples by 30 months
primary teeth are present
kick balls by 24 months
feed self with spoon and cup at 2 years
2-3 word sentences are spoken at 2 years
3-4 word sentence are spoken by 3 years
toy for toddlers
board and mallet
push and pull toys
toy telephones
stuffed animals and storybook with pictures depending on the reason for hospitalization
preschool child 3-6years milestones
kid learn to jump , skip, and hop
3 year old can ride a tricycle
use scissors by 4 years
a child tie his shoes by 5
child learn colors and shapes
thinking is egocentric and concrete
imaginary playmates and fears are common
Erikson : developing a sense of initiative vs guilt
preschool nursing care
explain to child that it's not their fault that they are hospitalized, its not a punishment for a bad deed
use simple words
therapeutic or medical play
fear of mutilation by procedures are important
bandaid helps with restoring body integrity
toys for preschooler include
coloring books
puzzles
cutting and pasting
dolls
building sblocks
clays, and toys
Use facts and principles related to growth and development in planning teaching interventions:
For example:
what task could a 5 year old boy with diabetes expect to accomplish by himself ?
Let him choose his injection sits
Give child a sense of control
school-age child 6-12 years: development milestones
each year a child gain 4-6 lbs
loss of primary teeth an eruption of most of permanent tooth
fine and gross mother skill mature
child can write a script by 8 years old
child can dress self completely
Social Awareness
Child learns how to tell time and understand past, present and future
Erikson: developing a sense of industry (industry vs inferiority)
school-age child 6-12 years: Nursing applications
child will need more support form parent then they admit
maintain contact wth peers and school activities while hospitalized
explanation of procedure is important
privacy and modesty are important
participation in care
Toys include : board games, caed games, hobbies such as stamp collecting, puzzles, and video games
tanner stages of pubertal development :
girls
Breast changes, Rapid increase in height and weight, Growth of pubic hair, Appearance of axillary hair, Menstruation, Abrupt deceleration of linear growth.
tanner stages of pubertal development : Boys
Enlargement of testicles, Growth of pubic hair, axillary hair, facial hair and body hair, Rapid increase in height, Changes in larynx and voice, Nocturnal emissions, Abrupt deceleration of linear growth.
school age children are in erikson's stage of industry , meaning
they are likely to do and accomplish things
peers are also becoming important for children of this age.
adolescent (12-19):
milestones
girls growth spurts begins earlier than boys
secondary sex characteristics develop
family conflicts develops
adult-like thinking begins around 15
problem solving and use abstract thinking
Erikson stage: Developing a sense of identity (iden- tity versus role confusion)
adolescent (12-19):
nursing application
1. Hospitalization of adolescents disrupts school and peer activities; they need to maintain contact with both.
2. They should share a room with other adolescents.
3. Illnesses, treatments, and procedures that alter the adolescent's body image can be viewed by the adolescent as being devastating.
4. Teaching about procedures should include time without the parents being present. It is important to direct questions to the adolescent when the parents are present.
5. The age of assent for making medical decisions in children and adolescents ranges from 7 to 14 years. Parental consent is also needed for treatment.
6. For prolonged hospitalizations, adolescents need to maintain identity (e.g., have their own clothing, posters, and visitors). A teen room or teen night is very helpful. The adolescent's parents should be discouraged to room-in.
7. Some assessment questions should be asked without parents' presence.
8. When teaching adolescents, the focus should be on the here and now�"How will this affect me today?
age groups concepts of bodily injury:
infants: after 6 months their cognitive development allows then to remember pain
Toddlers: they fear intrusive procedures
preschooler: Fear of body mutilation
school-age chide: fear loss of control of their bodies
what is adolescent main concern
body image change
major cause of death in adolescents and children?
accidents
Teach parents and children developmental appropriate safety and accident prevention techniques
pertinent history should be obtained
prior to administering certain immunizations because reactions to
previous immunizations or current health conditions may contraindicate current immunizations:
DTaP:
history of rxns, seizures, neurologic symptoms after previous vaccine or systematic allergic reactions
MMR
history of anaphylactic reactions to eggs or neomycin
preferred injections
SubQ rather than IM, invalidates the mantoux test
the common cold is
not contraindicated for immunization
teaching after immunizations
irritability, fever over 101, redness an soreness ar injection site for 2-4 days are normal side effects of DTaP and IPV
call HCP i seizes high feed or high--pitched crying occurs
a warm washcloth o the thigh injection site an bicycling the legs each diaper change decreases soreness
Acetaminophen ( tylenol) is administer orally eery 4-6 hours ( 10-15mg/kg
pertussis fatalities
continue to occurs in non immunized infants in the US
rubeolla (measles): viral disease
leads to neurologic problems
symptoms:
1.koplik spots
2.. confident rash that begins n the face and spreads downward
3.photophobia
Rubella (German Measles)
Teratogenic effects
Rash starts on face to the body
Pertussis ( whooping cough)
Complication
disease occurs in infancy
pneumonia, hemorrhage and seizures
paramyxovirus ( mumps): symptoms
Symptoms: Fever, headache, malaise, parotid gland
swelling and tenderness; manifestations include submaxillary and sublingual infection, orchitis, and meningoencephalitis
3. Transmitted by direct contact or droplet spread
4. Analgesics used for pain and antiseptics for fever
5. Bed rest maintained until swelling subsides
children with german measles
Poses a seizes threat to their unborn siblings
nurse should counsel all expectant mothers to be aware of the serious consequences of exposure to German measles during pregnancy
common childhood problems encounters by nurses carrying for the child
in a community or hospital settings. the child's age directly influence the severity and management of these problems.
pediculosis
an infections lice in human
most common form of head lice
appear small white flakes along the shaft of the hair
pediculosis Tx:
combing out the nits and using hair products containing permethrin or pyrethrin
anything the in direct contact with the infestation has to be treated to decrease spread of the lice
when do you add potassium ti IV fluids?
when there is adequate urine output
proper cooking
store milk in opaque container
proper cooking and storage methods to preserve potency. (ex cook veg install mat of liquid)
normal amount for urinary output for infants and children
1-2 mL/kg/hr
teaching about vomiting
teach parents that it us not recommended to induce vomiting in any way b/c it may cause more damage
Lead poisoning
More lead is absorbed on an empty stomach. Hot water can contain higher levels of lead b/c it dissolves lead more quickly the cold water so use only cold water for consumption
calorie intake
child need 150% of the usual calorie intake for normal growth and development
epiglotitis
do not examine the throat of a child with epiglottitis
do not push tongue blade or any object into the throat b/c of obstruction risk of the airway completely
in planning and providing nursing care, what is the# 1 priority always?
a patent airway regardless of age
primary reasons why families seek medical attention
respiratory disorders
he nurse should be sure prothrombin
have been determined prior to---- and
WHY
A tonsillectomy.
the nurse should asked whether there has been a history of bleeding, prolonged or excessive, and whether there is a history of any bleeding disorders in at the family.
what is common in children with cyanotic defects?
polycthemia
tetralogy of fallot
four defects:
PS (Pulmonary Stenosis)
VSD (Ventricular Septic Defect)
Overriding aorta
Right ventricular hypertrophy
signs of CHF:
poor feeding
poor weight gain
failure to thrive
the HR of a child increases with what?
fever and crying
feeding
infant may rewrite tube feeding to save energy
infants being tube-fed need to continue to satisfy sucking needs
Two objectives of CHF treatment:
increased CO
decrease heart's workload
CHF
more associate with acyanotic defects
digoxin management: administration
Apical pulse for 1 minute to assess for bradycardia.
Hold dose if pulse s below normal HR
Therapeutic range 0.8 - 2.0 ng/mL
Families should be taught safe home administration of digoxin
Administer in a regular basis,
Do not skip for make up for missed dose.
Give one hour before or 2 hours after meals, do not mix with formula or food
Keep in safe place
Take child's pulse prior administer, and knowledge when to call caregivers.
digoxin management: toxicity
vomiting
GI symptoms
neurologic signs
hypokalemia can increase toxicity
when frequent weight are required weigh,
weigh the client on the same scale at the same time of the day so accurate comparison can be made
RN goal when caring for a child w/ down syndrome
help the child to reach his or her optimal level of functioning
infants with cerebral palsy nursing interventions aimed at
preventing aspiration .
position child upright and support lower jaw
signs of increased ICP
decreased pulse
increase BP
(*opposite of shock)
signs of shock
increased pulse
deceased BP
baseline data on the child's usual behavior and level of development are essential so
changes associated with increased ICP can be detected early
Do not pump shunt
unless specifically prescribed.The shunt is made up of delicate valves, and pumping changes the pressures within the ventricles.
Medication noncompliance is the most common cause
increased seizure activity
what NOT to use during a seizure
tongue blade padded or not
because it can cause traumatic to oral cavity
meningitis management
manage iv therapy & hydration status
there may be inappropriate ADH secretion causing fluid retention(cerebral edema) and dilutional hyponatremia
Most postoperative clients with infratentorial tumors are prescribed to
lie flat or turn to either side.
large tumor may require that the child NOT be turned to the operative side.
causes of increased ICP
suctioning, coughing, straining, & turning
what is the first sign of renal failure
Decreased urinary output
Why Surgical correction for hypospadias is usually done before preschool years .
allow for the achievement of sexual identity, to avoid castration anxiety, and to facilitate toilet training.
Why surgical correction for hypospadias is usually done before preschool years .
allow for the achievement of sexual identity, to avoid castration anxiety, & to facilitate toilet training.
Children with cleft lip or palate and those with pyloric stenosis both have a nursing diagnosis of
Alteration in nutrition; less than body requirements.
Cleft palate is related to deceased ability to suck
pylori stenosis is related to frequent vomiting
Pyloric Stenosis
Narrowing of the pyloric canal; the sphincter (circular muscle of the pylorus) hypertrophies to twice the normal size.
pyloric stenosis: assessment and Tx
Palpable olive-shaped mass in upper right quadrant of
the abdomen
Visible peristaltic waves
vomiting
Tx: pyloromyotomy: cut and loosen a narrowed pylorus caused by pyloric stenosis
Nutritional needs and fluid and electrolyte balance are key problems for children with GI.
The younger the children, the more vulnerable they are to fluid and electrolyte imbalances and the greater is the need for the caloric intake required of growth.
HgB norms
newborn: 14-24 g/dL
infant: 10-17 g/dL
child: 9.5 to 15.5 g/dL
Teach family about administration of oral iron:
Give on empty stomach
Give with citrus juice
Use dropper or straw to avoid discoloration of teeth
Teach that stools will be tarry
Teach that iron can be fat in severe overdose: keep away from children
Do not give with any dairy products
hemophilia
Inherited bleeding disorder
autosomal recessive: both parents must be heterozygous, or carriers of the recessive trait, for the disease to be expressed in their offspring.
With each pregnancy , there is one in four chance that the infant will have the disease.
However, all children of such parents can get the disease not just 25%.
when people usually diagnose hemophilia
during circumcision
and loose baby tooth
**** have joint
Hemarthrosis (most frequent site of bleeding)
Spontaneous bleeding into muscles and tissues (less
severe cases have fewer bleeds)
Loss of motion in joints
sickle cell anemia
This is the transmission pattern of sickle cell anemia cystic fibrosis and PKU
X-linked recessive trait: the trait carried on the
X chromosome; therefore, it usually affects male offspring as in hemophilia.
With each pregnancy of a woman who is a carrier, there is a 25% chance of having a child with hemophilia.
if the child is male, he had a 50% chance of a getting hemophilia.
if the child is a female, she has a50% chance of being a carrier
Hydration
Hydration is very important in the hemodilution and circulation of red cells through the blood vessels.
Important terms:
Heterozygous gene HgbAS- sickle cell
Homozygous gene HbSS- sickle cell trait
Abnormal hemoglobin HgbS- disease and trait
IRON deficiency
Supplemental iron is not given to clients w/ sickle cell anemia.
The anemia is not caused by iron deficiency deficiency.
Folic acid is given orally to stimulate RBC synthesis.
Have epinephrine and oxygen readily available
to treat anaphylaxis when administering L-asparaginase (chemo)
prednisone
frequently used in combination with antineoplastic drugs to reduce the mitosis of lymphocytes.
Allopurinol, a xanthine oxidase inhibitor, is also administered to prevent renal damage caused by uric acid buildup and cellular lysis
An infant with hypothyroidism is often described as
a good, quiet baby by the parents.
Early detection of hypothyroidism and PKU is essential
for preventing cognitive impairment in infants.
Knowledge of normal growth and development patterns is important b/c a lack of attainment can be used to detect the presence of a disease and to evaluate
DM in children was typically diagnosed as insulnin- dependent diabetes (type 1) until recently. a marked increase in type 2 DM has occurred recently in the United States, particularly among Native American, African American, and Hispanic children and adol
Adolescence frequently causes difficulty in management because growth is rapid, and the need to be like peers makes compliance difficult occurred recently in the United States, particularly among Native American, African American, and Hispanic children and adolescents.
nutrasweet( aspartame) contains phenylalanine and should not, therefore, be given to a child with
PKU.
nutrasweet (aspartame) contains phenylalanine and should NOT be given to a child with
PKU.
There has been an increase in the number of children diagnosed with type 2 diabetes.The increasing rate of obesity in children is thought to be a contributing factor.
contributing factors include lack of physical activity and a family history of type 2 diabetes.
Pin sites can be source of infection. Monitor for signs of infection.
Cleanse and dress pin sites as prescribed.
skin traction should not be removed unless HCP prescribes its removal.
brace
A brace does not correct the spine's curve in a child with scoliosis; it only stops or slows the progression.
corticorticoids
used in the short term in low doses during exacerbations. Long-term use is avoided because of side effects and their adverse effects on growth
signs of diabetes :type 1
polyphagia
polydipsia
polyuria
skin condition : pinworms
itching is #1 symptom
UTI: why does kids gets it
they hold their pee a lot
improper wiping
Teach proper wiping front to back
cotton panties
diaper rash
prevention:
use zinc oxide and A&D ointment
neutropenic patients :
oncology patients:
hand washing is number 1 precaution
Asthma teaching
no carpet
no dust
asthma number one symptoms
non-productive cough
seizures
number one airway and safety
meningitis position
sim's position
bacterial meningitis
symptoms: irritability
cleft palate
affect language and feeding
more prone to aspiration
teaching abt blindness
keep the same routine
familiar toys
use of aspirin
Kawasaki disease - high fever
use high dose of aspirin
rheumatic fever
use low dose of aspirin b/c it easy vegetation of valve