OLDER FAMILY STAGE?

-RETIREMENT OF ONE OR BOTH PARENTS

LEADING CAUSES OF CHILD DEATHS?

1. VEHICLE ACCIDENTS
2. DROWNING
3. BURNS
4. FIREARMS
5. POISONING
6. SUFFOCATION

CHILDHOOD MORTALITY?

INFANT MORTALITY
-NUMBER OF DEATHS PER 1000 LIVE BIRTHS DURING FIRST YEAR OF LIFE

-NEONATAL PERIOD: <28 DAYS OF LIFE
-POSTNATAL PERIOD: 28 DAYS TO 1 YEAR OF LIFE

BIRTH WEIGHT:
-MAJOR DETERMINANT OF NEONATAL DEATH
-LBW= <2500g

OTHER STATISTICS:
-RACE: BLACKS > MORTALITY RATES THAN OTHERS
-PREMATURE
-MOTHER YOUNG/OLD
-CONSISTENCY OF PRENATAL CARE

MORTALITY STATISTICS?

-MORTALITY INCREASED IN TODDLERHOOD
-MORTALITY DECREASED IN AGES 5-14 YEARS
-MORTALITY INCREASED IN AGES 15-22 YEARS
-****BLACK MALES 16-22 YEARS HAS HIGHEST HOMICIDE RATE

4 FAMILY PRACTICE PATTERNS?

1. AUTHORITARIAN OR DICTATORIAL
2. PERMISSIVE OR LAISSEZ-FAIRE
3. AUTHORITATIVE OR DEMOCRATIC
4. UNINVOLVED

AUTHORITARIAN OR DICTATORIAL FAMILY PRACTICE PATTERN?

-RULES MADE AND ENFORCED BY PARENTS

-PARENTS TRY TO CONTROL THE CHILD'S BEHAVIORS AND ATTITUDES THROUGH UNQUESTIONED RULES AND EXPECTATIONS

EXAMPLE: THE CHILD IS NEVER ALLOWED TO WATCH TELEVISION ON SCHOOL NIGHTS

PERMISSIVE OR "LAISSEZ-FAIRE" PARENTING STYLE?

-PARENTS EXERT LITTLE OR NO CONTROL OVER THE CHILD'S BEHAVIORS, AND CONSULT THE CHILD WHEN MAKING DECISIONS.

-PARENTS DON'T REGULATE OR SET LIMITS

EXAMPLE: THE CHILD ASSISTS WITH DECIDING WHETHER OR NOT HE WILL WATCH TELEVISION

DEMOCRATIC OR AUTHORITATIVE PARENTING STYLE?

-ALL MEMBERS HAVE EQUAL INPUT AND ARE RESPECTFUL

-PARENTS DIRECT THE CHILD'S BEHAVIOR BY SETTING RULES AND EXPLAINING THE REASON FOR EACH RULE SETTING.

-PARENTS NEGATIVELY REINFORCE DEVIATIONS FROM THE RULES

EXAMPLES:
-THE CHILD CAN WATCH TELEVISION FOR 1 HR ON SCHOOL NIGHTS AFTER COMPLETING ALL OF HIS/HER HOMEWORK AND CHORES

-THE PRIVILEGE IS TAKEN AWAY BUT LATER REINSTATED BASED ON NEW GUIDELINES

UNINVOLVED OR PASSIVE PARENTING STYLE?

-LITTLE OR NO COMMITMENT TO PARENTING
-UNATTACHED OR INDIFFERENT

-PARENTS ARE UNINVOLVED, INDIFFERENT, AND EMOTIONALLY REMOVED

EXAMPLES:
-THE CHILD MAY WATCH TELEVISION WHENEVER HE/SHE WANTS

POSITIVE PARENTAL INFLUENCES?

-PARENTS HAVE GOOD MENTAL HEALTH
-MAINTAIN STRUCTURE AND ROUTINE IN THE HOUSEHOLD
-ENGAGE IN ACTIVITIES WITH THE CHILD
-VALIDATE THE CHILD'S FEELINGS WHEN COMMUNICATING
-MONITOR FOR SAFETY CONCERNS WITH SPECIAL CONSIDERATION FOR THE CHILD'S DEVELOPMENTAL NEEDS

WAYS TO PROMOTE ACCEPTABLE BEHAVIOR?

-VALIDATE THE CHILD'S FEELINGS, AND OFFER SYMPATHETIC EXPLANATIONS

-PROVIDE ROLE MODELING AND REINFORCEMENT FOR ACCEPTABLE BEHAVIOR

-SET CLEAR AND REALISTIC LIMITS AND EXPECTATIONS BASED ON THE CHILD'S DEVELOPMENTAL LEVEL

-FOCUS ON THE BEHAVIOR WHEN IMPLEMENTING DISCIPLINE

FAMILY ASSESSMENTS?

-MEDICAL HX OF PARENTS, SIBLINGS, AND GRANDPARENTS

-FAMILY STRUCTURE FOR ROLES/POSITION WITHIN THE FAMILY, AS WELL AS OCCUPATION AND EDUCATION OF FAMILY MEMBERS

-DEVELOPMENTAL TASKS A FAMILY WORKS ON AS THE CHILD GROWS

-FAMILY CHARACTERISTICS: CULTURAL, RELIGIOUS, AND ECONOMIC INFLUENCES ON BEHAVIOR, ATTITUDES, AND ACTIONS

-FAMILY STRESSORS, SUCH AS EXPECTED (BIRTH OF A CHILD) AND UNEXPECTED (ILLNESS OF A CHILD, DIVORCE, DISABILITY OR DEATH OF A FAMILY MEMBER) EVENTS THAT CAUSE STRESS

-AVAILABILITY OF AND FAMILY INTERACTIONS WITH COMMUNITY RESOURCES

-FAMILY SUPPORT SYSTEMS, SUCH AS AVAILABILITY OF EXTENDED FAMILY, WORK AND PEER RELATIONSHIPS, AS WELL AS SOCIAL SYSTEMS AND COMMUNITY RESOURCES TO ASSIST THE FAMILY IN MEETING NEEDS OR ADAPTING TO A STRESSOR

Leading causes of death, disease, & disability (cardiovascular, cancer, lung, depression, violence, substance abuse, injuries, nutritional deficiency, & HIV/AIDS) can be reduced by preventing 6 category of behavior:

Tobacco use, behaviors that result in injury or violence, alcohol or substance use, dietary & hygienic practices that cause disease, sedentary lifestyle, sexual behaviors that causes pregnancy & disease
Need: health promotion, good nutrition, dental care, & immunizations

COSANGUINEOUS FAMILY?

BLOOD RELATIONSHIP

AFFINAL FAMILY DEFINITION?

MARITAL RELATIONSHIP

FAMILY OF ORIGIN?

FAMILY UNIT BORN INTO

"HOUSEHOLD" FAMILY DEFINITION?

ACCOMMODATES OTHER VARIETIES OF FAMILY STYLES

Family systems theory:

family is system that continually interacts with its members and environment – nurse can intervene to help family prepare for and cope with change

Family stress theory:

crisis interventions are used by nurses to help family cope with challenging event

Developmental theory:

nurses provide anticipatory guidance to prepare family members for transition to next developmental stage

HEALTHY PEOPLE 2020 LEADING HEALTH INDICATORS AND GOALS?

GOALS
-INCREASE QUALITY AND LENGTH OF HEALTHY LIFE
-ELIMINATE HEALTH DISPARITIES

LEADING HEALTH INDICATORS
-physical activity
-overweight and obesity
-tobacco use
-substance use
-responsible sexual behavior
-mental health
-injury and violence
-environmental quality
-immunization
-access to health care

Culture?

is learned beliefs, values, and practices that are shared within the group

Race?

is division of humans possessing traits that are transmissible through descent

Ethnicity?

is affiliation of a set of people who share unique cultural, social, or linguistic heritage

Socialization?

is the process by which society imparts its competencies, values, and expectations to children

Social roles:

patterns of behavior for people in variety of social positions. Role prohibits some behaviors and allows others. Provides significant influence on development of child’s self-concept

Parent-Professional collaboration:

Encouraging activities to develop self-confidence and self-esteem
Displaying increased awareness of and respect for family caregivers
Recognizing that families vary in defining their role
Demonstrating an ability to understand the families’ approach to caregiving
Sharing perspectives, not just tasks and functions
Supporting family members in their primary, irreplaceable role as caregivers
Exchanging expertise in providing care to the child
Assisting families in recognizing their contributions as worthwhile
Identifying strengths and resources of child and family
Negotiating options, priorities, and preferences
Assisting with coping by allowing families to find meaning in caring for the patient at home

PRENATAL PERIOD?

CONCEPTION TO BIRTH

NEONATAL PERIOD?

BIRTH TO 4 WEEKS (28 DAYS)

INFANT PERIOD?

4 WEEKS (28 DAYS) TO 1 YEAR

TODDLER PERIOD?

1-3 YEARS

PRESCHOOL PERIOD?

3-6 YEARS

SCHOOL-AGE PERIOD?

6-12 YEARS

ADOLESCENCE PERIOD?

12-21 YEARS

NEONATAL REFLEXES AND WHEN THEY DISAPPEAR?

MORO= 3-4 MONTHS
TONIC NECK=5 MONTHS
ROOTING=4-6 MONTHS
SUCKING=6 MONTHS
BABINSKI= 3 MONTHS
PALMAR GRASP= 3 MONTHS

Growth?

– increase in physical size & weight of whole or any of its parts

Development?

– gradual change & expansion; advancement from lower to more advanced stage of complexity

DIRECTIONAL PATTERN OF GROWTH AND DEVELOPMENT?

Cephalocaudal: (head to tail) lower extremities
Proximodistal: (near to far) midline to peripheral concept.

Differentiation : simple operations to complex activities. Global patterns of behavior to specific refined patterns

SEQUENTIAL PATTERN OF GROWTH AND DEVELOPMENT?

definite, predictable sequence with each child passing thru each stage

Developmental pace:

has a fixed, precise order, it does not progress at the same rate or pace. There are periods of acceleration & decelerated growth in total body growth & in subsystems. Pass thru the predictable stage at different rates. Range of time rather than certain point. Proceeds in orderly sequence ht: sm-lg. motor: sit-creep-stand-walk-run

Sensitive periods:

-limited times during the process of growth when reacts with environment in a specific manner. (critical, sensitive, vulnerable and optimal times) Depends whether the quality of interactions will be beneficial or harmful.

-IF THEY MISS ANY SENSITIVE PERIOD IN DEVELOPMENT, THEY WON'T BE AS ADVANCED IF THEY TRY TO MAKE IT UP

SENSITIVE PERIODS:
-CRITICAL
-SENSITIVE
-VULNERABLE
-OPTIMAL

Individual difference:

Each child is unique
Motor skills: gross to refined skills
Childrelearn skill & behavior by practicing

Metabolic rate?

– higher in children
-Increased heat production
-Increased production of waste
-Body surface area of young children is greater in relation to body weight

Bone Growth?

-Best indicators of biological age
-Long bones growth continues until epiphyseal fusion
-Bone synthesis is greater than bone destruction
-Calcium stored in the ends of the long bones

IMPORTANT HT AND WT STATISTICS?

NEED TO KNOW!!!!

-Ht at 2 is approximately 50% of eventual adult ht
-Length at birth doubles by age 4
-Birth wt triples by end of 1st yr

GROWTH STANDARDS?

DIMENSIONS AND BMI

GROWTH DIMENSION STANDARDS?

Height or length
Weight
Volume
Thickness of tissues

BMI VALUES?

Age, gender specific, and nutritional status

FACTORS THAT INFLUENCE GROWTH AND DEVELOPMENT?

Hereditary traits
Nationality and race
Ordinal position
Gender
Environment
Family

TEMPERAMENT?

Manner of thinking, behaving, or reacting that is characteristic of individual

TYPES:
-EASY CHILD
-DIFFICULT CHILD
-SLOW TO WARM UP CHILD

Easy child TEMPERAMENT:

-even tempered, regular, predictable habits

-easygoing children are even tempered, are regular and predictable in their habits, and have a + approach to new stimuli. They are open and adaptable to change and display a mild-to-moderately intense mood that is typically positive. Approximately 40% of children fall into this category.

Difficult child TEMPERAMENT:

-highly active, irritable, and irregular habits

-difficult children are highly active, irritable, and irregular in their habits. Negative withdrawal responses are typical, and they require a more structured environment. These children adapt slowly to new routines, people, and situations. Mood expressions are usually intense and primarily negative. They exhibit frequent periods of crying, and frustration often produces violent tantrums. This group represents about 10% of children

Slow-to-warm-up child TEMPERAMENT:

-react negatively and with mild intensity to new stimuli; unless pressured, adapt slowly with repeated contact

-these children typically react negatively and with mild intensity to new stimuli and, unless pressured, adapt slowly with repeated contact. They respond with only mild but passive resistance to novelty or changes in routine. They are inactive and moody but show only moderate irregularity in functions. 15% of children demonstrate this temperament pattern.

Childhood morbidity:

-May denote acute illness, chronic disease, or disability
-Diseases vary according to age
-Low-income children do not fare as well
-Specific groups of children have increased health problems

What has had the greatest impact on reducing infant mortality in the United States?

-Access to high-quality prenatal care

-Access to and the use of high-quality prenatal care is a promising preventive strategy to decrease early delivery and infant mortality. The improvements in perinatal care, in particular respiratory care and care of the mother-baby dyad before delivery, have had the greatest impact. There has been a decrease in some congenital anomalies such as spina bifida, but this is not the greatest impact. Better maternal nutrition has had a positive influence but not the greatest overall impact. Changes in funding have not had the greatest impact.

The nurse teaching parents of an adolescent about nutrition will include what important information?

-Resources to assist lower income families about obtaining enough protein.

-Lower income families may need resources and information about how to obtain assistance in getting expensive foods such as meats to get enough protein intake. During adolescence, parental influence diminishes and the adolescent makes food choices related to peer acceptability and sociability. Occasionally these choices are detrimental to adolescents with chronic illnesses, such as diabetes, obesity, chronic lung disease, hypertension, cardiovascular risk factors, and renal disease. Families that struggle with lower incomes, homelessness, and migrant status generally lack the resources to provide their children with adequate food intake; nutritious foods, such as fresh fruits and vegetables; and appropriate protein intake. The result is nutritional deficiencies with subsequent growth and developmental delays, depression, and behavior problems. Behavior problems can indeed be related to nutritional deficiencies.

The role of the pediatric nurse is influenced by trends in health care. The greatest trend in health care is:

shift of focus to prevention of illness and maintenance of health.

Evidence-based practice, a current health care trend, is best described as:

- questioning why something is effective and whether there is a better approach.
-Evidence-based practice helps to focus on measurable outcomes and the use of demonstrated, effective interventions and questions whether there is a better approach.

The signs and symptoms in a nursing diagnosis describe:

- a cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems.

-This is the third part of the nursing diagnosis, the signs and symptoms.

-projected changes in an individual’s health status, clinical conditions, or behavior?

These are the outcomes or goals that are established.

-an individual’s response to health pattern deficits in the child, family, or community?

This is the definition of the problem statement, the first component of the nursing diagnosis.

- physiologic, situational, and maturational factors that cause the problem or influence its development?

This is the definition of etiology, the second component of the nursing diagnosis.

When teaching an adolescent mother about risk factors for neonatal death, the most important factor is:

- low birth weight.

-LBW, which is closely related to early gestational age, is considered the leading cause of neonatal death in the United States. Injuries are the leading cause of death in children over age 1 year, with the majority being motor vehicle accident (MVA) injuries. Injuries to the mother and chronic illness are not the major causes of neonatal death.

Nurses play an important role in current issues and trends in health care. Which is a current trend in pediatric nursing and health care today?

-Health promotion resources enable children to achieve their full potential.

-Health promotion provides opportunities to reduce differences in current health status among members of different groups and provides a better chance to achieve the fullest health potential. The patient and family is the unit of care for the health care provider. Discharge planning begins when the patient is admitted. The focus of pediatric health care is trending away from acute hospital settings.

What is the most appropriate teaching point to include in a health promotion teaching plan for parents of children age 5 to 14?

-Storing firearms in locked cabinets.

-Improper use of firearms is the fourth leading cause of death from injury in children 5 to 14. Mechanical suffocation is the leading cause of death from injury in infants. Homicide is the second leading cause of death in 15 to 19 year olds. Poisoning causes a considerable number of injuries in children under 4 years of age.

Place the following steps of the nursing process in the proper order of completion when the nurse is caring for a child with pneumonia. (Place the answer options in the correct order. Separate each answer by a comma.) (Select all that apply).

Determine whether antibiotic therapy has been effective by reviewing white blood cell count. Correct
Administer antibiotics as ordered. Correct
Listen to the child’s breath sounds and monitor vital signs. Correct
Identify the problem of impaired gas exchange. Correct
Establish therapeutic goals and prioritize health care provider orders. Correct

The correct steps in the nursing process are:

Assessment: listening to breath sounds
Diagnosis: identifying patient problems
Planning: establish goals and prioritize
Implementation: administer antibiotics
Evaluate: determine effectiveness of interventions

Which health promotion teaching points should a nurse include in a dental teaching plan to help prevent dental caries? (Select all that apply.)

-Drink fluoridated water.
-Dates and locations of free dental clinics.
-Dental caries are preventable.

-Dental caries is the single most common chronic disease of childhood. Nearly one in five children between the ages of 2 and 4 years has visible cavities. The most common form of early dental disease is early childhood caries, which may begin before the first birthday and progress to pain and infection within the first 2 years of life.

-Preschoolers of low-income families are twice as likely to develop tooth decay and only half as likely to visit the dentist as other children.

-Early childhood caries is a preventable disease, and nurses play an essential role in educating children and parents about practicing dental hygiene beginning with the first tooth eruption; drinking fluoridated water, including bottled water; and instituting early dental preventive care.

Children are taught the values of their culture through observation and feedback on their own behavior. A nurse teaching a class on cultural awareness-competence should be aware of which factor(s) that may be culturally determined? (Select all that apply.)

-Social roles
-Degree of competition
-Determination of status

-Social roles are influenced by culture.
-Cultures that value individual resourcefulness/competition of status is acceptable.
-Determination of status is culturally determined and varies according to each culture.
-Racial variation refers to transmissible traits. -Culture is composed of beliefs, values, practices, and social relationships that are learned.

-Cultural development may be limited by geography. The geographic boundaries are not culturally determined.

A camp nurse is assessing a group of children attending summer camp. Based on the nurse’s knowledge of special parenting situations, which group of children is at risk for a sense of belonging?

- Children recently placed in foster care

-Children placed in foster care are at greater risk to have problems perceiving a sense of belonging.
-Children adopted at birth have fewer problems with acceptance when parents follow preadoption counseling about disclosure.
-Children of divorced parents often fear abandonment.
-Children who gain a stepparent are at risk for having trust problems with the new parent.

What is appropriate advice for parents who are preparing to tell their children about their decision to divorce?

-Give reassurance that the divorce is not the children’s fault.

-Parents can cry in front of children; it may give the children permission to do the same.
-Parents should provide the reasons for the divorce in a manner the children will understand. -If parents are able, they should hold and touch children and reassure them that they are not the cause of the divorce.

The most overwhelming adverse influence on health is:

race.
customs.
socioeconomic status.
genetic constitution.

-socioeconomic status.

-Although children of different racial groups have differing health issues, socioeconomic status is a key predictor. Customs do not usually have an adverse effect on health. A higher percentage of lower-class individuals have some health problem at any one time than other individuals in different classes. There is a high correlation between poverty and poor nutrition. On a population basis, genetic constitution is not an overwhelming adverse influence.

Which statement is true concerning folk remedies?

They may be used to reinforce the treatment plan.
They are incompatible with modern medical regimens.
They are a leading cause of death in some cultural groups.
They are not a part of the culture in large, developed countries.

-They may be used to reinforce the treatment plan.

-Whenever they are compatible, folk remedies should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the remedy, they may not be incompatible. These circumstances vary with the remedy. These circumstances vary with the remedy.

The nurse is planning care for a patient with cultural background different from that of the nurse. An appropriate goal is to:

strive to keep cultural background from influencing health needs.
encourage continuation of cultural practices in the hospital setting.
attempt in a nonjudgmental way to change cultural beliefs.
adapt as necessary cultural practices to health needs.

-adapt as necessary cultural practices to health needs.

-The cultural background is part of the individual; it would be very difficult to eliminate its influence.
-The cultural practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.
-The cultural background is part of the individual; it would be very difficult to eliminate its influence.
-Whenever possible, nursing care should facilitate the integration of cultural practices into health needs.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy in the toddler?

Helping the toddler complete tasks
Providing opportunities for the toddler to play with other children
Helping the toddler learn the difference between right and wrong
Encourage the toddler to do things for self when capable of doing them

-Encourage the toddler to do things for self when capable of doing them

-To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks for the toddler.
-Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy. Toddlers have an increased ability to control their bodies, themselves, and the environment.

-Autonomy develops when children complete tasks of which they are capable. KNOW!!!

Before transporting a 16-year-old American Indian female for a magnetic resonance imaging (MRI) scan, the nurse notices the girl is wearing a decorated amulet necklace. The nurse’s next BEST action is to:

remove the necklace and place it at the nurse’s station.
explain the risks of wearing the necklace during the MRI.
ask the patient if there is a special reason for wearing the necklace.
place tape around the neck covering the necklace.

- ask the patient if there is a special reason for wearing the necklace.

-The nurse should first ask the patient the purpose of wearing the necklace. The amulet may be worn as a religious ritual or simply as an accessory. After assessing why the necklace is worn, the nurse could then explain the reason for having to remove the necklace for the procedure. The first step though is to assess. Placing tape around the neck is not an appropriate action and could be unsafe. The necklace should be left with family members if possible or in a locked cabinet, rather than at the nurse’s station.

Parents of a 10-year-old child are concerned that their child has recently been showing signs of loneliness and abandonment. What should the nurse consider when discussing this issue with the parents?

Changing self-esteem is difficult after about age 5.
Self-esteem is the objective judgment of one’s worthiness.
Transitory periods of loneliness and abandonment are expected developmentally.
High self-esteem develops when parents show adequate love for the child. Incorrect

- Transitory periods of loneliness and abandonment are expected developmentally.

-Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one’s worthiness. Self-esteem changes with development. Transient changes are expected and with positive encouragement and support are only temporary. Self-esteem is based on several components: competence, sense of control, moral worth, and worthiness of love and acceptance.

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents’ religious beliefs/practices. The nurse should recognize that this is:

normal in spiritual development.
abnormal in spiritual development.
related to illness and occurs only at times of crisis.
related to the inability of parents to explain adequately their beliefs/practices. Incorrect

-normal in spiritual development.

-This describes stage 4 in spiritual development. Adolescents attempt to determine which of their parental standards and beliefs to incorporate into their own.

Cultural practices possibly considered abusive by the dominant culture are:

• Coining—A Vietnamese practice that may produce weltlike lesions on the child’s back when the edge of a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of disease
• Cupping—An Old World practice (also practiced by the Vietnamese) of placing a container (e.g., tumbler, bottle, jar) containing steam against the skin surface to “draw out the poison” or other evil element. When the heated air within the container cools, a vacuum is created that produces a bruiselike blemish on the skin directly beneath the mouth of the container.
• Burning—A practice of some Southeast Asian groups whereby small areas of skin are burned to treat enuresis and temper tantrums
• Forced kneeling—A child discipline measure of some Caribbean groups in which a child is forced to kneel for a long time
• Topical garlic application—A practice of Yemenite Jews in which crushed garlic cloves or garlic–petroleum jelly plaster is applied to the wrists to treat infectious disease. The practice can result in blisters or garlic burns.

The practice of cultural humility is continual and an important concept in the nursing process. Nurses can facilitate this process by: (Select all that apply.)

integrating cultural knowledge.
recognizing cultural differences.
acting in a culturally appropriate manner.
being aware of their own beliefs and practices.
helping the family adapt to the health care practices.

-integrating cultural knowledge.
-recognizing cultural differences.
-acting in a culturally appropriate manner.
-being aware of their own beliefs and practices.

-Integrating cultural knowledge is essential to providing care to families and the community. Recognizing cultural difference is a component of cultural awareness, humility, and competence. Acting culturally appropriate is essential in understanding and being able to deal effectively with families in a multicultural community. Nurses must be aware of their own beliefs and practices before they can begin to understand the varied and numerous cultural influences on the life of children and family. It is essential that nurses make an effort to adapt health care practices to the family’s health needs rather the attempting to change longstanding beliefs.

The nurse is talking to a group of parents about different types of play in which children engage. Which statement made by a parent would indicate a correct understanding of the teaching?

“Parallel-play children borrow and lend play materials and sometimes attempt to control who plays in the group.”
“In associative play, children play independently but among other children.”
“During onlooker play, children play alone with toys different from those used by other children in the same area.”
“Cooperative play is organized, and children play in a group with other children.”

- “Cooperative play is organized, and children play in a group with other children.”

-Play in which children borrow and lend play materials and attempt to control who plays in the group is known as associative play.

-Parallel play occurs when children play independently but among other children.

-Onlooker play is described as play in which children watch but make no attempt to enter into play with other children.

-Cooperative play is play that is organized; children play in a group with other children and plan activities for purposes of accomplishing an end.

Which best describes Piaget’s cognitive stage of formal operations?

Deductive and abstract reasoning
Inductive reasoning and beginning logic
Transductive reasoning and egocentrism Incorrect
Cause-and-effect reasoning and object permanence

-Deductive and abstract reasoning

-Piaget’s cognitive stage of formal operations occurs between the ages of 11 and 15; deductive and abstract reasoning are developed.

-Inductive reasoning and beginning logic begin in the concrete operations stage between the ages of 7 and 11.

-Transductive reasoning and egocentrism occur in the preoperational stage at age 2 to 7.

-Cause-and-effect and object permanence occur during the sensorimotor stage from birth to 2 years.

Parents are often confused by the terms growth and development and use the terms interchangeably. Based on the nurse’s knowledge of growth and development, the most appropriate explanation of development is:

a child grows taller all through early childhood.
a child learns to throw a ball overhand. Correct
a child’s weight triples during the first year.
a child’s brain increases in size until school age.

- a child learns to throw a ball overhand. Correct

-Development is the mental and cognitive attainment of skills. Growth is the increase in physical size—both height and weight.

A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child’s development is on target?

The child has not gained weight for 3 months.
The child can throw a large ball but not a small ball.
The child’s arms are the most rapidly growing part of the child’s body.
The child can pull herself or himself to her or his feet before the child is able to sit steadily. Incorrect

Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones. Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child’s development may not be on target. In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child’s development may not be on target. A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet.

-The child can throw a large ball but not a small ball.

-Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones.

-Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child’s development may not be on target.

-In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child’s development may not be on target.

-A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet.

Based on Piaget’s theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life?

If an object is hidden, that does not mean that it is gone.
He or she cannot be fooled by changing shapes.
Parents are not perfect.
Most procedures can be reversed.

- If an object is hidden, that does not mean that it is gone.

-Part of learning permanence is learning that although an object is no longer visible, it still exists. At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years.

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson’s theories. Based on the nurse’s knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to:

feed lunch.
allow the toddler to start making choices about what to wear.
allow the toddler to pull a talking-duck toy.
turn on a TV show with bright colors and loud songs. Incorrect

- allow the toddler to start making choices about what to wear.

-A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler is developing autonomy and focusing on doing things for himself or herself and therefore would not want the mother to feed him or her. The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage. A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment.

A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group?

The amount of medicine is less.
The amount of medicine did not change, only its appearance.
Pouring medicine makes the medicine hot.
The glass changed shape to accommodate the medicine.

-The amount of medicine is less.

-A preschool child does not have the ability to understand the concept of conservation. This concept is not developed until school age.

-Understanding conservation occurs between 7 to 10 years of age, when a child begins to realize that physical factors, such as volume, weight, and number, remain the same even though outward appearances are changed. Children are able to deal with a number of different aspects of a situation simultaneously. This is not an expected response by a child. A preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass.

A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory?

Erikson
Fowler
Kohlberg
Freud

- Kohlberg

-Kohlberg developed the theory of moral development sequence for children. It includes how children acquire moral reasoning and is based on cognitive developmental theory.

-Erikson developed the theory of psychosocial development.

-Fowler developed the theory of spiritual development.

-Freud developed the theory of psychosexual development.

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as:

concrete operations.
preoperational.
school-age rhetoric.
formal operations.

-concrete operations.

-Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options.

-Preoperational thinking is concrete and tangible. During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration. Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience.

-School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school.

-Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years.

Which statement helps explain the growth and development of children?

Development proceeds at a predictable rate.
The sequence of developmental milestones is predictable.
Rates of growth are consistent among children.
At times of rapid growth, there is also acceleration of development.

-The sequence of developmental milestones is predictable.

-There is a fixed, precise order to development. There are periods of both accelerated and decelerated growth and development. Each child develops at his or her own rate. Physical growth and development proceed at differing rates.

During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse’s knowledge of developmental levels, the most appropriate toys to suggest are: (Select all that apply.)

push-pull toys.
toys with black-white patterns.
pop-up toys, such as a Jack-in-the-box.
soft toys that can be put in the mouth.
toys that pop apart and go back together.

-push-pull toys.
-pop-up toys, such as a Jack-in-the-box.
-toys that pop apart and go back together.

-Both gross and fine motor skills are becoming more developed and children at this age enjoy toys that can help refine these skills. Children at this age enjoy more colorful toys. Children at this age are less interested in placing toys in the mouth and more interested in toys that can be manipulated.

The nurse is developing a teaching plan about preventing fetal exposure to teratogens. The nurse should include which teratogenic agents or conditions? (Select all that apply.)

acetaminophen (Tylenol)
isotretinoin (Accutane)
Cocaine Correct
Hyperthermia Correct
Ethyl alcohol Correct
phenytoin (Dilantin) Correct

- isotretinoin (Accutane)
- Cocaine
-Hyperthermia
-Ethyl alcohol
-phenytoin (Dilantin)

-Teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors.

-Types of teratogens include drugs (phenytoin [Dilantin], warfarin [Coumadin], isotretinoin [Accutane]); chemicals (ethyl alcohol, cocaine, lead); infectious agents (rubella, cytomegalovirus); physical agents (maternal ionizing radiation, hyperthermia); and metabolic agents (maternal PKU). Many of these teratogenic exposures and the resulting effects are completely preventable, such as ingestion of alcohol resulting in fetal alcohol syndrome or fetal alcohol effects, which causes severe birth defects, including cognitive impairment. The incidence of fetal alcohol syndrome is estimated at 5.2 per 10,000 live births (American Academy of Pediatrics, 2000).

The nurse expects which characteristic of fine motor skills in a 5-month-old infant?

Strong grasp reflex
Neat pincer grasp
Able to build a tower of two cubes
Able to grasp object voluntarily

- Able to grasp object voluntarily

a=This is characteristic of a 1-month-old infant. b=This is characteristic of an 11-month-old infant.
c=This is characteristic of a 15-month-old infant. d=This is appropriate for a 5-month-old infant.

The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. The nurse should recognize that:

this assessment is normal.
the child is probably cognitively impaired.
developmental/neurologic evaluation is needed.
the parent needs to work with the infant to stop head lag.

- developmental/neurologic evaluation is needed.

-A 6-month-old infant should have social interaction beyond smiling and cooing. The child requires evaluation. The head lag should be almost gone by 4 months of age. This child requires evaluation. The child requires evaluation before interventions can be determined.

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of:

trust.
industry.
initiative.
separation.

-trust.

-The task of infancy is the development of trust. -Industry vs. inferiority is the developmental task of school-age children.
-Initiative vs. guilt is the developmental task of preschoolers.
-Separation occurs during the sensorimotor stage as described by Piaget.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse’s reply should be based on knowledge that:

the infant is most likely spoiled.
this is a normal reaction for this age.
this is an abnormal reaction for this age.
grandparents are not responsive to that infant.

-this is a normal reaction for this age.

-These are developmentally appropriate. The infant is experiencing stranger anxiety, which is expected for this age child. These are developmentally appropriate. No data have been shown to support this.

At what age would the nurse advise parents to expect their infant to be able to say “mama” and “dada” with meaning?

4 months
6 months
10 months
14 months

-10 months

-Consonants are added to infant vocalizations. Babbling resembles one-syllable sounds. At this age infants say sounds with meaning. This is late for the development of sounds with meaning.

The MOST appropriate recommendation for relief of teething pain is to instruct the parents to:

rub gums with aspirin to relieve inflammation.
apply hydrogen peroxide to gums to relieve irritation.
give child a frozen teething ring to relieve inflammation.
have child chew on a warm teething ring to encourage tooth eruption.

-give child a frozen teething ring to relieve inflammation.

-Gums should not be rubbed with aspirin. It can be dangerous if the child aspirates aspirin. Hydrogen peroxide would not be effective. Cold reduces inflammation and should be used for relief of teething irritation. Cold, not warmth, reduces inflammation.

The mother of a 3-month-old breastfed infant asks about giving her baby water since it is summer and very warm. The nurse should recommend that:

fluids in addition to breast milk are not needed.
water should be given if the infant seems to nurse longer than usual.
water once or twice a day will make up for losses caused by environmental temperature.
clear juices would be better than water to promote adequate fluid intake. Incorrect

=fluids in addition to breast milk are not needed.

-The child will nurse according to needs. Additional fluids are not necessary for the breastfed baby. Supplemental water should not be given. It may cause water intoxication. Supplemental water should not be given. It may cause water intoxication. Clear juices do not provide sufficient caloric or nutrient intake and may interfere with breastfeeding.

The parent of a 12-month-old infant says to the nurse, “He pushes the teaspoon right out of my hand when I feed him. I can’t let him feed himself; he makes too much of a mess.” The nurse’s BEST response is:

“It’s important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess.”
“You need to try different types of utensils, bowls, and plates. Some are specifically designed for young children.”
"It’s important to let him make a mess. Just try not to worry about it so much."
“Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable.”

-“Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable.”

-The child is developmentally ready for self-feeding. Ignoring the behavior and not allowing the child to self-feed is not fostering the child’s development. The child is developmentally ready for self-feeding. The parent should not force the use of the spoon but should substitute finger foods. This response minimizes the parent’s concerns about the mess created by self-feeding. At 12 months the child should be self-feeding. Since children this age eat primarily finger foods, it is useful to offer the parent suggestions for keeping the mess to a minimum.

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem?

Putting her in parents’ bed to cuddle
Beginning to put her to bed while still awake
Letting her cry herself back to sleep
Giving her a bottle of formula instead of breastfeeding her so often at night

-Beginning to put her to bed while still awake

-The nurse needs to discuss the issue of co-sleeping with parents. Having the infant in bed with them may still interfere with their sleep. Parents need to develop bedtime rituals that involve putting the child in bed when awake. If the child is put in bed awake, she will be able to return to sleep more easily if she awakens at night. Providing formula at night contributes to bottle-mouth caries.

A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention?

A= “Never shake baby powder directly on your infant because it can be aspirated into his lungs.”
B=“Do not permit your child to chew paint from window ledges because he might absorb too much lead.”
C= “When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall.”
D=“Keep doors of appliances closed at all times.”

-“When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall.”

A=This is appropriate guidance for a first-month appointment.

B=This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand.

C=Rolling over from abdomen to back occurs between 4 and 7 months. This is the appropriate anticipatory guidance for this age.

D= This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand.

The nurse in the pediatric clinic identifies which infants at risk for developing vitamin D–deficient rickets?

Lacto-ovo vegetarians
Those who are breastfed exclusively
Those using yogurt as primary source of milk
Those exposed to daily sunlight

-Those using yogurt as primary source of milk

-Individuals who follow this diet include milk and its products in their diet. Breast milk has sufficient vitamin D if the mother is not deficient in this vitamin. Yogurt may not be supplemented with vitamin D. Lack of sunlight contributes to vitamin D–deficient rickets.

A 3-month-old bottle-fed infant is allergic to cow’s milk. The nurse’s BEST option for a substitute is:

goat’s milk.
soy-based formula.
skim milk diluted with water.
casein hydrolysate milk formula.

-casein hydrolysate milk formula.

-The milk protein in goat’s milk cross-reacts with cow’s milk protein. This is avoided because of the cross-reaction with soy. The cow’s milk protein is also found in skim milk. The milk protein is broken down in these formulas.

The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse’s initial action is to:

advise the mother to follow a milk-free diet for 3 to 5 days.
take a thorough, detailed history of usual daily events.
administer simethicone drops to provide relief from gas pains.
explain that the parents need to stay calm so the infant will remain calm.

-take a thorough, detailed history of usual daily events.

-The initial step in managing colic is to take a thorough, detailed history of the usual daily events including: diet, time of day when child cries, presence of family members, type of cry, etc. Before suggesting formula changes or medications to relieve symptoms, a detailed history is needed. It is important that the nurse convey an empathetic and compassionate attitude and reassure the parents that they are not doing anything wrong.

Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake?

Using developmental stimulation by a specialist during feedings
Avoiding solids until after the bottle is well accepted
Being persistent through 10 to 15 minutes of food refusal
Varying schedule of routine activities on a daily basis

-Being persistent through 10 to 15 minutes of food refusal

-Feeding times should have a nonstimulating environment so the focus is on the meal. Solids should be introduced slowly to decrease dependence on the bottle. Calm perseverance is important. Parents often fail to persist through the child’s refusals. Daily schedule should be structured to provide consistency for the child.

The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was “just fine” when they put him in his crib already asleep. The nurse should suspect his death was caused by:

suffocation.
child abuse.
infantile apnea.
sudden infant death syndrome (SIDS).

-sudden infant death syndrome (SIDS).

-Although the child was found under the blanket, the bloody fluid is consistent with SIDS, not suffocation. No other injuries are reported. No previous acute life-threatening events had been reported. The death is consistent with the characteristics of SIDS.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant?

Vitamin B
Vitamin D
Vitamin C
Vitamin K

- Vitamin D

-The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 200 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamin B is not needed. Vitamin C is not needed. Vitamin K is not needed.

A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for:

rickets.
marasmus.
kwashiorkor.
pellagra.

-kwashiorkor.

-Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse’s knowledge of breastfed infants, what type of stool is expected?

Dark brown and small hard pebbles
Loose with green mucus streaks
Formed and with white mucus
Semiformed, seedy, yellow

-Semiformed, seedy, yellow

-Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant.

The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8-week-old make which statement? (Select all that apply.)

“I only smoke in the kitchen.”
“I put my baby to sleep on her back.”
“I have my baby sleep with me instead of alone in the crib.”
“I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib.”
“I always leave my baby’s favorite stuffed bunny rabbit in the crib to keep her from crying at night.”

-“I only smoke in the kitchen.”
-“I put my baby to sleep on her back.”
-“I have my baby sleep with me instead of alone in the crib.”
-“I always leave my baby’s favorite stuffed bunny rabbit in the crib to keep her from crying at night.”

-Maternal smoking increases the risk of SIDS. Smoking anywhere in the home with an infant present is not recommended. The “Back to Sleep” Campaign is given credit for reducing the rate of SIDS in the United States. Co-sleeping increases the risk of SIDS.
D. Overheating increases the risk of SIDS. Leaving a stuffed animal in the crib is a suffocation risk but still needs to be addressed as a safety hazard.

When preparing to administer Hepatitis B vaccine to a newborn, the nurse should: (Select all that apply.)

initiate an immunization record.
confirm the hepatitis B status of the newborn’s mother.
obtain a syringe with a 25-gauge, 5/8-inch needle.
assess the dorsogluteal muscle as the preferred site for injection.
confirm that the newborn’s mother has signed the informed consent.

-initiate an immunization record.
-confirm the hepatitis B status of the newborn’s mother.
-obtain a syringe with a 25-gauge, 5/8-inch needle.
- confirm that the newborn’s mother has signed the informed consent.

-An immunization record is important for the nurse to initiate and give to the mother so that a continuous record of immunizations is maintained. Hepatitis B vaccine is the primary prevention for the disease. If the mother is positive for the hepatitis B virus, the newborn will need to receive the hepatitis B immunoglobulin (HBIG) in addition to the hepatitis B vaccine. The dose of hepatitis B vaccine is 0.5 mL, to be given with a 25-gauge, 5/8 inch needle, intramuscularly (IM) in the newborn. Signed informed consent must be obtained from the mother before administration of the vaccine. The only safe intramuscular injection site for the newborn is the vastus lateralis muscle.

Infants most at risk for sudden infant death syndrome (SIDS) are those: (Select all that apply.)

who sleep supine
who sleep prone
who were premature
with prenatal drug exposure
with a cousin that died of SIDS

-who sleep prone
-who were premature
-with prenatal drug exposure

-Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were premature, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIDS. A cousin dying of SIDS does not present an increased risk for the infant.

The nurse is providing education to a parent of a 10-month-old infant receiving iron supplements. What will be included in the teaching? (Select all that apply.)

Administer iron with meals.
Place iron toward the back side of the mouth with a dropper.
Mix iron with milk for greater absorption.
Report black, tarry stools to health care provider. Incorrect
Apply barrier ointment if needed to buttocks.

Administration of Iron Supplements includes:
Ideally iron supplements should be administered between meals for greater absorption.
Liquid iron supplements may stain the teeth, therefore administer with a dropper. toward the back of the mouth (side). In older children, administer liquid iron. supplements through a straw or rinse mouth thoroughly after ingestion.
Avoid administration of liquid iron supplements with whole cow’s milk or milk. products as these bind free iron and prevent absorption.
Educate parents that iron supplements will turn stools black or tarry green.
Iron supplements may cause transient constipation. Caution parents not to switch to a low-iron containing formula or whole milk, which are poor sources of iron and may lead to iron deficiency anemia (see Iron Deficiency Anemia, Chapter 43).
In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz).
Avoid administration of iron supplements with food or drinks that bind iron and prevent absorption.

-Place iron toward the back side of the mouth with a dropper.
- Apply barrier ointment if needed to buttocks.

-Administration of Iron Supplements includes:

Ideally iron supplements should be administered between meals for greater absorption.
Liquid iron supplements may stain the teeth, therefore administer with a dropper. toward the back of the mouth (side). In older children, administer liquid iron. supplements through a straw or rinse mouth thoroughly after ingestion.
Avoid administration of liquid iron supplements with whole cow’s milk or milk. products as these bind free iron and prevent absorption.
Educate parents that iron supplements will turn stools black or tarry green.
Iron supplements may cause transient constipation. Caution parents not to switch to a low-iron containing formula or whole milk, which are poor sources of iron and may lead to iron deficiency anemia (see Iron Deficiency Anemia, Chapter 43).
In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz).
Avoid administration of iron supplements with food or drinks that bind iron and prevent absorption.

The primary goals in the nutritional management of children with failure to thrive (FTT) are: (Select all that apply.)

allow for catch-up growth.
correct nutritional deficiencies.
achieve ideal weight for height.
restore optimum body composition.
educate the parents or primary caregivers on child’s nutritional requirements.
educate the parents or primary caregivers that the child will need tube feedings first.

-allow for catch-up growth.
-correct nutritional deficiencies.
-achieve ideal weight for height.
-restore optimum body composition.
-educate the parents or primary caregivers on child’s nutritional requirements.

-The goal is to provide sufficient calories to support “catch-up” growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating any coexisting medical problems.
Accurate assessment of the child’s initial weight and height are important, as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition. A goal is to provide education to the parents or primary caregiver of the child’s nutritional requirements along with appropriate feeding methods.

SOCIAL-AFFECTIVE PLAY?

-PLAY BEGINS WITH SOCIAL-AFFECTIVE PLAY, WHEREIN INFANTS TAKE PLEASURE IN RELATIONSHIPS WITH PEOPLE.

-AS ADULTS TALK, TOUCH, NUZZLE, AND IN VARIOUS WAYS ELICIT RESPONSES FROM AN INFANT, THE INFANT SOON LEARNS TO PROVOKE PARENTAL EMOTIONS AND RESPONSES WITH SUCH BEHAVIORS AS SMILING, COOING, OR INITIATING GAMES AND ACTIVITIES.

SENSE-PLEASURE PLAY?

-A NONSOCIAL STIMULATING EXPERIENCE THAT ORIGINATES FROM WITHOUT.

-OBJECTS IN THE ENVIRONMENT (LIGHT AND COLOR, TASTES AND ODORS, TEXTURES AND CONSISTENCIES) ATTRACT CHILDREN'S ATTENTION, STIMULATE THEIR SENSES AND GIVE PLEASURE.

-PLEASURABLE EXPERIENCES ARE DERIVED FROM HANDLING RAW MATERIALS (WATER, SAND, FOOD), BODY MOTION (SWINGING, BOUNCING, ROCKING), AND OTHER USES OF SENSES AND ABILITIES (SMELLING, HUMMING).

SKILL PLAY?

-AFTER INFANTS HAVE DEVELOPED THE ABILITY TO GRASP AND MANIPULATE, THEY PERSISTENTLY DEMONSTRATE AND EXERCISE THEIR NEWLY ACQUIRED ABILITIES THROUGH SKILL PLAY, REPEATING AN ACTION OVER AND OVER AGAIN.

UNOCCUPIED BEHAVIOR?

-CHILDREN ARE NOT PLAYFUL BUT FOCUSING THEIR ATTENTION MOMENTARILY ON ANYTHING THAT STRIKES THEIR INTEREST.

-THEY DAYDREAM, FIDDLE WITH CLOTHES OR OTHER OBJECTS, OR WALK AIMLESSLY.

-THIS ROLE DIFFERS FROM THAT OF ONLOOKERS, WHO ACTIVELY OBSERVE THE ACTIVITY OF OTHERS

DRAMATIC OR PRETEND PLAY?

-ONE OF THE VITAL ELEMENTS IN CHILDREN'S PROCESS OF IDENTIFICATION IS DRAMATIC PLAY, ALSO KNOWN AS SYMBOLIC OR PRETEND PLAY.

-IT BEGINS IN LATE INFANCY (11-13 MONTHS) AND IS THE PREDOMINANT FORM OF PLAY IN PRESCHOOL CHILDREN.

-BY ACTING OUT EVENTS OF DAILY LIFE, THEY LEARN AND PRACTICE THE ROLES AND IDENTITIES MODELED BY THE MEMBERS OF THEIR FAMILY AND SOCIETY.

GAME PLAY?

-CHILDREN IN ALL CULTURES ENGAGE IN GAMES ALONE AND WITH OTHERS.

-SOLITARY ACTIVITY INVOLVING GAMES BEGINS AS VERY SMALL CHILDREN PARTICIPATE IN REPETITIVE ACTIVITIES AND PROGRESS TO MORE COMPLICATED GAMES THAT CHALLENGE THEIR INDEPENDENT SKILLS SUCH AS PUZZLES, SOLITAIRE, AND COMPUTER OR VIDEO GAMES.

-VERY YOUNG CHILDREN PARTICIPATE IN PAT-A-CAKE AND PEEK-A-BOO.

-PRESCHOOL CHILDREN LEARN AND ENJOY FORMAL GAMES, BEGINNING WITH RITUALISTIC, SELF-SUSTAINING GAMES SUCH AS RING-AROUND-A-ROSY AND LONDON BRIDGE.

-PRESCHOOL CHILDREN HATE TO LOSE AND TRY TO CHEAT, WANT TO CHANGE THEIR MOVES.

-SCHOOL-AGE CHILDREN AND ADOLESCENTS ENJOY COMPETITIVE GAMES, INCLUDING CARDS, CHECKERS, AND CHESS, AND PHYSICALLY ACTIVE GAMES SUCH AS BASEBALL.

ONLOOKER PLAY?

-CHILDREN JUST WATCH WHAT OTHER CHILDREN ARE DOING BUT MAKE NO ATTEMPT TO ENTER INTO THE PLAY ACTIVITY.

-EXAMPLE: WATCHING AN OLDER SIBLING BOUNCE A BALL IS A COMMON EXAMPLE OF ONLOOKER ROLE

SOLITARY PLAY?

-CHILDREN PLAY ALONE, FOCUS ON OWN ACTIVITY.

-THEY PLAY ALONE WITH DIFFERENT TOYS THAN WHAT OTHER CHILDREN ARE PLAYING WITH.

-THEY ENJOY THE PRESENCE OF OTHER CHILDREN BUT MAKE NO EFFORT TO GET CLOSE TO OR SPEAK TO THEM.

PARALLEL PLAY?

-CHILDREN PLAY BESIDE SOMEONE, BUT NOT WITH THAT SOMEONE.

-THEY PLAY WITH TOYS SIMILAR TO THOSE THAT THE CHILDREN AROUND THEM ARE USING BUT AS EACH CHILD SEES FIT, NEITHER INFLUENCING NOR BEING INFLUENCED BY THE OTHER CHILDREN.

-THERE IS NO GROUP ASSOCIATION.

-THIS TYPE OF PLAY IS NORMALLY OBSERVED IN TODDLERS

-INDIVIDUALS WHO ARE INVOLVED IN A CREATIVE CRAFT WITH EACH PERSON SEPARATELY WORKING ON AN INDIVIDUAL PROJECT ARE ENGAGED IN PARALLEL PLAY.

ASSOCIATIVE PLAY?

-CHILDREN PLAY TOGETHER WITH SIMILAR OR IDENTICAL TOYS OR ACTIVITIES.

-THERE IS NO ORGANIZATION IN THEIR PLAY, DIVISION OF LABOR, LEADERSHIP ASSIGNMENT, OR MUTUAL GOAL.

-CHILDREN BORROW AND LEND PLAY MATERIALS WITH OTHER CHILDREN, FOLLOW EACH OTHER WITH WAGONS AND TRICYCLES, AND SOMETIMES ATTEMPT TO CONTROL WHO MAY OR MAY NOT PLAY IN THE GROUP.

-THERE IS NO GROUP GOAL.

-THERE IS A GREAT DEAL OF BEHAVIORAL CONTAGION; WHEN ONE CHILD INITIATES AN ACTIVITY, THE ENTIRE GROUP FOLLOWS THE EXAMPLE.

COOPERATIVE PLAY?

-CHILDREN PLAY IN A GROUP, OBTAIN A GOAL, FORM A GAME, THEY HAVE LEADERS AND FOLLOWERS.

-PLAY IS ORGANIZED

-THE LEADER-FOLLOWER RELATIONSHIP IS DEFINITELY ESTABLISHED, AND THE ACTIVITY IS CONTROLLED BY ONE OR TWO MEMBERS WHO ASSIGN ROLES AND DIRECT THE ACTIVITY OF THE OTHERS.

PIAGET THEORY?

-SENSORIMOTOR STAGE= BIRTH TO 2YEARS OF AGE
-PROGRESSES FROM REFLEXIVE TO SIMPLE REPETITIVE TO IMITATIVE ACTIVITIES
-SEPARATION, OBJECT PERMANENCE, AND MENTAL REPRESENTATION ARE 3 IMPORTANT TASKS ACCOMPLISHED IN THIS STAGE.

-SENSORIMOTOR STAGE TRANSITIONS TO THE PREOPERATIONAL STAGE AROUND THE AGE OF 19-24 MONTHS

LANGUAGE DEVELOPMENT:
-CRYING IS THE FIRST FORM OF VERBAL COMMUNICATION
-VOCALIZES WITH COOING NOISES
-RESPONDS TO NOISES
-TURNS HEAD TO THE SOUND OF A RATTLE
-LAUGHS AND SQUEALS
-PRONOUNCES SINGLE-SYLLABLE WORDS
-BEGINS SPEAKING 2-WORD PHRASES AND PROGRESSES TO SPEAKING 3-WORD PHRASES
-SAYS 3-5 WORDS AND COMPREHENDS "NO" BY THE AGE OF 1 YEAR

ERIKSON THEORY?

PSYCHOSOCIAL DEVELOPMENT
-TRUST VS MISTRUST=BIRTH TO 1 YEAR
-ACHIEVING THIS TASK IS BASED ON THE QUALITY OF THE CAREGIVER-INFANT RELATIONSHIP AND THE CARE RECEIVED
-INFANT BEGINS TO LEARN DELAYED GRATIFICATION
-TRUST IS DEVELOPED BY MEETING COMFORT, FEEDING, STIMULATION, AND CARING NEEDS
-MISTRUST DEVELOPS IF NEEDS ARE INADEQUATELY OR INCONSISTENTLY MET, OR IF NEEDS ARE CONTINUOUSLY MET BEFORE BEING VOCALIZED BY THE INFANT

PIAGET= SEPARATION TASK?

INFANTS LEARN TO SEPARATE THEMSELVES FROM OTHER OBJECTS IN THE ENVIRONMENT

PIAGET=OBJECT PERMANENCE?

THE PROCESS BY WHICH INFANTS KNOW THAT AN OBJECT STILL EXISTS WHEN IT IS OUT OF VIEW.

-OCCURS APPROXIMATELY 9 MONTHS OF AGE

PIAGET=MENTAL REPRESENTATION?

THE RECOGNITION OF SYMBOLS

SOCIAL DEVELOPMENT OF INFANT?

-INITIALLY INFLUENCED BY INFANTS' REFLEXIVE BEHAVIORS AND INCLUDES ATTACHMENT, SEPARATION, RECOGNITION/ANXIETY, AND STRANGER FEAR

-ATTACHMENT IS OBSERVED WHEN INFANTS BEGIN TO BOND WITH THEIR PARENTS. USUALLY SEEN IN 1ST MONTH, BUT IT ACTUALLY BEGINS BEFORE BIRTH.

-ATTACHMENT IS ENHANCED WHEN INFANTS AND PARENTS ARE IN GOOD HEALTH, HAVE POSITIVE FEEDING EXPERIENCES, AND RECEIVE ADEQUATE REST

-SEPARATION-INDIVIDUATION OCCURS DURING THE 1ST YEAR OF LIFE AS INFANTS FIRST DISTINGUISH THEMSELVES AND THEIR PRIMARY CAREGIVER AS SEPARATE INDIVIDUALS, AND THEN DEVELOP OBJECT PERMANENCE.

-SEPARATION ANXIETY BEGINS AROUND 4-8 MONTHS. INFANTS WILL PROTEST WHEN SEPARATED FROM PARENTS, WHICH CAN CAUSE CONSIDERABLE ANXIETY FOR PARENTS

-STRANGER FEAR BECOMES EVIDENT BETWEEN 6-8 MONTHS OF AGE, WHEN INFANTS ARE LESS LIKELY TO ACCEPT STRANGERS.

-REACTIVE ATTACHMENT DISORDER RESULTS FROM MALADAPTIVE OR ABSENT ATTACHMENT BETWEEN THE INFANT AND PRIMARY CAREGIVER, AND CONTINUES THROUGH CHILDHOOD AND ADULTHOOD.

BODY-IMAGE CHANGES OF INFANT?

-INFANTS DISCOVER THAT MOUTHS ARE PLEASURE PRODUCERS
-HANDS AND FEET ARE SEEN AS OBJECTS OF PLAY
-INFANTS DISCOVER THAT SMILING CAUSES OTHERS TO REACT

AGE-APPROPRIATE ACTIVITIES?

-INFANTS HAVE SHORT ATTENTION SPANS AND WILL NOT INTERACT WITH OTHER CHILDREN DURING PLAY=SOLITARY PLAY

APPROPRIATE INFANT TOYS:
-RATTLES, TEETHING TOYS, NESTING TOYS, PLAYING PAT-A-CAKE, PLAYING WITH BALLS, READING BOOKS, MIRRORS, BRIGHTLY COLORED TOYS, PLAYING WITH BLOCKS

INDICATORS FOR INTRODUCING SOLID FOODS TO INFANTS?

-INTEREST IN SOLID FOODS, VOLUNTARY CONTROL OF THE HEAD AND TRUNK, AND DISAPPEARANCE OF THE EXTRUSION REFLEX=TONGUE MOVEMENT

-NEW FOODS SHOULD BE INTRODUCED ONE AT A TIME, OVER A 4-7 DAY PERIOD, TO OBSERVE FOR SIGNS OF ALLERGY OR INTOLERANCE, WHICH MAY INCLUDE FUSSINESS, RASH, VOMITING, DIARRHEA, AND CONSTIPATION.

-IRON-FORTIFIED CEREALS ARE THE FIRST SOLID FOOD INTRODUCED DUE TO THE HIGH IRON CONTENT.

-VEGETABLES OR FRUITS ARE STARTED FIRST BETWEEN 6-8 MONTHS OF AGE. AFTER BOTH HAVE BEEN INTRODUCED, MEATS MAY BE ADDED.

-CITRUS FRUITS, MEATS, AND EGGS ARE NOT STARTED UNTIL AFTER 6 MONTHS OF AGE

-BREAST MILK/FORMULA SHOULD BE DECREASED AS INTAKE OF SOLID FOODS INCREASES, BUT SHOULD REMAIN THE PRIMARY SOURCE OF NUTRITION THROUGH THE 1ST YEAR.

-TABLE FOODS THAT ARE COOKED, CHOPPED, AND UNSEASONED ARE APPROPRIATE BY 9 MONTHS OF AGE.

-APPROPRIATE FINGER FOODS INCLUDE: RIPE BANANAS, TOAST STRIPS, GRAHAM CRACKERS, CHEESE CUBES; NOODLES, AND PEELED CHUNKS OF APPLES, PEARS, OR PEACHES.

WEANING INFANTS?

-CAN BE ACCOMPLISHED WHEN INFANTS SHOW SIGNS OF READINESS, AND ARE ABLE TO DRINK FROM A CUP (SOMETIME IN THE 2ND 6 MONTHS)

-BEDTIME FEEDINGS ARE THE LAST TO BE STOPPED

TODDLER DEVELOPMENT?

-ANTERIOR FONTANELS CLOSE BY 18 MONTHS OF AGE
-WT=AT 2.5 YEARS (30 MONTHS) TODDLERS SHOULD WEIGH 4 TIMES THEIR BIRTH WEIGHT
-HT=TODDLERS GROW ABOUT 7.5 CM (3 INCHES)/YEAR
-HEAD CIRCUMFERENCE AND CHEST CIRCUMFERENCE ARE USUALLY EQUAL BY 1-2 YEARS OF AGE

ERIKSON AND PIAGET DEVELOPMENT IN TODDLERS?

-SENSORIMOTOR STAGE (PIAGET) TRANSITIONS TO THE PREOPERATIONAL STAGE AROUND THE AGE OF 19-24 MONTHS.

-CONCEPT OF OBJECT PERMANENCE BECOMES FULLY DEVELOPED
-TODDLERS HAVE AND DEMONSTRATE MEMORIES OF EVENTS THAT RELATE TO THEM
-DOMESTIC MIMICRY (PLAYING HOUSE) IS EVIDENT
-PREOPERATIONAL THOUGHT DOES NOT ALLOW FOR TODDLERS TO UNDERSTAND OTHER VIEWPOINTS, BUT IT DOES ALLOW THEM TO SYMBOLIZE OBJECTS AND PEOPLE TO IMITATE PREVIOUSLY SEEN ACTIVITIES.

LANGUAGE
-INCREASES TO ABOUT 300 WORDS BY THE AGE OF 2
-1 YEAR=USES ONE-WORD SENTENCES, OR HOLOPHRASES
-2 YEAR=USES MULTIWORD SENTENCES BY COMBINING 2-3 WORDS
-3 YEARS=COMBINE SEVERAL WORDS TO CREATE SIMPLE SENTENCES USING GRAMMATICAL RULES

ERIKSON=AUTONOMY VS SHAME AND DOUBT
-INDEPENDENCE IS PARAMOUNT FOR TODDLERS, WHO ARE ATTEMPTING TO DO EVERYTHING FOR THEMSELVES
-TODDLERS OFTEN USE NEGATIVISM, OR NEGATIVE RESPONSES, AS THEY BEGIN TO EXPRESS THEIR INDEPENDENCE
-RITUALISM, OR MAINTAINING ROUTINES AND RELIABILITY, PROVIDES A SENSE OF COMFORT FOR TODDLERS AS THEY BEGIN TO EXPLORE THEIR ENVIRONMENT BEYOND THOSE MOST FAMILIAR TO THEM

MORAL DEVELOPMENT:
-CLOSELY ASSOCIATED WITH COGNITIVE DEVELOPMENT
-EGOCENTRIC=TODDLERS ARE UNABLE TO SEE THINGS FROM THE PERSPECTIVES OF OTHERS; THEY CAN ONLY VIEW THINGS FROM THEIR PERSONAL POINTS OF VIEW
-PUNISHMENT AND OBEDIENCE ORIENTATION BEGIN WITH A SENSE THAT GOOD BEHAVIOR IS REWARDED AND BAD BEHAVIOR IS PUNISHED

SELF-CONCEPT DEVELOPMENT:
-TODDLERS PROGRESSIVELY SEE THEMSELVES AS SEPARATE FROM THEIR PARENTS AND INCREASE THEIR EXPLORATIONS AWAY FROM THEM

BODY-IMAGE CHANGES:
-TODDLERS APPRECIATE THE USEFULNESS OF VARIOUS BODY PARTS
-TODDLERS DEVELOP GENDER IDENTITY BY 3 YEARS OF AGE

AGE-APPROPRIATE ACTIVITIES:
-SOLITARY PLAY EVOLVES INTO PARALLEL PLAY, IN WHICH TODDLERS OBSERVE OTHER CHILDREN AND THEN MAY ENGAGE IN ACTIVITIES NEARBY

APPROPRIATE ACTIVITIES FOR TODDLERS:
-FILLING AND EMPTYING CONTAINERS, PLAYING WITH BLOCKS, LOOKING AT BOOKS, PUSH-PULL TOYS, TOSSING BALLS, FINGER PAINTS, LARGE-PIECE PUZZLES, THICK CRAYONS

PRESCHOOLERS DEVELOPMENT (3-6 YEARS)?

PIAGET:
-PRECONCEPTUAL PHASE TRANSITIONS TO THE PHASE OF INTUITIVE THOUGHT AROUND THE AGE OF 4 YEARS. INTUITIVE PHASE LASTS UNTIL THE AGE OF 7 YEARS.

-PRESCHOOLER MOVES FROM TOTALLY EGOCENTRIC THOUGHTS TO SOCIAL AWARENESS AND THE ABILITY TO UNDERSTAND THE VIEWPOINTS OF OTHERS

-PRESCHOOLERS MAKE JUDGMENTS BASED ON VISUAL APPEARANCES. THIS INCLUDES MAGICAL THINKING, ANIMISM, AND CENTRATION

ERIKSON:
INITIATIVE VERSUS GUILT
-PRESCHOOLERS BECOME ENERGETIC LEARNERS, DESPITE NOT HAVING ALL OF THE PHYSICAL ABILITIES NECESSARY TO BE SUCCESSFUL AT EVERYTHING.
-GUILT MAY OCCUR WHEN PRESCHOOLERS BELIEVE THEY HAVE MISBEHAVED OR WHEN THEY ARE UNABLE TO ACCOMPLISH A TASK
-GUIDING PRESCHOOLERS TO ATTEMPT ACTIVITIES WITHIN THEIR CAPABILITIES WHILE SETTING LIMITS IS APPROPRIATE

INFECTIOUS DISEASE?

-A DISEASE CAUSED BY INVASION AND MULTIPLICATION OF MICROORGANISMS

COMMUNICABLE DISEASE?

A DISEASE CAUSED BY AN INFECTIOUS AGENT THAT IS TRANSMITTED TO A PERSON BY DIRECT OR INDIRECT CONTACT, VEHICLE OR VECTOR, OR AIRBORNE ROUTE.

6 LINKS OF CHAIN OF INFECTION?

1. CAUSATIVE AGENT=VIRUS, BACTERIA, FUNGUS
2. RESERVOIR=INFECTED HOST
3. PORTAL OF EXIT=WOUNDS, SNEEZING, COUGHING
4. MODE OF TRANSMISSION=AIRBORNE, DROPLET, CONTACT
5. PORTAL OF ENTRY= IN NEW UNINFECTED HOST
6. SUSCEPTIBLE HOST

WHAT 3 LINKS MUST BE PRESENT FOR AN ILLNESS TO OCCUR?

1. PATHOGEN
2. EFFECTIVE MEANS OF TRANSMISSION
3. SUSCEPTIBLE HOST

Chain of infection DEFINITION?

-The process by which pathogens are transmitted from the environment to a host, invade the host, and cause infection

Safe Injection Practices include:

-Use of a new needle and syringe every time a medication vial or IV bag is accessed
-Use of a new needle and syringe with each injection of a client
-Using medication vials for one client only, whenever possible

Direct TRANSMISSION?

—transmitted by contact with an infected person

Indirect TRANSMISSION?

—transmitted by contact with objects that have been contaminated by an infected person (fomites)

AIRBORNE INFECTIOUS ORGANISMS?

-TB
-MEASLES
-SARS
-VARICELLA

DROPLET INFECTIOUS ORGANISMS?

-INFLUENZA
-PERTUSSIS
-MENINGOCOCCAL DISEASE
-SMALLPOX

CONTACT INFECTIOUS ORGANISMS?

-NOROVIRUS
-ROTAVIRUS
-DRAINING ABSCESSES
-HEAD LICE
-RSV
-MRSA
-VRE
-C. DIFFICILE

EXPANDED PRECAUTIONS (PROTECTIVE ISOLATION)?

-Used for patients who are not communicable but have high susceptibility to infection, such as a neutropenic patient or bone marrow transplant recipient
-Strict adherence to standard/transmission-based precautions are required at all times, this includes any visitors

--NOTE: If a disease has more than one mode of transmission, then more than one precaution technique is used

REASONS FOR VULNERABILITY OF CHILDREN TO COMMUNICABLE DISEASES?

-IMMATURE IMMUNE SYSTEM
-INCOMPLETE DISEASE PROTECTION THROUGH IMMUNIZATION
-DECREASED MATERNAL ANTIBODIES=PASSIVELY ACQUIRED BY CHILD
-TRANSMISSION FACILITATED BY POOR HYGIENE BEHAVIORS OF YOUNG CHILDREN

KNOW!!!!!=FECAL-ORAL AND RESPIRATORY ROUTES MOST COMMON

EXAMPLES OF THESE ROUTES:
-DON'T WASH HANDS AFTER TOILETING
-PUTS TOYSIN MOUTH
-CAN'T CARE FOR RUNNY NOSE
-CHILD CARE STAFF DON'T USE PROPER HANDWASHING

VACCINE TYPES?

1. KILLED VIRUS
2. TOXOID
3. LIVE VIRUS
4. RECOMBINANT FORM
5. CONJUGATED FORM

Killed virus?

-inactivated poliovirus
-MICROORGANISM THAT HAS BEEN KILLED BUT STILL CAPABLE OF INDUCING THE BODY TO PRODUCE ANTIBODIES

Toxoid?

-tetnus toxoid
-TOXIN TREATED BY HEAT OR CHEMICAL TO WEAKEN ITS TOXIC EFFECTS

Live virus?

-MEASLES
-MICROORGANISM IS LIVE BUT ATTENUATED OR WEAKENED FORM

Recombinant VACCINE form?

-HBV
-GENETICALLY ALTERED FOR USE IN VACCINES

Conjugated VACCINE FORM?

-hiB (H. INFLUENZAE TYPE b)

-JOINED WITH ANOTHER SUBSTANCE TO INCREASE THE IMMUNE RESPONSE

TYPES OF IMMUNIZATION?

-ACTIVE IMMUNITY
-PASSIVE IMMUNITY
-TRANSPLACENTAL IMMUNITY

Active immunity?

-antibody production is stimulated (antigen given in vaccine form)

Passive immunity?

-antibodies produced in another and given (does not have lasting effects-must develop active immunity)

Transplacental immunity?

-passive immunity transferred from mother (decreases or disappears as child develops ability to make antibodies

Chronic illness:

Interferes with ADLs for more than 3 months in a year

Congenital disability:

Existed since birth

Developmental delay:

Maturational lag

Developmental disability:

Any mental or physical disability present before age 22

Disability:

Functional limitation that interferes with a person’s ability (walk, lift, hear, or learn)

Handicap:

Condition or barrier imposed by society, environment, or own self

Impairment:

Loss or abnormality of structure or function

Technology-dependent:

Birth to 21years old with chronic disability that requires routine use of a medical device to compensate for loss of life-sustaining body function. Requires daily care

Children with special health care needs are defined as:

SCOPE: those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition requiring health & related services of a type or amount beyond what are required for healthy children.

-Commonly: Respiratory tract & impairments of speech, special senses, & intelligence.
1/6 of all childhood disability = mental & nervous system disorders

ISBARR COMMUNICATION

I=INTRODUCTION
-IDENTIFY SELF=NAME, ROLE, LOCATION, UNIT
-GIVE REASON FOR CALLING

S=SITUATION
-GIVE AT LEAST 3 PATIENT IDENTIFIERS (NAME, AGE, GENDER, REASON FOR ADMISSION)
-WHAT IS GOING ON WITH THE PT?
-WHAT IS THE PTS STATUS NOW?

B=BACKGROUND
-WHAT IS THE CLINICAL BACKGROUND/CONTEXT?
-GIVE THE RELEVANT DETAILS SUCH AS PRESENTING PROBLEMS AND CLINICAL HX

A=ASSESSMENT
-WHAT IS THE PROBLEM?
-PROVIDE AN OVERVIEW OF THE PTS CURRENT CONDITION, RISKS AND NEEDS, NURSING ACTIONS AND PT RESPONSE.
-LATEST ASSESSMENT AND TIME OF ASSESSMENT (VS, PAIN SCORE, LAST PAIN MED/DOSE/ROUTE/RESPONSE)

R=RECOMMENDATION
-BE CLEAR ABOUT WHAT ACTION/RESPONSE YOU ARE REQUESTING AND WHEN THIS SHOULD OCCUR (URGENT CONSULT, TRANSFER, REVIEW, OR TX)

R=READBACK
-REPEAT AND VERIFY ANY TX OR MEDICATION ORDERS

ASSISTING FAMILY MEMBERS IN MANAGING FEELINGS OF DISABLED CHILD?

Family responses vary dependent on characteristics of the ill individual, presence of additional stressors, coping skills, resources available, values & beliefs, duration & characteristics of the illness

-Individual: age, gender, personality type, developmental level

-Resources: financial, time, knowledge, social & emotional support & services

PITFALLS OF COMMUNICATION?

Giving advice, talking about yourself, telling pt is wrong, entering into hallucinations and delusions of patient, false reassurance, cliché, giving approval, asking WHY, changing subject, defending doctors and other health team members

-Non-therapeutic: talking too rapidly, giving one’s own opinion (words such as nice, bad, right, wrong, should and ought), incongruence

The Typologies of Chronic Illness Across the Life Cycle?

-Newly married couples
-Families with young children
-Families of adolescents
-Families launching children
-Families in later life

Newly married couples:

May romanticize the illness during courtship, but are soon faced with the challenges of chronic illness and the impact on employment, relationships, finances, sexuality and reproduction, and life expectancy.

Families of adolescents:

The impact of chronic illness on an adolescent and the family is similar to other stages with the added impact on both individual and family developmental tasks.

Families with young children:

Chronic illness significantly impacts parenting strategies, equality between children (sharing of resources, family tasks, time, etc.), and family routines and rituals. For example, a child with severe asthma may not have as many chores as his siblings, and the rush to the emergency room during life-threatening events may become a family “routine”, with each family member knowing their role.

Families launching children:

When launching of children is delayed or prevented due to a chronic illness, families tend to turn inward, further delaying other developmental milestones, including employment, marriage, child bearing, and other adult roles.

Families in Later Life:

This stage is characterized by family members focusing on maintaining health or adapting to chronic illness.

NORMALIZATION?

REFERS TO THE EFFORTS THAT FAMILY MEMBERS MAKE TO CREATE A NORMAL FAMILY LIFE, THEIR PERCEPTIONS OF THE CONSEQUENCES OF THESE EFFORTS, AND THE MEANINGS THEY ATTRIBUTE TO THEIR MANAGEMENT EFFORTS.

-FOR CHRONICALLY ILL CHILDREN;
-ATTENDING SCHOOL, PURSUING HOBBIES, AND RECREATIONAL INTERESTS, AND ACHIEVING EMPLOYMENT AND A LEVEL OF INDEPENDENCE.

FOR FAMILIES:
-ADAPTING THE FAMILY ROUTINE TO ACCOMMODATE THE ILL OR DISABLED CHILD'S HEALTH AND PHYSICAL NEEDS.

HOME CARE GOALS OF THE ILL CHILD?

-NORMALIZE THE LIFE OF THE CHILD, INCLUDING THOSE WITH TECHNOLOGICALLY COMPLEX CARE, IN A FAMILY AND COMMUNITY CONTEXT AND SETTING

-MINIMIZE THE DISRUPTIVE IMPACT OF THE CHILD'S CONDITION ON THE FAMILY

-FOSTER THE CHILD'S MAXIMUM GROWTH AND DEVELOPMENT.

4 TYPES OF PARENTAL REACTIONS TO THE PERIOD OF ADJUSTMENT OF AN ILL CHILD?

1. OVERPROTECTION
2. REJECTION
3. DENIAL
4. GRADUAL ACCEPTANCE

OVERPROTECTION REACTION OF PARENTS WITH ILL CHILD?

-PARENTS FEAR LETTING THE CHILD ACHIEVE ANY NEW SKILL, AVOID ALL DISCIPLINE, AND CATER TO EVERY DESIRE TO PREVENT FRUSTRATION.

REJECTION REACTION OF PARENTS WITH ILL CHILD?

PARENTS DETACH THEMSELVES EMOTIONALLY FROM THE CHILD BUT USUALLY PROVIDE ADEQUATE PHYSICAL CARE OR CONSTANTLY NAG AND SCOLD THE CHILD.

DENIAL REACTION OF PARENTS WITH ILL CHILD?

-PARENTS ACT AS IF THE DISORDER DOES NOT EXIST OR ATTEMPT TO HAVE THE CHILD OVERCOMPENSATE FOR IT.

GRADUAL ACCEPTANCE REACTION OF PARENTS WITH ILL CHILD?

-PARENTS PLACE NECESSARY AND REALISTIC RESTRICTIONS ON THE CHILD, ENCOURAGE SELF-CARE ACTIVITIES, AND PROMOTE REASONABLE PHYSICAL AND SOCIAL ABILITIES.

FUNCTIONS OF PLAY?

Sensorimotor development
-predominant form of play in infancy
-active play is essential for muscle development and serves a useful purpose as a release of surplus energy.
-children explore the nature of the physical world
-infants gain impressions of themselves and their world through tactile, auditory, visual, and kinesthetic stimulation
-toddlers and preschoolers revel in body movement and exploration of objects in space

Intellectual development
-through exploration and manipulation children learn colors, shapes, sizes, textures, and the significance of objects.
-they learn the significance of numbers and how to use them
-they learn to associate words with objects
-they develop an understanding of abstract concepts and spatial relationships such as up, down, under and over.
-activities such as puzzles and games help them develop problem solving skills
-books, stories, films, and collections expand knowledge and provide enjoyment as well

Creativity
-primarily a product of solitary play
-enhanced in group settings where listening to others’ ideas stimulates further exploration of one’s own ideas

Self-awareness:
-children learn who they are and their place in the world
-they become increasingly able to regulate their own behavior, learn what their abilities are, and compare their abilities with those of others
-they can test their abilities, assume and try out various roles, and learn the effects that their behavior has on others.
-they learn the sex role that society expects them to fulfill and approved patterns of
Intellectual development

Therapeutic value
Moral value

5 PRINCIPLES OF FAMILY CENTERED CARE?

The five main principles include:
-recognizing families as “the constants” in children’s lives, while the personnel in the health care system fluctuate;

-openly sharing information about alternative treatments, ethical concerns, and uncertainties about health care treatments;

-forming partnerships between families and health professionals to decide what is important for families;

-respecting the racial, ethnic, cultural, and socioeconomic diversity of families and their ways of coping;

-supporting and strengthening families’ abilities to grow and develop

ELEMENTS OF FAMILY CENTERED CARE?

1. The Family is at the Center
The family is the constant in the child’s life

2. Family-Professional Collaboration
Collaboration includes the care of the individual child, program development, policy formation at all levels of care- hospital, home, and community.

3. Family-Professional Communication
Information exchange is complete, unbiased and occurs in a supportive manner at all times.

4. Cultural Diversity of Families
Honors diversity (ethnic, racial, spiritual, social, economic, educational, and geographic), strengths, and individuality within and across all families.

5. Coping Differences and Support
Recognizes and respects family coping, supporting families with developmental, educational, emotional, spiritual, environmental, and financial resources to meet diverse needs.

6. Family-Centered Peer Support
Families are encouraged to network and support each other.

7. Specialized Service and Support Systems
Support systems for children with special health and developmental needs in the hospital, home, and community are accessible, flexible, and comprehensive.

8. Holistic Perspective of Family-Centered Care
Families are viewed as families and children are viewed as children recognizing their strengths, concerns, emotions, and aspirations beyond their specific health needs.

WHAT RISK FACTORS SHOULD NURSES ASSESS FOR IN CHILDREN?

Unintentional injuries
Obesity
Suicide
Disease (i.e., communicable diseases and STD’s)
Substance abuse
Violence
Mental health
Poor school performance

Unintentional injuries: The highest risk across childhood is unintentional injuries, with motor vehicle accidents (MVA) accidents impacting 34.7 children per 100,000 ages 15 to 24 died in MVA I 2001. Thirty-two percent of deaths of youth ages 14 to17 were due to MVA.
Obesity: The incidence has risen to 15% (an increase of 4% over the past decade). Behaviors contributing to this trend include over-feeding by parents, use of food as rewards, fast, high fat foods, and some cultural beliefs that overweight signifies wealth and success.
Suicide: According to the Youth Risk Behavior Surveillance System (YRBS), a national survey given to high school students, 12% of youth deaths were due to suicide and up to 8.8% of youth completing the survey had tried to commit suicide.
Substance abuse:Substance abuse continues to plague our youth, with 47% reporting drinking alcohol in the last 30 days, and 31% reporting being in car with an intoxicated driver. Thirty-three percent reported using tobacco and 24% report using marijuana.
Violence: Youth may not be more violent than in the past, but their access to and use of guns makes their violent acts more lethal. Six percent of youth in high school report bringing a firearm to school and 9% report being threatened by a firearm at school.
Mental health: The behaviors we see, such as violence, early sexual behavior, substance abuse, poor school performance and suicide are symptoms of a deeper mental health disorder, primarily depression.
Poor school performance: Fourteen percent of 8th graders cannot read proficiently. Poor reading skills increase the risk for high school drop-out. Poor school performance is more common in single parent homes, low income families, having other family members who dropped out of high school such as older siblings or parents, English as a second language, and being at home alone for two or more hours per day.
Many of the above risk factors are disproportionately represented by the poor. Many risk factors are reduced as families move out of poverty. Therefore, interventions aimed at improving employment, increasing income, providing quality learning experiences and care for young children, providing instruction in English and assuring health benefits such as insurance can greatly enhance the overall health of a family.

STRESSORS OF HOSPITALIZATION?

SEPARATION ANXIETY PHASES:
PROTEST PHASE
DESPAIR PHASE
DETACHMENT PHASE

PROTEST PHASE OF SEPARATION ANXIETY?

-Cry and scream, cling to parent

Observed during later infancy: Cries, Screams, Searches for parent with eyes, Clings, Avoids & rejects contact with strangers
Toddler: Verbal attack, Physical attack, Attempts to find parent, Tries to force parent to stay
Behaviors may last from hrs to days
Protest such as crying, may be continuous, ceasing only with physical exhaustion

DESPAIR PHASE OF SEPARATION ANXIETY?

-Crying stops; evidence of depression

Despair: Inactive; Withdraws from others; Depressed, sad; Uninterested in environment; Uncommunicative; Regressesive behavior; ---may last variable length of time. Child may deteriorate from refusal to eat or drink.

DETACHMENT PHASE OF SEPARATION ANXIETY?

-Denial; resignation but not contentment
-May seriously affect attachment to parent after separation

Detachment: Shows > interest in environment; Interacts with strangers or familiar caregivers; Forms new but superficial relationships; Appears happy ---- detachment usually occurs after prolonged separation from parent; rarely seen in hospitalized children
Behaviors represent superficial adj. to loss

FAMILY INTERACTION MODEL?

The family interaction model is a good model to use to assist nurses in helping family members understand developmental and family career changes, and how these changes impact their ability to adapt to an illness of a family member.

The assumptions of this model include:
1. Meanings of health, illness & disease are created through interactions between family members and society.
2. Meanings are influenced by development

The concepts included include:
FAMILY CAREER
IDENTIFICATION OF FAMILY STAGES
TASKS
FAMILY TRANSITIONS
INDIVIDUAL DEVELOPMENT
PATTERNS OF HEALTH, DISEASE, AND ILLNESS

FAMILY CAREER CONCEPT IN FAMILY INTERACTION MODEL?

Family career is the interaction between development and transitions experienced by a family over time, represented by family stages and family transitions. This concept incorporates stages, tasks and transitions, combining the expected developmental stages and the diverse experiences of American families, such as divorce, blended families, adoption, and death. This concept reminds us that families are constantly changing and diverse.

IDENTIFICATION OF FAMILY STAGES IN FAMILY INTERACTION MODEL

Identification of family stages help families and nurses predict needs. For example, if a family is in the stage of raising school-age children, they will need knowledge of school-age development, such as knowing children are beginning to develop judgments about themselves and others, and they are identifying their strengths and weaknesses. This is the age children identify what they are “good” at and thrive on non-monetary achievements. They are also beginning to understand morals and ethics in a concrete manner (right or wrong), and have trouble understanding the “gray” areas. Parents of school-aged children are faced with working with community schools and agencies to assure they expose their children in a positive manner to these outside resources. They are also faced with encouraging independence in hygiene, increasing responsibility, and increased negotiation with all activities. Anticipating these tasks can help nurses provide the support needed for successful family coping.

TASKS CONCEPT IN FAMILY INTERACTION MODEL?

Tasks: Across all stages are specific tasks. Overall tasks to survival continue regardless of the stage, and include 1) securing shelter, food and clothing, 2) developing emotionally healthy individuals, 3) assuring each individual can function in a social world, 3) assuring the family is able to contribute to the next generation and 5) assuring the family is able to promote the health of individuals within the family. The nurse’s role is to assist families in being successful with these tasks so the health of the family is maintained.

FAMILY TRANSITIONS CONCEPT IN FAMILY INTERACTION MODEL?

Family transitions: Family transitions are events that signal a reorganization of family roles and tasks. They may be developmental or situational. Transitions are what impact health. Developmental transitions are more predictable and called normative. Situational transitions, in contrast, are not predictable and vary from family to family. They include changes such as moves, financial changes, divorce, marriage, unexpected births and deaths, etc. These are referred to as non-normative changes. When thinking about the non-normative changes, it is helpful to recall systems theory, as an unexpected change in one family member impacts all family members. Likewise, a change in the whole family, such as a move, impacts each individual member. It is at times of greatest transition that a family is at greatest risk for health problems.

INDIVIDUAL DEVELOPMENT CONCEPT IN FAMILY INTERACTION MODEL?

Individual development: the expected changes in each member associated with growth and development. The three dimensions of individual development include: social-emotional, cognitive, and physical. [Review Table 11-1 at this point to review the different areas of individual development, including ages, social-emotional stages by Erickson, significant relationships, stage-sensitive family developmental tasks (Duvall & Miller), human needs (Maslow), Values orientation (Kohlberg), Cognitive stage of Development (Bukatko and Daehler, Piaget and Inhelder), Developmental landmarks or milestones, physical maturation, developmental steps, and common developmental problems.

PATTERNS OF HEALTH, DISEASE, AND ILLNESS CONCEPT IN FAMILY INTERACTION MODEL?

Patterns of health, disease and illness: expected behaviors in these health situations: Healthy behaviors are those behaviors that promote optimal physical and social-emotional well-being. Disease is pathology or what has gone wrong within the body, mind, or spirit. Disease is often culturally defined, and families often rely on health professionals to define what is a disease. A disease may be physical, emotional, spiritual, familial or social. For example, sickle-cell anemia is a physical disease, whereas child abuse is a family and social disease. Diseases are often further classified into acute, chronic, life-threatening or end-of-life. Illness represents the family activities associated with managing the disease. The illness patterns are shaped by family interactions. After an acute illness, families typically return to their pre-illness state. However, after the diagnosis of a chronic illness, the family has to adapt long-term, and has to develop new patterns.
By considering each of these concepts, family career, individual development, and patterns of health, disease, and illness, nurses can help families adapt to acute, chronic, life threatening, and end-of-life illnesses.

DISEASE?

Disease is pathology or what has gone wrong within the body, mind, or spirit. Disease is often culturally defined, and families often rely on health professionals to define what is a disease. A disease may be physical, emotional, spiritual, familial or social. For example, sickle-cell anemia is a physical disease, whereas child abuse is a family and social disease. Diseases are often further classified into acute, chronic, life-threatening or end-of-life.

ILLNESS?

Illness represents the family activities associated with managing the disease. The illness patterns are shaped by family interactions. After an acute illness, families typically return to their pre-illness state. However, after the diagnosis of a chronic illness, the family has to adapt long-term, and has to develop new patterns.

LOSS OF CONTROL: INFANT NEEDS?

Trust
Consistent loving caregivers
Daily routines

LOSS OF CONTROL: TODDLER NEEDS?

Autonomy
Daily routines and rituals
Loss of control may contribute to:
Regression of behavior
Negativity
Temper tantrums

LOSS OF CONTROL: PRESCHOOLER NEEDS?

Egocentric and magical thinking typical of age
May view illness or hospitalization as punishment for misdeeds
Preoperational thought

LOSS OF CONTROL: SCHOOL AGE NEEDS?

Striving for independence and productivity
Fears of death, abandonment, permanent injury
Boredom

LOSS OF CONTROL: ADOLESCENT NEEDS?

Struggle for independence and liberation
Separation from peer group
May respond with anger, frustration
Need for information about their condition

YOUNG INFANTS RESPONSE TO PAIN?

Generalized response of rigidity, thrashing
Loud crying
Facial expressions of pain (grimace)
No understanding of relationship between stimuli and subsequent pain

-Loud crying, screaming
-Verbalizations: “Ow,” “Ouch,” “It hurts”
-Thrashing of limbs
-Attempts to push away stimulus

OLDER INFANTS RESPONSE TO PAIN?

Withdrawal from painful stimuli
Loud crying
Facial grimace
Physical resistance

SCHOOL AGE CHILD'S RESPONSE TO PAIN?

Stalling behavior (“wait a minute”)
Muscle rigidity
May use all behaviors of young child

ADOLESCENT RESPONSE TO PAIN?

Less vocal protest, less motor activity
Increased muscle tension and body control
More verbalizations (“It hurts,” “You’re hurting me”)

EFFECTS OF HOSPITALIZATION ON THE CHILD?

-Effects may be seen before admission, during hospitalization or after discharge

-Child’s concept of illness is more important than intellectual maturity in predicting anxiety=KNOW!!!

INDIVIDUAL RISK FACTORS THAT INCREASE VULNERABILITY TO STRESSES OF HOSPITALIZATION?

“Difficult” temperament
Lack of fit between child and parent
Age (especially between 6 mos and 5 yrs)
Male gender
Below-average intelligence
Multiple and continuing stresses (e.g., frequent hospitalizations)

CHANGES IN THE PEDIATRIC POPULATION?

More serious and complex problems
Fragile newborns
Children with severe injuries
Children with disabilities who have survived because of increased technologic advances
More frequent and lengthy stays in hospital

BENEFICIAL EFFECTS OF HOSPITALIZATION?

Recovery from illness
Increase coping skills
Master stress and feel competent in coping
New socialization experiences

PARENTAL RESPONSES TO CHILD HOSPITALIZATION?

-Disbelief, anger, guilt
Especially if sudden illness

-Fear, anxiety
R/T child’s pain, seriousness of illness

-Frustration
Especially r/t need for information

-Depression

SIBLINGS REACTION TO ILL-CHILD HOSPITALIZATION?

Loneliness, fear, worry
Anger, resentment, jealousy
Guilt

ALTERED FAMILY ROLES DUE TO ILL-CHILD HOSPITALIZATION?

-Anger and jealousy between siblings and ill child
-Ill child obligated to play sick role
-Parents continue pattern of overprotection and indulgent attention

INTERVENTIONS TO PREVENT OR MINIMIZE SEPARATION?

-Primary nursing goal
-Especially for children <5 years
-Family-centered care
-Parents are not “visitors”
-Familiar items from home

INTERVENTIONS TO NORMALIZE THE HOSPITAL EXPERIENCE?

-Maintain child’s routine, if possible
-Time structuring
-Self-care (age appropriate)
-School work
-Friends and visitors

PAIN FACTS AND FALLACIES?

FACT: children are undertreated for pain
FACT: analgesia is withheld for fear of the child becoming addicted
FALLACY: analgesia should be withheld because it may cause respiratory depression in children
FALLACY: infants do not feel pain

PRINCIPLES OF PAIN ASSESSMENT IN CHILDREN: QUESTT?

Question the child
Use a pain-rating scale
Evaluate behavioral and physiologic changes
Secure parent’s involvement
Take the cause of pain into account
Take action and evaluate results

NONPHARMACOLOGIC INTERVENTIONS FOR PAIN?

-Based on age
-Swaddling, pacifier, holding, rocking
-Distraction
-Relaxation, guided imagery
-Cutaneous stimulation

ANESTHETICS; TOPICAL AND LOCALS?

-Major advancement for atraumatic care
-EMLA
-NUMBY stuff
-Intradermal local anesthetics
-Importance of timing

ANALGESICS USED FOR PAIN IN CHILDREN?

-Opioids
-NSAIDs
-“Potentiators”
-Lytic cocktail (DPT)—Demerol, Phenergan, and -Thorazine
-Co-analgesics, amnestics, sedatives, etc.
-Role of placebos

DOSAGE OF ANALGESIA USED FOR CHILDREN?

-Based on body weight up to 50 kg
-Concept of “titration”
-Ceiling effect of nonopioids
-First pass effect
-PCA

CONCEPTS OF HOME CARE FOR ILL CHILD?

-Care provided in family’s residence for children with complex health care needs

-Home-based health care recognizes the family’s valuable contribution to the child’s overall health

-Different from hospice care (care for the dying patient)

-Parental desire and ability
-Professional assistance
-Community preparedness
-Increasing numbers of children with long-term, complex health care needs
-Improving the quality of life for the child and family
-Lower cost of home care

Central concepts of home care model:
Home as familiar: where one is most comfortable
Home as center: location of rewarding everyday experiences
Home as protection: privacy, safety

Promotion of optimal development:
Living at home offers most children with complex medical problems social and emotional advantages
Each family is entitled to an Individual Family Service Plan
Promoting coping and capability can buffer stress and contribute to mental health and self-esteem of the child

ROLE OF THE NURSE PROVIDING HOME CARE FOR ILL CHILD?

-Assess needs
-Plan for comprehensive care
-Link clients with providers
-Coordinate services
-Monitor and evaluate services provided
-Advocate for appropriate services
-Provide administrative support

PARENT-PROFESSIONAL COLLABORATION WITH HOME CARE?

Parent-Professional collaboration:

-Encouraging activities to develop self-confidence and self-esteem

-Displaying increased awareness of and respect for family caregivers

-Recognizing that families vary in defining their role

-Demonstrating an ability to understand the families’ approach to caregiving

-Sharing perspectives, not just tasks and functions

-Supporting family members in their primary, irreplaceable role as caregivers

-Exchanging expertise in providing care to the child

-Assisting families in recognizing their contributions as worthwhile

-Identifying strengths and resources of child and family

-Negotiating options, priorities, and preferences

-Assisting with coping by allowing families to find meaning in caring for the patient at home