314- Children are Unique Flashcards
Communicating with Infants, Children, and Young Adults
Listen with the ear of your heart to both verbal and nonverbal communication
Say less as it is not the number of words that are said, but the way in which they are said
Give older children the opportunity to talk without parents
Offer a choice when one exists
Assessment
Health history is similar to adults with a few unique features:
Gather data from the parent or care giver, but do remember most children has a story to tell and the nurse if they are given the opportunity
Prenatal/birth history if relevant to the age of the patient or primary concerns that have been identified
Developmental history and assessment
Immunization history
Family structure
Assessment of the Infant, Child, and Young adult
Health history is similar to adults with a few unique features:
Gather data, both subjective and objective, to identify primary concerns
Identification of primary care givers
Family social and health history
Day history – play, sleep, hygiene, nutrition, safety
Daycare utilization
Based on age, what is the history of attendance at school
Differences between Children and Adults
Age Physical development Cognitive Age and Development Developmental Stage Psychosocial development
Child Body Differences
Children are not “little adults”
The body of a child is not physiologically comparable to that of an adult until the child is between 8-10 years of age
From birth until 22 years of age, a person will go through 5 developmental stages: Infant, Toddler, Preschool, School-aged, and Adolescent
Differences between Children and Adults
Respiratory System:
Cartilage in airway of an infant is soft
The trachea of an infant is 1/3 that of an adult
At birth, there are 25-40 million alveoli and 300-400 million alveoli by age 8-10
The size of alveoli does not change
Children generally have cardiac arrests secondary to primary respiratory arrests
Differences between Children and Adults
-Cardiac System
Heart is fully developed and pumping by week 7
-Neurological System
Myelination of neurological system is greatest in the last trimester and the first two years of life
Differences between Children and Adults
-Head size varies proportionally over time
One year of age: 19% of body surface
Five years of age: 15% of body surface
Adult: 9% of body surface
Differences between Children and Adults
- Thermoregulation
- -The smaller the infant/child, the greater the disproportion of surface area to body mass ratio: There is a larger surface area in proportion to body mass
- -This increases the risk for heat loss, which can result in hypoglycemia and hypoxia
- -The goal is to keep the infant/child in a Neutral Thermal Environment
- -The smaller the infant/child, the greater the disproportion of surface area to body mass ratio: There is a larger surface area in proportion to body mass
Differences between Children and Adults
- Higher Body Water Content
- At birth: 90%
- Within 24-48 hours: 70%
- 12 months of age (comparable to that of an adult): 61%
Differences between Children and Adults
-Less able to concentrate urine
Increasing risk for fluid imbalance, specifically dehydration which leads to hypovolemia
-Lower glycogen stores
Increasing risk for hypoglycemia
-Rapid metabolism
Increasing risk for hypoglycemia and hypoxia
Infant Development
Erickson: Trust vs. Mistrust
Piaget: 0-2 Years of Age,
Sensorimotor
Development of routines
Transitional items represent absent parents/caregivers
Huge developmental strides
Social skills-cooing, smiling, laughing, verbal
Infant Development
-Primitive reflexes present Rooting Sucking Tongue extrusion Moro Babinski Stepping Tonic neck Blink Palmar Plantar
Infant Development
- Stranger anxiety- peaks 7-8 months and 18-20 months
- Prefer upright position vs. horizontal
- Lack of object permanence – what I cannot see is not there
- Gross motor: creeping by 4-5 months, sitting by 6-8 months, walking by 12-15 month (These are typical times, but there are individual variations)
Newborn Physical Assessment
- Avoid rapid, startling movements
- Cluster assessment to allow periods of uninterrupted rest
- Start with least invasive first and those that are top priority (heart, lungs, bowel sounds)
- Temperature taken per organization policy
- BP may be difficult to obtain, but assessment done in an inpatient setting, while typically not done in an outpatient setting
- Apical heart rate
