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NU 374 > Ch. 2 & 4 (Normal G&D) > Flashcards

Ch. 2 & 4 (Normal G&D) Flashcards

Growth and Development Pt. 1

1
Q

developmental surveillance

A

skilled observations made by the pediatrician of a child and their family that takes into account parental concerns and the child’s developmental history

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2
Q

developmental screening

A

use of a standardized objective measure that is given to the parent to assess development
- recommended at 9, 18, 24 months

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3
Q

autism-specific screening is performed at what ages?

A

18 and 24 month visits

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4
Q

a child with 1 predictive concern is how likely to have needs for services (speech/OT)?

A

8x more likely to be eligible

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5
Q

a child with 2 predictive concern is how likely to have needs for services (speech/OT)?

A

20x more likely to be eligible

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6
Q

developmental milestones fall into what categories?

A
  • language
  • emotional
  • motor
  • social
  • cognitive
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7
Q

milestones: newborn-1month

A
  • responds to visual or auditory stimuli
  • sucks in a coordinated fashion
  • fixes briefly on faces or objects
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8
Q

anticipatory guidance to parents of: newborn-1month

A
  • discuss how newborns learn by hearing parents speak to them and examining their faces
  • talk about attachment and promote the important role of the new parent in a child’s development
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9
Q

milestones: 2months

A
  • lifts head/chest when prone
  • social smile
  • tracks horizontally with gaze
  • stays alert for longer periods of time
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10
Q

milestones: 4months

A
  • engages with environment more, which is how they learn and gain motor skills
  • atonic neck reflexes fade, which allows them to roll front to back
  • uses sounds to communicate
  • laughs, orients to parent voice
  • hands to midline
  • grasp objects
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11
Q

milestones: 6months

A
  • sits with minimal support
  • babbles
  • reaches for caregivers and toys
  • transfers objects from one hand to another
  • primitive reflexes should be gone at this point
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12
Q

anticipatory guidance to parents of: 4months

A
  • now that the child is rolling, falls are more of a risk
  • never leave a baby unattended on a bed or a couch
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13
Q

anticipatory guidance to parents of: 6months

A
  • start child-proofing the home as the child is starting to move around more and explore the environment
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14
Q

persistent primitive reflexes beyond 6 months are

A

a red flag!
- warrant further evaluation

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15
Q

primitive reflexes include

A
  • moro
  • atonic neck
  • fisting
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16
Q

milestones: 9 months

A
  • pulls to stand, cruises
  • says “mama” and “dada” indiscriminately
  • 2-3 word vocabulary
  • immature pincer grasp (pointer finger and thumb- can grab food with pincer grasp, probably not a spoon)
  • turn pages in board book
  • object permanence
  • separation anxiety
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17
Q

anticipatory guidance to parents of: 9 months

A
  • since the child is picking up smaller objects, discuss choking risks
  • could talk about beginning to baby proof the house because if child is standing with support, walking is coming next
  • talk about separation anxiety
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18
Q

milestones: 12 months

A
  • “mama” and “dada” are applied to correct person
  • one word in addition to “mama” and “dada”
  • 4-5 word vocabulary
  • points: sounds and gestures tell people what she wants
  • joint attention: pair points with eye contact and sign or word
  • first steps
  • more developed pincer grasps
  • understands simple commands with a gesture
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19
Q

red flags: 12 months

A
  • hand preference before age 1: may indicate decreased strength or tone on one side which is indicative of a neuro deficit
  • minimal response to name
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20
Q

milestones: 15 months

A
  • 3-6 word vocabulary
  • points to objects
  • feeds self with spoon and cup
  • stoops and recovers
  • scribbles (like with markers)
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21
Q

anticipatory guidance to parents of: 15 months

A
  • discuss how to handle tantrums
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22
Q

red flags: 15 months

A
  • no words or pointing
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23
Q

milestones: 18 months

A
  • 10-20 word vocabulary
  • jargoning
  • points to 1 body part
  • imitates those around her
  • stacks 3 blocks
  • run
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24
Q

red flags: 18 months

A
  • doesn’t point to show things to others
  • can’t walk
  • doesn’t imitate
  • doesn’t gain new words
  • doesn’t notice when caregiver leaves or returns
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25
Q

milestones: 2 years

A
  • 2-word phrases
  • 200-300 word vocabulary (50% understood)
  • follows 2-step commands
  • goes down stairs 2 feet at a time
  • feeds self with spoon and fork
  • jumps with 2 feet
  • parallel play
  • turns thin pages
  • draws a line
  • stacks 6 blocks
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26
Q

red flags: 2 years

A
  • doesn’t use 2-word phrases
  • doesn’t know what to do with common things
  • doesn’t imitate actions or words
  • doesn’t follow simple instructions
  • doesn’t walk steadily
  • loses skills they once had
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27
Q

milestones: 3 years

A
  • goes up and down stairs with alternating feet
  • peddles a tricycle
  • draws circles
  • stacks 9 blocks
  • uses pronouns correctly
  • 3-word sentences, 75% understood
  • puts on shoes, undresses self, brushes teeth
  • knows name, age, and colors
  • toilet-trained during the day
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28
Q

red flags: 3 years

A
  • falling frequently
  • repetitive behaviors
  • no 3-word phrases
  • not playing pretend or not playing with other children
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29
Q

milestones: 4 years

A
  • draws a square or cross
  • hops on one foot
  • can manipulate buttons
  • 4-5 word phrases
  • 100% of language understood
  • answers “what?” and “when?”
  • plays cooperatively in a group (knows rules)
  • knows at least 4 colors
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30
Q

red flags: 4 years

A
  • difficulties with feeding, sleep, or toileting
  • speech is not clear
  • doesn’t follow 3-part commands
  • doesn’t speak in short sentences
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31
Q

milestones: 5 years

A
  • skips
  • ties shoes
  • draws triangle
  • writes name
  • draws a person with head and body parts
  • knows left and right
  • asks “why”
  • follows 3-step commands
  • knows address, birthday, and phone number
  • knows alphabet and counts to 10
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32
Q

red flags: 5 years

A
  • cannot perform basic tasks independently (ie getting dressed)
  • difficulty attending to an activity for more than 5 minutes
  • doesn’t talk about daily activities or experiences
  • extreme behavior (unusually fearful, aggressive, shy, or sad)
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33
Q

live attenuated vaccines

A

contain weakened, live pathogens and cannot be given to children with immunodeficiency

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34
Q

inactive vaccines

A

contain killed or inactive viruses or bacteria

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35
Q

conjugate vaccines

A
  • combat bacteria with polysaccharide capsules
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36
Q

toxoid vaccines

A
  • contain weakened toxins absorbed to aluminum or calcium salts to enhance the immune response
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37
Q

subunit vaccines

A

contain only antigens from the pathogen, which leads to fewer side effects but also a weaker immune response

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38
Q

mild side effects to vaccines

A
  • local redness or soreness
  • fussiness
  • low-grade fever

**resolves in a couple days

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39
Q

at birth, newborns should receive (medication/vaccines)

A
  • Hep B (1st dose)
  • Vit K
  • erythromycin
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40
Q

2 month vaccines

A
  • Hep B (2nd dose)
  • DTaP (1st dose)
  • H. Flu (1st dose)
  • PCV13 (1st dose)
  • inactivated polio (1st dose)
  • rotavirus (oral solution) (1st dose)
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41
Q

4 month vaccines

A
  • DTaP (2nd dose)
  • H. Flu (2nd dose)
  • PCV13 (2nd dose)
  • inactivated polio (2nd dose)
  • rotavirus (oral solution) (2nd dose)
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42
Q

6 month vaccines

A
  • Hep B (3rd dose)
  • DTaP (3rd dose)
  • H. Flu (3rd dose)
  • PCV13 (3rd dose)
  • inactivated polio (3rd dose)
  • rotavirus (oral solution) (3rd dose)
  • influenza (need a second dose at a min of 4 weeks after 1st dose- then 1 dose annually after)
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43
Q

12 month vaccines

A
  • H. Flu (4th dose/final)
  • PCV13 (4th dose/final)
  • MMR (1st dose)
  • varicella (1st dose)
  • Hep A (1st dose)
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44
Q

15 month vaccines

A
  • DTap (4th dose)
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45
Q

18 month vaccines

A
  • Hep A - if 1st dose was given at least 6 months prior (2nd dose)
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46
Q

4-6 year vaccines

A
  • DTap (5th dose)
  • inactivated polio (4th dose)
  • MMR (2nd dose)
  • varicella (2nd dose)
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47
Q

11-12 year vaccines

A
  • meningococcal (1st dose)
  • Tdap (1st dose)
  • HPV (1st dose)
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48
Q

if HPV vaccine is given before 15 years of age, the series consists of ___ doses

A

2 doses
- separated by 6-12 months
- 1st dose as early as 9 years old

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49
Q

if the HPV vaccine is started at 15 years or older, the teenager needs ___ doses

A

3 doses
- 2nd dose 4 weeks after 1st
- 3rd dose 6 months after 1st dose

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50
Q

16 year vaccines

A
  • meningococcal (2nd dose)
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51
Q

patients with what conditions require additional immunizations?

A
  • sickle cell disease
  • HIV
  • immunodeficiency
  • anatomic or functional asplenia
  • other chronic conditions
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52
Q

the PPSV23 (pneumococcal polysaccharide vaccine) vaccine should be administered for children with

A
  • chronic heart disease
  • chronic lung disease
  • diabetes
  • once over age of 2, a child with any of these conditions should receive at least one dose of PPSV23 at least 8 weeks after a previous PCV13 dose
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53
Q

what conditions require one dose of PPSV23 at least 8 weeks after PCV13, as well as a second dose of PPSV23 5 years later?

A
  • renal failure
  • malignancies
  • sickle cell
  • asplenia
  • HIV
  • children treated with immunosuppressant drugs
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54
Q

the meningococcal vaccine is a “special circumstance/concern” with what health conditions?

A
  • sickle cell disease
  • anatomic or functional asplenia
  • HIV
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55
Q

physical developmental highlights: 0-6 months

A
  • raises head and chest when prone
  • opens and shuts hands
  • brings hand to mouth
  • grasps and shakes toys
  • rolls both ways
  • sits with and without support of hands
  • supports whole weight on legs
  • reaches with one hand
  • transfers object from hand to hand
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56
Q

social developmental highlights: 0-6 months

A
  • smiles spontaneously
  • enjoys playing with people
  • imitates some movements & expressions
  • interested in mirror images
  • responds to expressions of emotions
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57
Q

sensory developmental highlights: 0-6 months

A
  • follows moving objects
  • recognizes familiar objects and people
  • finds partially hidden objects
  • explores with hands and mouth
  • struggles to get objects that are out of reach
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58
Q

physical developmental highlights: 7-12 months

A
  • transitions to sitting position without help
  • crawls forward on belly
  • assumes hands-and-knees positions
  • gets from sitting to crawling position
  • pulls self up to stand
  • walks holding on to furniture
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59
Q

social developmental highlights: 7-12 months

A
  • shy or anxious with strangers
  • cries when parents leave
  • enjoys imitating people in play
  • prefers certain people and toys
  • tests parental response
  • feeds themselves with fingers; uses utensils messily
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60
Q

sensory developmental highlights: 7-12 months

A
  • explores objects in different ways
  • finds hidden objects easily
  • looks at correct picture when the image is named
  • imitates gestures
  • begins to use objects correctly
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61
Q

the posterior fontanel closes by what age?

A

1-2 months

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62
Q

the anterior fontanel closes by what age?

A

12-18 months

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63
Q

infants should gain approximately how much weight during their first 5-6 months of life?

A

1.5lb (680g) per month

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64
Q

birth weight should double by age __ and triple by age ___ and quadruple by age ___

A

birth weight should double by 5 months of age and triple by 12 months of age and quadruple by 30 months of age

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65
Q

how much do infants grow in the first 6 months of life?

A

approximately 1 in (2.5 cm) per month

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66
Q

growth occurs in spurts after what age?

A

6 months

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67
Q

birth length increases by __% by the age of 12 months

A

50%

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68
Q

when do the first teeth erupt?

A

around 6 and 10 months

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69
Q

how many teeth should erupt by the end of the first year of age?

A

6-8 teeth

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70
Q

what are some indications of teething?

A
  • sucking or biting their fingers or hard objects and drooling
  • difficulty sleeping
  • mild fever
  • rub their ears
  • decreased appetite for solid foods
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71
Q

the number of teeth a child should have can be identified with what equation?

A

age in months - 6 = number of teeth child should have

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72
Q

physical developmental highlights: toddler (1-3 years)

A
  • walks alone (13 months)
  • pulls toys behind when walking
  • begins to run (24 months)
  • kicks a ball (24 months)
  • beginning to dress self (24 months)
  • two foot jumps (30 momths)
  • stands on tiptoes (30 months)
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73
Q

social developmental highlights: toddler (1-3 years)

A
  • tolerates some separation (15 months)
  • imitates behavior of others (15 months)
  • temper tantrums common (18 months)
  • increased independence from parents (24 months)
  • likes to play with other children
  • parallel play
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74
Q

cognitive developmental highlights: toddler (1-3 years)

A
  • forms memories of events that relate to them (13+ months)
  • finds objects in several hiding spots (19+ months)
  • object permanence fully develops (19+ months)
  • sorts by shape and color (24+ months)
  • plays make-believe (house, mom, dad) (24+ months)
  • uses 2-3 word phrases (24+ months)
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75
Q

what physical developmental highlights can a toddler do at 24 months?

A
  • begin to run
  • kick a ball
  • beginning to dress self
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76
Q

what physical developmental highlights can a toddler do at 30 months?

A
  • two foot jumps
  • stand on tiptoes
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77
Q

when can a toddler walk alone?

A

13 months

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78
Q

what social developmental highlights can a toddler do at 15 months?

A
  • tolerate some separation
  • imitate behavior of others
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79
Q

temper tantrums are common at age ___

A

18 months (toddler)

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80
Q

increased independence from parents begins around age ___

A

24 months (toddler)

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81
Q

around what age do toddlers form memories of events that relate to them?

A

13+ months

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82
Q

what cognitive developmental highlights can a toddler do at 19+ months?

A
  • find objects in several hiding places
  • object permanence fully developed
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83
Q

what cognitive developmental highlights can a toddler do at 24+ months?

A
  • sort by shape and color
  • play make believe (house, mom, dad)
  • uses 2-3 word phrases
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84
Q

at 30 months old, toddlers should weigh ___x their birth weight

A

4x their birth weight

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85
Q

toddlers grow approximately ____ per year (weight)

A

1.8-2.7kg (4-6lb) per year

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86
Q

toddlers grow about ___ per year (height)

A

7.5 cm (3in) per year

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87
Q

at what age should a child have an established dental provider?

A

by 1 year old

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88
Q

dental care of child

A
  • flossing and brushing should be done by the adult caregiver (removes plaque the best)
  • brush teeth after meals and at bedtime
  • nothing to eat or drink, except water, is given to the child after bedtime cleaning
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89
Q

what is the consequence to starting potty training too early?

A

training may take longer

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90
Q

when do children start to show signs of readiness to begin potty training?

A

18 months - 3 years
- toddler age

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91
Q

signs of readiness to start potty training include

A
  • recognizing sensation of needing to urinate or defecate **
  • ability to communicate to go potty **
  • voluntary control of anal and urethral sphincters (dry for at least 2 hours of time) **
  • able to sit for short periods of time
  • able to dress/undress for toileting
  • interest in sitting on the potty

**main signs

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92
Q

nursing care of toddler ready to being potty training

A
  • get them used to sitting on the training toilet
  • getting the child in the mindset of going to bathroom (a relaxing place)
  • give them something to do while sitting on the training toilet for a little while
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93
Q

physical developmental highlights: preschooler (3-6 years)

A
  • climbs well
  • walks up and down stairs
  • kicks ball
  • runs easily
  • pedals a tricycle
  • bends over without falling
  • eruption of deciduous (primary) teeth is finalized by the beginning of the preschool years
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94
Q

social developmental highlights: preschooler (3-6 years)

A
  • egocentric** (everything is all about them, temper tantrums may still occur)
  • imitates adults and playmates
  • show affection for familiar playmates
  • can take turns in games
  • understands “mine” and “his”/”hers”
  • enjoys talking
  • associative play
    • putting puzzles together
    • computer programs
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95
Q

cognitive developmental highlights: preschooler (3-6 years)

A
  • makes mechanical toys work
  • matches an object in hand to picture in book
  • sorts objects by shape and color
  • completes 3-4 piece puzzles
  • language primary form of communication
  • feel good about gaining independence
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96
Q

eruption of deciduous (primary) teeth is finalized by what age?

A

the beginning of the preschool years (~3 years)

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97
Q

physical developmental highlights: school-age (6-12 years)

A
  • rapid growth in height and weight
  • prepubertal changes
  • permanent teeth eruption
  • differences in the rate of growth and maturation between boys and girls becomes apparent
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98
Q

social developmental highlights: school-age (6-12 years)

A
  • peer group play
  • bully
  • make crafts
  • collect things/engage in hobbies
  • play board and card games
  • join organized competitive sports
  • need for privacy
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99
Q

general cognitive developmental highlights: school-age (6-12 years)

A
  • conceptual thinking
  • learn to tell time
  • see perspective of others
  • solve problems
  • classifies more complex information
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100
Q

cognitive developmental highlights: early school-age

A
  • judgement guided by rewards and punishment
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101
Q

social developmental highlights: later school-age

A
  • treats other the way they want to be treated
  • awareness of self in relation to others
  • opinions of peers and teacher more valuable
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102
Q

physical developmental highlights: adolescent (12-20 years)

A
  • sexual maturation
    • differs male to female
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103
Q

female sexual maturation occurs in the order of

A
  • breast development
  • pubic hair growth (some girls experience hair growth before breast development)
  • axillary hair growth
  • vaginal discharge
  • menstruation
104
Q

male sexual maturation occurs in the order of

A
  • testicular enlargement
  • pubic hair growth
  • penile erection
  • growth of axillary hair
  • increase in muscularity
  • early voice changes
  • early facial hair growth
105
Q

social developmental highlights: adolescent (12-20 years)

A
  • begins with close, same-sex friendships during early adolescence
    • transitions from friendships to intimate relationships
  • mood swings
  • compares self to peers
  • view self as invincible, risky behaviors increase
  • body image
106
Q

cognitive developmental highlights: adolescent (12-20 years)

A
  • capable of evaluating the quality of their own thinking
  • highly imaginative and idealistic
  • able to maintain attention for longer periods of time
  • increasingly capable of using formal logic to make decisions
  • thinking beyond current circumstances
  • able to understand how the actions of an individual influence others
107
Q

erikson’s stage of development

A
  • 8 stages
  • include name, age, psychosocial crisis, positive outcome and negative outcome
108
Q

erikson’s stage of development: stage 1

A
  • name: infancy
  • age: day 1-1.5 years
  • psychosocial crisis: trust vs. mistrust
  • positive outcome: feelings of trust
  • negative outcome: fear or mistrust
109
Q

erikson’s stage of development: stage 2

A
  • name: early childhood
  • age: 1.5-3 years
  • psychosocial crisis: autonomy vs shame and doubt
  • positive outcome: self sufficiency
  • negative outcome: lack of independence
110
Q

erikson’s stage of development: stage 3

A
  • name: play age
  • age: 3-5 years
  • psychosocial crisis: initiative vs guilt
  • positive outcome: discovers ways to initiate actions
  • negative outcome: guilt form actions or thoughts
111
Q

erikson’s stage of development: stage 4

A
  • name: school age
  • age: 5-12 years
  • psychosocial crisis: industry vs. inferiority
  • positive outcome: development of sense of competence
  • negative outcome: no sense of mastery
112
Q

erikson’s stage of development: stage 5

A
  • name: adolescence
  • age: 12-18 years
  • psychosocial crisis: identity vs. role confusion
  • positive outcome: awareness of uniqueness of self
  • negative outcome: inability to identify the appropriate roles of life
113
Q

erikson’s stage of development: stage 6

A
  • name: young adult
  • age: 18-25 years
  • psychosocial crisis: intimacy vs isolation
  • positive outcome: development of loving, sexual relationships
  • negative outcome: fear of relationships with others
114
Q

erikson’s stage of development: stage 7

A
  • name: middle adult
  • age: 25-65 years
  • psychosocial crisis: generative vs. stagnation
  • positive outcome: sense of contribution to continuity of life
  • negative outcome: feeling one’s activities are trivial
115
Q

erikson’s stage of development: stage 8

A
  • name: late adult
  • age: 65+ years
  • psychosocial crisis: ego integrity vs despair
  • positive outcome: sense of unity in life’s achievements
  • negative outcome: regret over lost opportunities of life
116
Q

psychosocial crisis: trust vs. mistrust

A

trust or mistrust that basic needs, such as nourishment and affection, will be met

  • trust: when baby is crying in the crib, parent comes to soothe the baby, feed the baby, change the baby, etc.
  • mistrust: when baby is crying in the crib and no one come to soothe
117
Q

psychosocial crisis: autonomy vs. shame and guilt

A

develop a sense of independence in many tasks

118
Q

psychosocial crisis: initiative vs. guilt

A

take initiative on some activities- may develop guilt when unsuccessful or boundaries overstepped
*age of magical thinking

119
Q

psychosocial crisis: industry vs. inferiority

A

develop self-confidence in abilities when competent or sense of inferiority when not

120
Q

psychosocial crisis: identity vs. role confusion

A

experiment with and develop identity and roles

121
Q

psychosocial crisis: intimacy vs. isolation

A

establish intimacy and relationships with others

122
Q

psychosocial crisis: generative vs. stagnation

A

contribute to society and be part of a family

123
Q

psychosocial crisis: ego integrity vs. despair

A

assess and make sense of life and meaning of contributions

124
Q

family systems theory

A

change has a domino affect

125
Q

family system theory: what to assess

A
  • family’s ability to accept new ideas, resources, and opportunities
126
Q

family stress theory

A

stress affects families

127
Q

family stress theory: what to assess for

A
  • coping and resiliency of each family member
128
Q

Duvall’s Developmental stages theory

A

families develop and change
- as a family grows the dynamics of the family evolve and change

129
Q

Duvall’s Developmental theory: what to assess for

A
  • anticipatory guidance effectiveness
130
Q

family systems theory: common interventions

A
  • interacting with family members as a group
  • being a skillful communicator
  • anticipatory guidance to help prepare and cope with change
131
Q

family stress theory: common interventions

A
  • use crisis intervention strategies to help family members cope with existing challenges
132
Q

Duvall’s Developmental theory: common interventions

A
  • provide anticipatory guidance to prepare for the transition into the next family stage
133
Q

sociocultural theory of development

A

a person’s cognitive development is largely influenced by their surrounding culture
- religious
- farming
- musician

134
Q

parents and caregivers relinquish control when their children begin ___

A

attending school

135
Q

___ influences affect psychological development

A

outside influences

136
Q

socialization is fostered by

A
  • school
  • peers
  • community: family, neighborhood, school, youth organization, etc.
137
Q

general principles of communication

A
  • remember the child- call by name
  • recognize the child’s perception
  • be aware of facial cues
  • use simple terminology
  • be aware of double meanings
  • individualize information given
  • understand the patient’s learning style
  • use routine and structure
  • leave your baggage at the door
138
Q

things to consider to establish rapport

A

how will you…
- approach a child?
- incorporate their likes?
- share your thoughts and observations?
- demonstrate listening?
- handle a parent who is talking unfavorably about their child?

what tone and vocabulary will you use?

139
Q

pediatric health history includes

A
  • demographic information
  • chief complaint
  • present history
  • past history (from birth)
  • review of systems
  • family medical history (risk factors)
  • psychosocial history
  • sexual history
  • family dynamic (getting to know the family)
  • nutritional assessment
140
Q

past medical history includes

A
  • birth history (gestational age)
  • dietary history
  • illness, injuries, hospitalizations, surgeries
  • allergies (medicine, environmental)
  • medications and immunizations
  • growth and development
  • habits
141
Q

review of systems: order of questioning

A
  • order of questioning should begin with least invasive and move towards the most invasive
142
Q

a comprehensive physical exam includes

A
  • general growth
  • skin
  • HEENT
  • chest
  • respiratory
  • CV
  • GI
  • GU/GYN
  • musculoskeletal
  • neurologic
  • endocrine
  • hematology/lymphatic
  • allergic/immunology
  • psychiatric
  • physical appearance
  • state of nutrition
  • behavior
  • personality
  • interactions with parents, siblings, nurse
  • posture
  • development**
    • gross motor
    • fine motor
    • language
    • social skills
143
Q

physical examination of an infant: position

A
  • before able to sit alone: supine or prone, preferably in parent’s lap
    • before 4-6 months: can place on exam table
  • after able to sit alone: sitting in parent’s lap whenever possible
    • if on the table, place with parent in full view
144
Q

physical examination of an infant: sequence

A
  • if quiet, auscultate heart, lungs, abdomen
  • record HR and RR
  • palpate and percuss same areas
  • proceed in usual head to toe direction
  • perform traumatic procedures last (eyes, ears, mouth [while crying])
  • elicit reflexes as body part is examined
  • elicit moro reflex last
145
Q

physical examination of an infant: preparation

A
  • completely undress if room temp permits
  • leave diaper on male infant
  • gain cooperation with distraction, bright objects, rattles, talking
  • smile at infant, use soft gentle voice
  • pacify with bottle of sugar water or feeding
  • enlist parent’s aid for restraining to examine ears and mouth
  • avoid abrupt, jerky movements
146
Q

physical examination of a toddler: position

A
  • sitting or standing on or by parent
  • prone or supine in parent’s lap
147
Q

physical examination of a toddler: sequence

A
  • inspect body area through play: “count fingers” “tickle toes”
  • use minimum physical contact initially
  • introduce equipment slowly
  • auscultate, percuss, palpate whenever quiet
  • perform traumatic procedures last (eyes, ears, mouth [while crying])
  • elicit reflexes as body part is examined
148
Q

physical examination of a toddler: preparation

A
  • have parent remove outer clothing
  • remove underwear as body part is examined
  • allow to inspect equipment, demonstrating use of equipment is ineffective
  • if uncooperative, perform procedures quickly
  • use restraint when appropriate, request parent’s assistance
  • talk about examination if cooperative, use short phrases
  • praise for cooperative behavior
149
Q

physical examination of a preschool child: position

A
  • prefer standing or sitting
  • usually cooperative prone or supine
  • prefer parent’s closeness
150
Q

physical examination of a preschool child: sequence

A
  • if cooperative, proceed in head-to-toe directions
  • if uncooperative, proceed as with toddler
151
Q

physical examination of a preschool child: preparation

A
  • request self-undressing
  • allow to wear underpants if shy
  • offer equipment for inspection, briefly demonstrate use
  • make up story about procedure (ie. im seeing how strong your muscles are [BP])
  • use paper dolls technique
  • give choices when possible
  • expect cooperation, use positive statements (open your mouth)
152
Q

physical examination of a school-age child: position

A
  • prefer sitting
  • cooperative in most positions
  • younger child prefers parent’s presence
  • older child may prefer privacy
153
Q

physical examination of a school-age child: sequence

A
  • proceed head-to-toe direction
  • may examine genitals last in older child
154
Q

physical examination of a school-age child: preparation

A
  • request need for privacy
  • request self-undressing
  • allow to wear underpants
  • give gown to wear
  • explain purpose of equipment and significance of procedure, such as otoscope to see eardrum, which is necessary for hearing
  • teach about body function and care
155
Q

physical examination of an adolescent: position

A
  • prefer sitting
  • cooperative in most positions
  • offer option of parent’s presence
156
Q

physical examination of an adolescent: sequence

A
  • proceed head-to-toe direction
  • may examine genitals last
157
Q

physical examination of an adolescent: preparation

A
  • allow to undress in private
  • give gown
  • expose only area to be examined
  • respect need for privacy
  • explain findings during examination: Your muscles are firm and strong
  • matter-of-factly comment about sexual development: your breasts are developing as they should be
  • emphasize normalcy of development
  • examine genitalia as any other body, may leave to end
158
Q

nutritional status exam includes

A
  • dietary history
  • anthropometric measures
  • general growth percentiles for age
    • height, weight, head circumference, BMI
  • body systems impacted by nutrition
159
Q

what are the body systems impacted by nutrition?

A
  • skin and hair: decreased skin turgor, dry/brittle skin, thin hair
  • HEENT: dehydration- under eyes, dry lips, dry mucosal membranes in mouth and nose
  • chest: concave
  • abdomen: concave (thin), constipated: distended abdomen
  • neuro: decreased/delayed cognitive abilities, slow and groggy, lethargic
160
Q

infant and toddler vital sign order

A

1st: respirations first (before disturbing the child)
2nd: apical heart rate
3rd: (temoral) temperature
4th: SpO2
5th: BP

161
Q

the width of the bladder of the BP cuff should be approximately ____% of the circumference of the upper arm midway between the ___ and ____

A

the width of the bladder of the BP cuff should be approximately __40__% of the circumference of the upper arm midway between the __olecranon__ and __acromion__

162
Q

the length of the bladder of the cuff should encircle ____% of the circumference of the upper arm midway between the ___ and ____

A

the length of the bladder of the cuff should encircle __80-100__% of the circumference of the upper arm midway between the __olecranon__ and __acromion__

163
Q

in children, are lymph nodes typically palpable?

A

yes
- lymph nodes react with what is going on with the body
- concerned when they are enlarged and not going away or are unilateral

164
Q

in children, can eye abnormalities result in blindness?

A

sometimes, yes

165
Q

could craniosynostosis and torticollis be seen in children?

A

yes

166
Q

craniosynostosis

A

a birth defect in which the bones in a baby’s skull join together too early
- occurs before brain is fully formed
- as brain grows, skull becomes more misshapen

167
Q

torticollis

A

rare condition in which the neck muscles contract, causing the head to twist to one side (ie. chin to shoulder)
- stiff neck; painful to turn head

168
Q

in children, do tonsils typically appear large or small?

A

large
- grow into their tonsils
- allow up to age 8 years to have normal size tonsils

169
Q

are child lung, cardiac and abdominal sounds similar to or different than adults?

A

similar to

170
Q

do genitals of children need to be examined?

A

maybe
- tanner stages

171
Q

in children, are musculoskeletal abnormalities congenital or acquired?

A

they can be either congenital or acquired

172
Q

in children, developmental assessments are ___

A

ongoing

173
Q

neurological assessment of children can be __

A

challenging

174
Q

where should you place your stethoscope on a child to assess cardiac?

A

apical
- apex of the heart

175
Q

what part of the stethoscope do you use to assess cardiac in children?

A

start with diaphragm
- bell for murmurs

176
Q

what are you listening for when assessing cardiac in children?

A
  • HR (whooshing sound)
  • S1
  • S2
  • murmur (functional murmur: if murmur is heard when patient is sitting down, but goes away when sat up)
  • hand on chest for thrills
177
Q

what pulses can you feel in children?

A
  • radial, brachial (harder in younger), pedal, femoral
178
Q

pacifier: yes or no, according to AAP 2022 safe sleep?

A

full-term baby, with mom who is exclusively breastfeeding: don’t introduce until breastfeeding is established and only during nap-time, wean by 6 months
NICU babies: recommended as a soothing technique

179
Q

babies consume breastmilk or formula ONLY for the first ____ of life

A

4-6 months

180
Q

how are new foods introduced?

A
  • one at a time
  • repetition of the same food before starting a new one
181
Q

50-90% of reactions are _____, not ____

A

50-90% are sensitivities, not allergies

182
Q

primary source of calories when introducing new foods

A

fluids
- breastmilk/formula

183
Q

why is it easy to confuse adjustment with dislike of new foods?

A

babies have to adapt to texture

184
Q

food introduction is a ____ process

A

slow progressive process
- should NOT be rushed

185
Q

nursing questions to ask infants caregiver regarding nutrition

A
  • how much baby is drinking (# oz/day)
  • what kinds of foods
  • type of preparation/source of food
  • likes/dislikes
186
Q

positional plagiocephaly (how does it differ from brachiocephaly?)

A

one sided flat shape of their head (brachiocephaly would be both sides)
- increase since “back to sleep” campaign began advocating for prone sleeping positioning
- may be combined with torticollis

187
Q

positional plagiocephaly: nurse interventions

A
  • educate parents on importance of tummy time during awake hours
  • use a boppy pillow to get them off their head
  • hang toy on opposite side of the crib to get them to turn their head and lay on opposite side
  • teach parents passive range of motion-moving head back and forth
188
Q

how is positional plagiocephaly treated?

A

skull-molding helmet can prevent surgical correction
- have to go every 2 weeks to get readjusted
- cannot use helmet once the anterior fontanel closes
- if introduced early, it won’t be on long; if introduced late, it will be a longer process

189
Q

common health concerns of school-aged children (6-12 years)

A
  • obesity
190
Q

when is a child considered obese?

A
  • their BMI for gender and age is >95% when compared with children of the same age and sex
191
Q

therapeutic management of obesity

A
  • Diet modification (not dieting)
  • Exercise/physical activity
  • Behavior modification
  • Get a nutrition expert involved
  • Counseling
  • Pharmacological (Orlistat)
  • Family interventions
192
Q

prevention of obesity

A
  • Limit sugar consumption
  • Increase fruits and veggies
  • Limit electronic time
  • Limit the location of electronics
  • Breakfast daily
  • Limit eating out
  • Family meals and food prep
  • Limit portion size
  • Increasing physical activity
193
Q

common health concerns of adolescents (13-18 years)

A
  • puberty (abnormal development)
194
Q

progression through Tanner Stages is very stressful for someone who

A

does not identify as their biological gender

195
Q

female tanner stage 2 (beginning)

A
  • early or pre; age 8-11 years
  • thelarche-breast bud is forming
  • beginning changes to nipple, areola
196
Q

female tanner stage 2 (middle)

A
  • pubarche = few strands of pubic and axillary hair visible
  • begins approx. 2-6 months after thelarche
197
Q

female tanner stage 2 (end)

A
  • physiologic leukorrhea begins
  • increased vaginal discharge in preparation for menstruation
  • growth spurt begins
198
Q

female tanner stage 2-3

A
  • middle (9-12 years)
  • breast, axillary, and genital hair growth continues
  • breasts and hair development progress to adult like appearance
  • peak height and weight velocity occurs approx. 6-12 months before onset of menses (age 12)
  • fat mass accumulates
199
Q

female tanner stage 3-4

A
  • late (10-14 years)
  • onset of menses
  • scant volume, irregular cycle with no ovulation for first 6-14 months
  • growth plateaus approx. 2-2.5 years after onset of menses
200
Q

female past age 14, tanner stage __

A

5

201
Q

concerns warranting further assessment: female puberty

A
  • secondary sex characteristics before the age of 8 in females
  • absence of menarche (1st period) past the age of 15
202
Q

tanner stage of breast development: stage 2 (pubertal)

A

breast bud stage- small area of elevation around papilla; enlargement of areolar diameter
*usually 2 years after this, the female will start their period

203
Q

tanner stage of breast development: stage 3

A

further enlargement of breast and areola with no separation of their contours

204
Q

tanner stage of breast development: stage 4

A

projection of areola and papilla to form a secondary mound (may not occur in all girls)

205
Q

tanner stage of breast development: stage 5

A

mature configuration; projection of papilla only caused by recession of areola into general contour

206
Q

tanner stage of female pubic hair development: stage 1 (prepubertal)

A

no pubic hair

207
Q

tanner stage of female pubic hair development: stage 2

A
  • course few little hairs (downy straight hair)
    sparse growth of long, straight, downy, and slightly pigmented hair extending along labia; between stages of 2 and 3 begins to appear on pubis
208
Q

tanner stage of female pubic hair development: stage 3

A
  • extends a little, a little more curly
  • hair darker, coarser, and curly and spread sparsely over entire pubis in the typical female triangle
209
Q

tanner stage of female pubic hair development: stage 4

A
  • extending and more in volume
  • pubic hair denser, curled, and adult in distribution but less abundant and restricted to the pubic area
210
Q

tanner stage of female pubic hair development: stage 5

A
  • hair goes onto thighs and legs
  • hair adult in quality, type, and pattern with spread to inner aspect of thighs
211
Q

tanner stage of female pubic hair development: the average span for stages 2-5

A

11-14 years

212
Q

concerns warranting further assessment: male puberty

A
  • secondary sex characteristics before the age of 9 in males
  • absence of genitalia enlargement by age 14
213
Q

male tanner stage 2 (beginning)

A
  • early or pre (age 9-14 years)
  • testicular enlargement
  • initial changes to size of testicles
214
Q

male tanner stage 2 (middle)

A
  • scrotal changes begin
  • reddening and textural changes to scrotal skin
215
Q

male tanner stage 2 (end)

A
  • sparse pubic hair
  • slight hair growth at base of penis
216
Q

male tanner stage 2-3

A
  • middle (10-14 years)
  • testicles, scrotum, and genital hair growth continues, penis growth and ejaculation occur
  • Genitalia and hair development progress to adult like appearance
  • Growth spurt begins, muscle mass increases, early voice changes and facial hair growth
  • gynecomastia may develop
  • breast development disappears within 2 years of onset
217
Q

male tanner stage 3-4

A
  • late (age 13-16 years)
  • axillary hair develops, facial hair extends to neck
  • final voice changes
  • peak height velocity and weight velocity around age 14 with continued growth until age 18-20 years
218
Q

tanner stage 5 for males may not occur until what developmental age?

A
  • end of adolescence
219
Q

tanner stages of male genitalia development: stage 1 (prepubertal)

A
  • no pubic hair; essentially the same as during childhood
220
Q

tanner stages of male genitalia development: stage 2

A
  • initial enlargement of scrotum and testes; reddening and textural changes of scrotal skin; sparse growth of long, straight, downy, and slightly pigmented hair at base of penis
221
Q

tanner stages of male genitalia development: stage 3

A

initial enlargement of penis, mainly in length; testes and scrotum further enlarged; hair darker, coarser, and curly and spread sparsely over entire pubis

222
Q

tanner stages of male genitalia development: stage 4

A
  • increased size of penis with growth in diameter and development of glans; glans larger and broader; scrotum darker; pubic hair more abundant with curling but restricted to pubic area
223
Q

tanner stages of male genitalia development: stage 5

A

testes, scrotum, and penis adult size and shape; hair adult in quality and type with spread to inner surface of thighs

224
Q

gynecomastia

A
  • extra breast tissue
  • could be unilateral or bilateral
  • extra estrogen surge

*not concerned unless it continues to occur for 2 years or greater, or it happens after puberty- concerned for tumor (pituitary/adrenal/testicular)

225
Q

when does gynecomastia occur?

A

70% of males going through puberty
- normal

226
Q

how is gynecomastia resolved?

A

usually resolves in under 2 years

227
Q

when do babies start to see color?

A

2 months

228
Q

how far away can a 1 month old baby see?

A

10 inches

229
Q

rolling back to stomach happens around what age?

A

5 months
- begin rolling at 4 months

230
Q

transferring objects hand to hand doesn’t usually happen before what age?

A

3 months

231
Q

head lag

A

the head falls backward when not supported due to lack of strength in neck muscles
- occurs until around 4 months (when the neck muscles get stronger)

232
Q

crawling occurs around what age?

A

start around 8 months
- backwards first

233
Q

when does walking usually occur?

A

as early as 10 months, usually 11-12 months
- if there is a delay, could be related to family history OR need interventions

234
Q

what would we be concerned about if the anterior fontanel closes too early?

A

cranial stenosis
- brain would not be able to grow due to restricted head size

235
Q

how much do infants grow from 6-12 months of life?

A

0.5 inch per month

236
Q

vocabulary: 9 months

A

2-3 words

237
Q

vocabulary: 12 months

A

4-5 words

238
Q

vocabulary: 18 months

A

10-20 words

239
Q

vocabulary: 24 months (2 years)

A

> 200-300 words
- 2 word phrases
- 50% understood

240
Q

vocabulary: 36 months (3 years)

A

3 word phrases
75% understood

241
Q

vocabulary: 4 years

A

4-5 word phrases
100% understood

242
Q

young school age covers the ages of

A

6, 7, 8 and 9 years

243
Q

older school age covers the ages of

A

10, 11 and 12 years

244
Q

how do male and female puberty (sexual development differ)?

A

females: mature top to bottom
males: mature bottom to top

245
Q

what occurs characteristically during adolscence

A
  • should know right from wrong
  • testing limits
  • experimenting
  • rebellious
  • undergoing puberty
246
Q

what is the purpose of anticipatory guidance?

A

preparing the family for what to expect

247
Q

how would the nurse handle a parent who is talking unfavorably about their child?

A
  • offer the parent a break (may be stressed out)
  • maybe the parent needs more resources
  • ask if there is anything you can do to help them
  • if very heated- ask them to come out of the room, take a walk with them
248
Q

when would you do a tympanic temperature on a child with a history of ear infections?

A

as the last vital sign

249
Q

what is the equation for how much a baby should be consuming in oz per day?

A

weight (lb) x 2.5 oz = total amount in oz that they should be eating/day

250
Q

maternal iron stores decrease around what age?

A

4-5 months

251
Q

iron needs to be introduced to babies around what age? what is it usually introduced as?

A

4 months
- rice cereal

252
Q

when are solid foods introduced?

A

around 4 months
- 1 food at a time for several days
- usually start with rice cereal for several weeks before starting other foods (may combine rice cereal with breast milk to soften and serve on a spoon)

253
Q

allergies are mediated by

A

IgE
- means that if you are allergic to something, you have a IgE in your blood

254
Q

if a baby crosses __ percentiles, concern is warranted

A

crosses 2 percentiles

255
Q

expected range for urine specific gravity

A

1.005-1.020

NU 374 (18 decks)

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