exam 1 Flashcards
Erikson’s stages of development
Infant- Birth-1yr
Trust vs. Mistrust
Toddler- 1-3yrs
Autonomy vs. Shame and Doubt
Preschool- 3-6 yrs
Initiative vs. Guilt
School-age- 6-10yrs
Industry vs. Inferiority
Adolescent- 10-18yrs
Identity vs. Role Confusion
appropriate nursing care for: infant
NURSING CONSIDERATIONS:
knowing how to appropriately play
PSYCHOSOCIAL DEVELOPMENT Stranger Anxiety Separation Anxiety Temperament Object permanence
Most infants double their weight by 4 months and triple weight by one year of age.
Height is increased by 50 percent at 1year of age
GROSS MOTOR DEVELOPMENT 1 month: Lift and turns head 2-3 months: Raises head/chest, slight head lag pulling to sitting 4-5 months: Roll-over 6-8 months: Sitting 9 months: Crawling 10 months: Pull to stand, cruising 12 months: Sit from standing position, walking
FINE MOTOR DEVELOPMENT
1 month: Fist clenched, involuntary
5 months: Grasps rattle
6 months: Releases object in hand to take another
8 months: Gross pincher grasp
10 months: Fine pincher grasp
12 months: Feeds self with cup and spoon, pokes with index finger
appropriate nursing care for: toddler
NURSING CONSIDERATIONS Toddlers may rely on a security item. Giving toddlers choices Allowing some control Potty training Separation Anxiety Parallel play Safety issues
PSYCHOSOCIAL DEVELOPMENT
Language- 12 months of age when a toddler begins to understand common words, but may still use pointing fingers to indicate their wants.
By 36 months- understands most sentences and speech is usually understood by those who know the child (half understood by outside of family)
Temper tantrums
PHYSICAL GROWTH
12-15 months
Walks independently, uses index finger to point, feed self finger foods
18 months
Climbs stairs, pulls toys while walking, stacks blocks, turns pages, removes shoes and socks
24 months
Runs, kicks balls carries several toys, climbs on furniture, stacks 6 cubes, turns knobs, scribbles, R or L handed
36 months
Pedals tricycle, walks up and down stairs alternating feet, undresses self, copies circle, hold pencil in writing position, stacks 9 cubes
appropriate nursing care for: preschool
NURSING CONSIDERATIONS
Magical thinking may be a “good” or “bad” thing
Play is important (ie, medical play, therapeutic art, transitional objects)
Safety issues with strangers, water safety, car seats
Establishing a routine is important
Sometimes view medical treatment as a punishment
PHYSICAL
Much better coordination with walking, running, jumping, climbing
Able to draw shapes, eventually print letters (5y)
Learns to be more independent with self care, at 5years begins to tie shoes
PSYCHOSOCIAL DEVELOPMENT Likes to please parents Initiates activities with other children Acts out roles (domestic mimicry) Develops a conscience Magical thinking
appropriate nursing care for: school aged
NURSING CONSIDERATIONS
Less fearful of harm to their body, but worried about surgery and being kidnapped.
Praise and sense of accomplishment is important to this age group
Consider teaching self injections and encourage child to perform treatments independently
Rewards/punishment/positive reinforcement
PHYSICAL
Early school years vs. later school years
All 20 teeth are lost
Some secondary sex characteristics start to show
Gross motor and fine motor skills improve (sports, playing instruments)
PSYCHOSOCIAL Principle of Conservation- same amount of fluid in both glasses Self esteem develops Group play, team sports high reward
appropriate nursing care for: adolescent
NURSING CONSIDERATIONS Develop trust. Involve peer interaction when warranted. Be aware of body image focus. Speak to them as equal. Consider Tanner’s stages. Provide opportunities to maintain independence. Allow child to participate in decisions.
PSYCHOSOCIAL DEVELOPMENT
Focuses on bodily changes and outward appearance.
Frequent mood changes.
Importance placed on conformity to peer norms and acceptance from peers.
Defines boundaries with parents and authority.
Identifies with same-sex peers.
Egocentric thinking.
Thinks of themselves as invincible
medication administration in hospitalized client
5 R’s
3 checks
check name band and ask parent
choose the least invasive route
different types of play
Medical play: Helps them see what will happen and lessen their fears Or correct misconceptions
Using play/expressive activities to minimize stress
Diversional activities
Toys
Expressive activities
Therapeutic play
Dramatic play
tv, games, songs, videos
normalizing hospital environment: treat it like its home
family’s role in care
family centered care: take care of the parents as well
stressors: Separation from parents and loved ones Fear of the unknown Loss of control and autonomy Bodily injury resulting in discomfort, pain, and mutilation Fear of death
sibling reactions: Loneliness, fear, worry Anger, resentment, jealousy Guilt ENCOURAGE SIBLINGS TO VISIT
STRESSORS AND REACTIONS FROM FAMILY Disbelief, anger, guilt Especially if sudden illness Fear, anxiety Related to child’s pain, seriousness of illness Frustration Especially related to need for information Depression
PHASES OF SEPARATION ANXIETY
Protest phase: crying & clinging
Despair phase: no crying, isolating
Detachment phase: happens after being hospitalized for a long time- start to forget who their parents are d/t so many people coming in and out of the room
Infants’ Needs Trust Toddlers Needs Autonomy Preschoolers Magical thinking, guilt School age Independence Adolescents Independence, peers
calculating maintenance
(100x10)+(50x10)+(20x_)
shock treatment
Shock is circulatory FAILURE- causes may be different, but results are the same
Hypovolemic shock- reduction in circulating blood volume (in this case extracellular fluid loss)
Manifestations- hypotension, poor perfusion, tachycardia, lethargy
Tx- Bolus 20ml/kg of Normal Saline or Lactated Ringers, rapid, until good UOP and VS have returned to normal. Then keep maintenance fluids going until able to take PO
dehydration classifications
Mild <50ml/kg TBW loss in 48hr period-
Up to 5% loss of body weight
Moderate 50-90 ml/kg TBW loss
5-9% loss of body weight
Severe >/or equal to 100ml/kg TBW loss
10% or higher loss of body weight
CLINICAL MANIFESTATIONS MILD Few loose stools Pale Tacky mucous membranes VS unchanged Normal behavior 1.020 Specific gravity of urine
MODERATE Several loose watery stools Decreased urine output Irritable Gray color Dry mucous membranes Slightly depressed anterior fontanel Increased pulse, BP normal or slightly low, Capillary refill 2-3 seconds 1.020-1.030 specific gravity
SEVERE Lethargic Mottled Skin Parched mucous membranes Little to no urine or stool output Sunken anterior fontanel Rapid pulse, lower blood pressure Capillary refill greater than or equal to 3 seconds. 1.030 > specific gravity
assessment and causes of dehydration at all ages and recovery
HEALTH HISTORY Medical history Onset and progression Chief complaint History of vomiting: Contents/character Effort and force Timing History of Diarrhea: Stool description Medical history
PHYSICAL ASSESSMENT Well Appearing Look/Listen/Feel S/S of dehydration Mild/Moderate/Severe Isotonic, hypotonic, and hypertonic dehydration
DIAGNOSTICS Laboratory Stool culture Radiologic Xray, ultrasound, CT scan
RISK FACTORS IN CHILDREN
-Greater amount of total body water (TBW) than adults
Age, sex, body fat content
Extracellular fluid (ECF)
-Immature Kidney function
-Greater vulnerability to severe electrolyte losses
-Higher metabolic rate
rehydration process: oral, IV, calculate caloric requirements
Oral rehydration
Mild to moderate dehydration resulting from vomiting
0.5-2oz oral replacement every 15 minutes
Increase as tolerated
. Wait 1-2 hours after last emesis and then introduce an appropriate rehydration solution: pedialyte for an infant up to 1 year, Gatorade beyond. Do not give carbonated beverages or sugary juices for this process
-IV fluids Used when not tolerating oral rehydration Requires IV access Strict calculations! -Maintenance Therapy
Caloric requirements
Accurate weight and height is necessary
-Can change quickly with growth spurts or illness
-Convert to Kg ( Lb/2.2=Kg)
-Calculate with every growth spurt or drastic change
Assess the child’s intake at home
breastfeeding and formula
Infant formula feedings
Calories/ounce the client consumes in 24 hours is considered
Standard formulas, nonfat cow’s milk-whey/casein base
Enfamil
Similac
Carnation- Good Start
Lactose intolerant-soy based
Prosobee
Isomil
Nusoy
Others
Malabsorption, carb intolerant/protein modified
Specialty Formulas, impaired renal, GI, and CV functions
Standard formula is 20cal/oz, including breast milk
-Older Child
Measure consumption by percentages
Calorie counts will often be ordered in the hospital and done per institutional requirements and policy
BREASTFEEDING
Difficult to quantify unless mom is pumping
Measure in minutes
Discuss with mom the quality of the suck: constant, sleepy, ect.
Can fortify milk with formula if baby isn’t gaining weight
Increases calories of the breastmilk while still allowing mom to pump
Lactation
Always initiate when in the hospital
Can be initiated by the nurse
