EXAM 1 Flashcards
(202 cards)
1
Q
Stages of Embryonic & Fetal Development
A
Ovum released from ovary; passes into open fallopian tube; starts journey downward toward the sperm for fertilization
- preembryonic stage
- embryonic stage = (MOST CRITICAL TIME)
- fetal stage
2
Q
what is the preembryonic stage
A
fertilization through second week
- fertilization = takes place in the fallopian tube.
- union and eggs and ovum forms a zygote (46 chromosomes)
- blastocyst = inner cell ( EMBRYO AND AMNION )
- trophoblast= outta cell ( CHORION AND PLACENTA
chorion ( outer most cover of the embryo (amnion fluid)
- implantation
3
Q
Embryonic stage:
A
end of second week through eighth week
- MOST CRITICAL TIME In EMBRYONIC DEVELOPMENT
- basic structures of major body organs and main external feature
4
Q
Fetal stage
A
end of the eighth week until birth
5
Q
how long does gestation (period of pregnancy) last
A
Lasts approximately 280 days or 10 lunar months = 9 calendar months
37 to 42 weeks
6
Q
normal term timeframe of gestation
A
37 to 42 weeks
7
Q
Naegle’s Rule:
A
Last mentrual period (LMP) + 7 days – 3 months = estimated due date (EDC)
8
Q
what weeks are most crucial in regards to development
A
The first 8 weeks are the most crucial in regards to development.
9
Q
neural tube defects up to how many weeks
A
6 weeks
and it happens due to low FOLATE ACID INTAKE
10
Q
when does cleft palate form
A
early, 5-6 weeks
11
Q
when does the heart develop
A
between weeks 3-8
12
Q
funtions of the placenta
A
- Serving as the interface between the mother and fetus
- Making hormones to control the physiology of the mother
- Protecting the fetus from immune attack by the mother
- Removing waste products from the fetus
- Inducing the mother to bring more food to the placenta
- Producing hormones that prepare fetal organs for life outside of uterus
- Does metabolic functions of: respiration, nutrition, excretion, storage of nutrients
- THE PLACENTA TAKES OVER THE FUCNTIONS OF THE LUNGS, KIDNEYS DURING FETAL LIFE SO LARGE VOLUME OF OXYGEN NOT NEEDED
13
Q
hormones of the placenta
A
hCG (human chorionic gonadotropin) = preserves corpus luteum and its progesterone production maintains the endometrium lining of the uterus is maintained.
Human placental lactogen (hPL) or human chorionic somatomammotropin (hCS) = decreases maternity insulin sensitivity which leads to increase in availability for fetal nutrition
Estrogen = stimulates myometrial contractility Progesterone = decrease contractility of the uterus, maintains endometrium Relaxin = soften the cervix and causes relaxation
14
Q
Miscarriage occurs if ….. stops functioning
A
corpus luteum
15
Q
function of the human chorionic gonadotropin (hCG)
A
preserves the corpus luteum and its progesterone production so that the endometrial lining of the uterus is maintained; this is the basis for pregnancy tests
16
Q
basis for pregnancy test
A
hCG ( human chorionic gonadotropin )
17
Q
fucntion of the hPL (Human placental lactogen )
A
modulates fetal and maternal metabolism, participates in the development of maternal breasts for lactation, and DECREASES maternal insulin sensitivity to INCREASE its availability for fetal nutrition
18
Q
fucntion of Progesterone (progestin
A
maintains the endometrium, DECREASES THE CONTRACTILITY of the uterus, stimulates MATERNAL METABOLISM and breast development, provides nourishment for the early conceptus
19
Q
Relaxin fucntion
A
acts synergistically with progesterone to maintain pregnancy, causes relaxation of the pelvic ligaments, softens the cervix in preparation for birth (Freemark, 2015).
20
Q
what is the significance of the veins and arteries in the umbilical cord ( one large vein and two small arteris)
A-V-A
A
- the Vein carries OXYGENATED blood to the FETUS
- Arteries carry DEOXYGENATED blood to the PLACENTA
21
Q
what could only one artery and vein signify?
A
COULD SIGNIFY CONGENITAL MALFORMATION of renal or cardiac nature
22
Q
function of the wharton jelly that surrounds the vein and arteries of the umbilical cord
A
it prevents compression & gives nutrition
23
Q
where does the umbilical cord orginates from
A
Originates from the connecting stalk
- At week #5 the stalk is compressed by the amnion and forms the narrow part of the umbilical cord.
SO THE UMBILICAL CORD IS FORMED FROM THE AMNION
24
Q
AMNIOTIC FLUID FUNCTION
A
- Helps maintain a constant body temperature for the fetus
- Permits symmetric growth and development
- CUSHION FROM TRAUMA
- BARRIER TO INFECTION
- allows the UMBILICAL CORD to be relatively free of COMPRESSION
- Promotes fetal movement to enhance MUSCULOSKELETAL MOVEMENT
- repository for waste
- source of oral fluid
25
composition of amniotic fluid ( increases weekly )
large part is fetal urine which means the amount of amniotic fluid is a result of how functional the renal is
= fluid from the respiratory and GI tracts of the fetus also enter the amniotic cavity
26
what is fetal circulation
blood from the placenta to and through the fetus and then back to placenta
27
Three shunts during fetal life:
- Ductus venosus: connects the umbilical vein to the inferior vena cava
- Ductus arteriosus: connects the main pulmonary artery to the aorta
- Foramen ovale: anatomic opening between the right and left atrium
28
Foramen ovale:
anatomic opening between the right and left atrium
29
ductus venosus fucntion
connects the umbilical vein to the inferior vena cava
30
function of the ductus arteriosus
connects the main pulmonary artery to the aorta
31
Neonatal Cardiovascular Physiological changes
↓ Pulmonary resistance leads to ↑ pulmonary blood flow leading to ↑ systemic vascular resistance
Ductus venosus closure
Foramen ovale closure
Ductus arteriosus closure
32
Human somatic cells contain
46 chromosomes arranged as 23 pairs of homologous
chromosomes
- Each “pair” has one set of chromosomes from each parent.
- 22 pairs of autosomes
- 1 pair of sex chromosomes
33
A gene is considered “dominant”
2 slightly different genes at the same location are expressed; called heterozygous (i.e. brown eyes are dominant over blue eyes)
34
what is Autosomal dominant inherited
Autosomal dominant inherited disorders occur when a single gene in the heterozygous state is capable of producing the phenotype. In other words, the abnormal or mutant gene overshadows the normal gene and the person will demonstrate signs and symptoms of the disorder.
35
what is Autosomal Recessive Inheritance
Autosomal recessive inherited disorders occur when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be heterozygous carriers of the gene (clinically normal but carriers of the gene).
36
what is X-linked Recessive Inheritance
X-linked inherited disorders are those associated with altered genes present on the X chromosome.
37
what is X-linked Dominant Inheritance
X-linked dominant inheritance occurs when a male has an abnormal X chromosome or a female has one abnormal X chromosome
38
Abnormalities of chromosome number
Monosomies; trisomies
| Polyploidy
39
what are some abnormalities of chromosome structure
Deletions
Inversions
Translocations
40
Signs and Symptoms of Pregnancy
Presumptive
Probable
Positive
41
what is the presumptive sign and symptom of pregnancy
- Signs women experiences that make her think she might be pregnant
- Least reliable, can be caused by other conditions
42
what is the probable sign and symptom of pregnancy
- Changes that can be detected on physical exam by a health care provider
- Can still be caused by other conditions
43
what is the positive sign and symptom of pregnancy
- Signs that are directly attributed to the fetus
| - Can be explained only by pregnancy
44
what is the Goodell’s sign
An indication of pregnancy in which the cervix and vagina soften
45
what is the hegar's sign
a non-sensitive indication of pregnancy in women .
its absence does not exclude pregnancy. It pertains to the features of the cervix and the uterine isthmus. It is demonstrated as a softening in the consistency of the uterus, and the uterus and cervix seem to be two separate regions.
46
what is the Chadwick's sign
an early sign of pregnancy
It occurs when blood flow to the cervix and vagina increases around the fourth week of pregnancy, causing those tissues to become purplish-red.
47
limitations of home pregnancy tests.
| tests in sensitivity, specificity and accuracy
Influenced by length of gestation, specimen concentration, presence of blood, and presence of some drugs
48
what does the elevation of hCG corresponds to
corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy.
49
hCG levels in normal pregnancy.
Human chorionic gonadotropin (hCG) is the earliest biochemical marker for pregnancy
- it doubles every 48 to 72 hours.
this helps differentiate normal from abnormal pregancy
50
what are some situations that intefere with the accuracy of the fundus height
Obesity, hydramnios, and uterine fibroids
51
what is the fundus height
measurement from the symphysis bone up to the xiphoid process.
- it is most accurately between 18 and 32 weeks .
- height of top of the uterus in cm = # of gestational weeks. fundal height by 20 weeks at gestation level of umbilicus (20 cm)
52
uterus adaptations during pregnancy
- Increases in size ofc
- Changes shape: pear to ovoid
- Positive Hegar’s sign
- Ascends into abdomen after first 3 months
53
cervix adaptations during pregnancy
- Softens (Goodell’s sign)
- Mucous plug forms
- Increased vascularization (Chadwick’s sign)
- Ripening about 4 weeks before birth
54
vagina adaptations during pregnancy
- Increased vascularity with thickening
- Lengthening of vaginal vault
- Secretions more acidic, white, and thick; leukorrhea
55
ovaries adaptation during pregnancy
- Enlarge until 12th to 14th week of gestation
| - Ovulation and menses cease
56
breast adaptations during pregnancy
- Breasts increase in size and areolar pigmentation; nipples become more erect
- Tubercles of Montgomery (sebaceous glands) become prominent. Keep nipples lubricated for breastfeeding
- Blood vessels more prominent; blood flow to breasts doubles
PRODUCE COLOSTRUM after 12th week
- COLOSTRUM: antibody-rich, yellow fluid
colostrum converts to mature milk after delivery
57
what minerals are usually insufficient and needs to be supplemented for the demands of pregnancy
Many women enter pregnancy with insufficient iron stores and thus need supplementation to meet the extra demands of pregnancy.
58
pulse and pregancy
increase of 10-15 bpm
59
blood pressure during pregnancy (1st Trimester)
at pre-pregnancy levels
2nd Trimester: Sl. ↓
3rd trimester: return to prepreg. levels
60
blood pressure during pregnancy (2nd Trimester)
SI decreases
61
blood pressure during pregnancy (3rd Trimester)
return to pre-preg. levels
62
Blood volume during pregnancy
INCREASE by 1500 ml or 40-50% above prepreg. Level
- The rise in blood volume correlates directly with fetal weight, supporting the concept of the placenta as an arteriovenous shunt in the maternal vascular compartment.
63
RBC during pregancy
increase by 17%
64
hemoglobin and hematocrit during pregnancy
decreases because the plasma becomes more than the red mass cell
another way to think of it.
fluid deficit or dehydration causes hemoglobin and hematocrit to INCREASE! so this the opposite
65
cardiac output during pregnacy
↑30-50%
Sl. cardiac hypertrophy
66
Supine Hypotension Syndrome
the vena cava and the aorta are between the uterus and the spinal cord so if the pregancy lady lays supine, the uterus compresses them.
- it is rather advisable to lay in the side-lying position
67
expiratory volume during pregnacy
decreases whiles inspiratory INCREASES
68
vital capacity during pregancy
DOES NOT CHANGE
69
tidal volume during pregnancy
↑ 30-40% resulting hyperventilation & lower PCO2. This lower PCO2 leads to maternal resp. alkalosis facilitating transfer of CO2 from fetus to mother
70
BMR during pregnancy
↑ 15-20%
71
Renal System Changes during pregnancy
Renal pelvis become dilated & The ureters (especially the right ureter) elongate, widen, and become more curved above the pelvic rim.
- Glucoseurea in 20% of pregnant women
- bladder capacity increases time 2
- GFR & renal plasma flow ↑ from ↑ hormones & ↑ blood volume (Renal plasma flow ↑ 30%; GFR ↑ 40-60%)
72
creatine levels during pregancy
DECREASES
73
Musculoskeletal System: Maternal Postural Changes
- Due to change in center of gravity
- Shoes can make a difference in balance
- May have balance issues due to anemia, medications, etc.
- Key is to counsel woman about shoes, posture, good body mechanics
- Calcium storage
- Postural changes
- Abdominal wall
74
Integumentary System Changes
```
↑ in skin thickness & subdermal fat
↑ hair & nail growth
↑ sweat & sebaceous gland activity
↑ circulation & vasomotor activity
↑ fragility of elastic tissue causing striae gravidarum (stretch marks)
- Pigment changes (linea nigra,chloasma)
- Tiny, bright red angiomas
Nevi, hirsuitism, softer nails
```
75
VASCULAR-RELATED SKIN CHANGES during pregnancy
Vascular changes during pregnancy manifest in the integumentary system include varicosities of the legs, vulva, and perineum. Varicose veins are commonly the result of distention, instability, and poor circulation secondary to prolonged standing or sitting and the heavy gravid uterus placing pressure on the pelvic veins, preventing complete venous return.
76
Interventions to reduce the risk of developing varicosities include
- Elevating both legs when sitting or lying down
- Avoiding prolonged standing or sitting; changing position frequently
- Resting in the left lateral position
- Walking daily for exercise
- Avoiding tight clothing or knee-high hosiery
- Wearing support hose if varicosities are a preexisting condition to pregnancy
77
Gastrointestinal Changes during pregnancy
- Estrogen causes ↑ blood flow to mouth leading to gums being more friable & leads to ↑ gingivitis
- saliva is more acidic
- Fetus gets calcium from maternal stores NOT from her teeth
- Progesterone causes smooth muscle relaxation leading to ↓ tone of lower esophageal sphincter w/resultant reflux & heartburn
- Estrogen ↑ influences gale bladder leading to stasis of bile salts (cholestasis of pregnancy resulting in pruritis & icterus
- smooth muscle relaxation leads to ↓ motility & prolonged emptying time & complete intestinal tract in sm. intestine leads to ↑ absorption of minerals, nutrients & drugs
- smooth muscle relaxation leads to ↓motility of the Lg. intestine leading to constipation as slow transit time leads to ↑ water absorption & flatulence
78
Gum Fragility in Pregnancy
- Bleeding of gums during pregnancy results from increased estrogen levels that cause blood vessel proliferation. This then leads to increased blood vessels in the gums and an increased chance of bleeding.
79
endocrine controls during pregancy
- integrity and duration of gestation by maintaining the corpus luteum via hCG secretion;
- production of estrogen, progesterone, hPL, and other hormones and growth factors via the placenta;
- release of oxytocin (by the posterior pituitary gland), prolactin (by the anterior pituitary), and relaxin (by the ovary, uterus, and placenta).
80
Immune System during pregnancy
- Immune system undergoes complicated immune system adaptation
- A general enhancement of innate immunity (inflammatory response and phagocytosis) and SUPPRESSION of adaptive immunity (protective response to a specific foreign antigen) take place during pregnancy.
- Involves maternal organism becoming “tolerant of the foreign” fetus keeping fetus from being rejected & protecting it from infection
**These immunologic alterations help prevent the mother’s immune system from rejecting the fetus (foreign body), increase her risk of developing certain infections, and influence the course of chronic disorders such as autoimmune diseases.
81
Psychosocial Adaptations
| ( Maternal Emotional Responses )
```
Ambivalence = accepting that they might be pregnant
Introversion
Acceptance
Mood swings
Changes in body image
```
82
Rubin’s Maternal Role Tasks : Tasks a woman must accomplish to incorporate the maternal role into her personality
- Ensuring safe passage throughout pregnancy and birth
- Seeking acceptance of infant by others
- Seeking acceptance of self in maternal role to infant (“binding in”)
- Learning to give of oneself
83
healthy Weight BMI During Pregnancy
18.5 - 35 lb
84
Nutritional Needs during pregnancy
- Direct effect of nutritional intake on fetal well-being and birth outcome
- Vitamin and mineral supplement is generally prescribed (IRON)
85
Dietary recommendations during pregnancy
- Increase in protein (basic growth), iron (increase maternal RBCs), folate (prevent neural tube defects)
- Increase of 300 calories / day
- Use of USDA’s Food Guide MyPlate
- Avoidance of some fish due to mercury content
Avoid contamination with
- Listeria (avoid soft cheeses, meat spreads, smoked seafood, unpasteurized milk; heat hot dogs and luncheon/deli meats until steaming hot)
- limit caffeine
- no alcohol
86
what vitamin/mineral is very important in the periconceptual (BEFORE CONCEPTION) period
Folate or folic acid ( leafy greens, brocolli, asparagus, papaya, oranges, avocado, seeds&nuts, brussels sprouts, beans/peas/lentils, okra, cauliflower, beets, bell peppers
- Neural tube defects are more common in infants of women with poor folic acid intake
- healthful diet before conception ensures that adequate nutrients are available for developing fetus
87
nutrient Needs During Pregnancy
Protein
Omega 3 fatty acids
Fluids
```
- Minerals and vitamins
Iron
Calcium
Fat-soluble vitamins
Vitamins A, D, E, and K
```
```
- Water-soluble vitamins
Folate or folic acid
Pyridoxine
Vitamin C
Vitamin B6
Vitamin B12
```
88
Nutrition Issues During Pregnancy
- Alcohol
- Caffeine
- Artificial sweeteners
- PICA
- Food cravings
- Nausea and Vomiting (See - Box 9.6) vs. Hyperemesis gravidarum
- MVI Intake
Hyperemesis gravidarum, or severe and persistent vomiting causing weight loss, dehydration, and electrolyte abnormalities, occurs in up to 1% of pregnant women. Intravenous fluid and electrolyte replacement, enteral tube feeding, and rarely total parenteral nutrition have been used to nourish women with hyperemesis gravidarum. There is very limited evidence that acupressure and ginger might provide some relief
89
preeclampsia
- The cause is still unknown
- Speculation that poor intake of specific nutrients may be a contributing factor
- An adequate diet remains the best means of prevention
90
Nutrient Needs During Lactation
- Nutrition needs during lactation similar to those during pregnancy
- Needs for energy (calories), protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs
- Energy intake increase of 330 kcal more than woman’s nonpregnant intake recommended
- Increased maternal weight loss during lactation
- Smoking, alcohol intake, and excessive caffeine intake should be avoided during lactation
91
Lactation and body weight
- Those who gain more weight than recommended have lower breastfeeding rates
- Obese women who breastfeed often do so for less time than normal-weight women
- Weight loss if lactating is slower than nonlactating women
92
what is the difference between growth, development and maturation
GROWTH - increase in physical size
DEVELOPMENT - sequential process by which infants and children gain various skills and function
MATURATION: increases functionality of various body systems or developmental skills
93
tools that may be used to assess development
Denver II Developmental Screening Test
Prescreening Developmental Questionnaire (PDQ II)
Ages and Stages Questionnaire (ASQ)
Infant–Toddler Checklist for Language and Communication
Infant Development Inventory
94
how do you assess Growth and Development of a Premature Infant
1. use the infants adjusted age to determine expected outcomes
2. Subtract the number of weeks that the infant was premature from the infant’s chronologic age.
3. Plot growth parameters and assess developmental milestones based on adjusted age.
95
Infant Organ System Maturation
```
Neurologic system
Cardiovascular system
Respiratory system
Gastrointestinal (digestive) system
Renal system
Hematopoietic system
Immunologic system
Integumentary system
```
96
Newborn States of Consciousness: QUIET ALERT STATE
infant’s eyes are open wide and body is calm.
97
Newborn States of Consciousness: ACTIVE ALERT STATE
infant’s face and body move actively
98
Newborn States of Consciousness: DROWSINESS
eyes may close; the infant may be dozing.
99
Newborn States of Consciousness: Light sleep
infant may move a little while sleeping and startle to noises.
100
what is a moro reflex
also known as the startle reflex
101
what is a root reflex
when the corner of the baby's mouth is stroked or touched
102
what is a Suck reflex
when you touch the roof of an infant mouth and they start sucking
103
what is Babinski reflex
when you tickle inside of the foot.
INFANTS TOES FLEX UP
ADULTS FLEX DOWN
104
what is the step reflex
when you hold an infant on their feet and they try to walk even though they cant ealk
105
what is Plantar and palmar grasp
when you put a finger in a childs palm, they automatically grasp it.
SAME FOR THE FOOT. press inside of the infants foot, it'll grasp it also just like the palm
106
what is the Asymmetric tonic neck
neck/head face the same direction of their fully extended hand is
107
Respiratory System of the Infant Versus Adult
- The nasal passages are narrower.
- The trachea and chest wall are more compliant.
- The bronchi and bronchioles are shorter and narrower.
- The larynx is more funnel shaped.
- INFANTS TONGUE is larger.
- There are significantly fewer alveoli.
108
Maturation of the Cardiovascular System of the Infant in First Year of Life
- The heart doubles in size.
- The average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.
- Blood pressure steadily increases, from an average of 60/40 in the newborn to 100/50 in the 12-month-old.
- The peripheral capillaries are closer to the surface of the skin, making the newborn and young infant more susceptible to heat loss.
- Thermoregulation becomes more effective.
109
First Year of Life Changes
- Eruption of teeth
- Consistency and frequency of stools change over the first year of life
- Acrocyanosis is normal in newborns and that they often experience mottling of the skin
ACROCYANOSIS- bluish discoloration in the extremities
- NORMAL IN KIDS
110
what is the psychosocial development
- Erik Erikson theory
| - Crisis of infancy as trust versus mistrust
111
Gross and Fine Motor Skills (FIRST 12 MONTHS)
- phenomenal increases
- First 12 months
- Development in this stage in a cephalocaudal fashion
- Fine motor development includes maturation of hand and finger use and develops in proximodistal fashion
```
CEPHALOCAUDAL = head to toe
PROXIMODISTAL = from center outwardly towards the fingers and going down to feet/toes
```
112
Warning Signs Indicating Problems With SENSORY DEVELOPMENT
- Young infant does not respond to loud noises.
- Child does not focus on a near object.
- Infant does not start to make sounds or babble by 4 months of age.
- Infant does not turn to locate sound at age 4 months.
- Infant crosses eyes most of the time at age 6 months.
113
Warning Signs Indicating Problems With LANGUAGE DEVELOPMENT
- Infant does not make sounds at 4 months of age.
- Infant does not laugh or squeal by 6 months of age.
- Infant does not babble by 8 months of age; infant does not use single words with meaning at 12 months of age (mama, dada).
114
Social and Emotional Development of the Infant
Stranger anxiety
- Indicates infant recognizes self as separate from others
Separation anxiety
- Infant becomes distressed when parent leaves
Temperament
- Ranges from low to moderately active, regular, and predictable, to highly active, more intense, and less adaptable
Cultural differences
115
EXCEPTION TO BREASTFEEDING
- if the infant is galactosemia
- Maternal use of illicit drugs and a few prescription medications
- Maternal untreated active tuberculosis
- Maternal HIV infection in developed countries
116
Nutritional Plan First Year of Life
- Optimal feeding pattern
- Infant feeding opportunity to establish good eating behaviors
- Special formulas have been developed to meet the nutritional needs of infants with allergies or disorders
117
nutrition after 6 months
- Nutrients available in solid foods in addition to breast milk or formula
- Introduce one new food every 4 to 7 days for identification of food allergies
118
Role of Nurse on growth and development
Promote early learning, safety, proper nutrition, healthy sleep and rest, healthy teeth and gums, and appropriate discipline techniques
119
Common Developmental Concerns in Infancy
Colic -
Spitting up
Thumb sucking, pacifiers, security items
Teething
120
average weight gain of a toddler
3-5 lbs per year
121
what time does the toddlers fontanel close
by 18 months
122
what age is the toddler head size more proportional to body
by age 3
123
average height of a toddler
Height increases an average of 3 in per year
124
physical growth of a toddler vs infant
toddler height and weight increase steadily in spurts at a slower rate than the infant
- Generally reach half adult height by age 2
125
Organ System Maturation: neurologic system
- Brain reaches about 90% of size by age 2
126
Organ System Maturation: respiratory system
Alveoli increase in number until age 7; trachea and airways small compared to adult
127
Organ System Maturation: Cardiovascular system
Heart rate decreases; blood pressure increases
128
Organ System Maturation: Gastrointestinal system
Stomach increases in size; small intestine grows in length; STOOL PASSAGE DECREASES
129
Organ System Maturation: Genitourinary system
Bladder and kidney reach adult function by 16 to 24 months; bladder capacity increases; urethra remains short.
130
Organ System Maturation: Musculoskeletal system
Bones increase in length; muscle matures; swayback and pot belly appear due to weak muscles until 3 years old.
131
what does Freud’s theory of growth focuses on
focuses on the satisfaction and/or frustration of expelling feces (anal stage).
132
what does piaget's theory of growth focuses on
focuses on development of the senses of the toddler.
133
what does erikson's theory of growth focuses on
focuses on achievement of autonomy and self-control.
134
what does kohlberg’s theory of growth focuses on
focuses on the moral development of the toddler.
135
what are some gross motor skills of a toddler
Include running, climbing, jumping, pushing or pulling a toy, throwing a ball, and pedaling a tricycle
136
what are some fine motor skills of a toddler
Progress from holding and pinching to the ability to manage utensils, hold a crayon, string a bead, and use a computer
137
Common occurrences of speech development of a toddler
Echolalia: repetition of words and phrases without understanding
Telegraphic speech: speech that contains only the essential words to get the point across
138
what is the Receptive language development
the ability to understand what is being said or asked
- Typically far more advanced than expressive language development (ability to communicate desires and feelings)
139
Sensory Development of a toddler
- Use all senses to explore the world
- Vision progresses
- Depth perception matures
- Hearing at adult level
- Sense of smell matures
- Taste discrimination not completely developed
140
Emotional and Social Development of the Toddler
- FOCUS
Separation
Seeing oneself as separate from the parent
- INDIVIDUATION
Forming a sense of self and learning to control one’s environment lead to emotional lability.
- EGOCENTRISM
Focus on self
141
Typical Behaviors of the Toddler
- May rely on a security item
- Becomes aware of gender differences
- May display aggressive behaviors
- May show fear of loss of parents and of strangers
- Becomes more self-aware; does not have clear body boundaries
Separation anxiety may reoccur
May resist invasive procedures
142
Promoting Growth and Development of the Toddler Through Play
- Play is the major socializing medium for toddlers.
- Toddlers need 30 minutes of structured physical activity and 1 to 3 hours of unstructured physical activity per day.
- Parents should limit television and encourage creative and physical play instead.
- Toddlers engage in parallel play (playing alongside another child) instead of cooperative play.
- Toddlers are egocentric and do not like to share.
- The short attention span of toddlers will make them change toys frequently.
- Toddlers do not need expensive toys.
143
Promoting Safety for the Toddler
- Provide a childproof environment
- Use a safe car seat in back of car
- Provide a safe home environment
* Avoid exposure to tobacco smoke
* Prevent injury
* Prevent poisoning
144
Sleep and Dental Health Requirements for the Toddler
- 18-month-old: 13.5 hours of sleep per day
- 24-month-old: 13 hours of sleep per day
- 3-year-old: 12 hours of sleep per day
- A typical toddler should sleep through the night and take one daytime nap
- Most children discontinue daytime napping at around 3 years of age
- 30 months toddler has full set of primary teeth
145
Toddlers who consume a strictly vegan diet (no food from animal sources) are at risk for what
are at risk for deficiencies in vitamin D, vitamin B12, and iron. - Supplementation with these nutrients should occur to promote adequate nutrition and growth.
146
Promoting Self-Feeding in Toddlers
- Use a child-sized spoon and fork with dull tines
- Seat the toddler in a high chair or at a comfortable height in a secure chair
- Never leave the toddler unattended while eating
- Minimize distractions during mealtime
147
Common Developmental Concerns of the Toddler
```
Toilet teaching
Negativism
Temper tantrums
Thumb sucking and pacifiers
Sibling rivalry
Aggression
```
148
Signs a Toddler Is Ready for Toilet Teaching
- Regular bowel movement
- Expresses knowledge of need to defecate or urinate
- The diaper is not always wet
- The toddler is willing to follow instructions
- The toddler walks well alone and can pull down pants
- The toddler follows caregiver to bathroom
- The toddler climbs onto potty chair or toilet
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Focus of Discipline for the Toddler
- Limit setting
- Negotiation
- Techniques to assist the toddler to learn problem solving
150
Physical Growth Developments of the Preschooler
- Average growth of 2.5 to 3 in per year
- Average weight gain around 5 lb per year
- Loss of baby fat and growth of muscle
- Length of skull increases slightly; lower jaw more pronounced; upper jaw widens
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expected gross motor skills of a 3 year old
- climbs well
- pedals tricycle
- runs easily
- walks up and down stairs with alternate feet
- bends over easily without falling
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expected fine motor skills of a 3 year old
- undress self
- copies circle
- builds tower of 9 or 10 cubes
- holds a pencil in writing position
- screws and unscrews lids, nuts, bolts
- turns book pages one at a time
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expected gross motor skills of a 4 year old
- throws ball overhand
- kicks ball forward
- catches bounced ball
- hops on one foot
- stands on one foot up to 5 seconds
- alternates feet going up and down steps
- moves backward and forward with agility
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expected fine motor skills of a 4 year old
- uses scissors successfully
- copies capital letter
- draws circles and squares
- traces a cross or diamond
- draws a person with two or four body parts
- laces shoes
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expected gross motor skills of a 5 year old
- stands on one foot 10 seconds or longer
- swings and climbs well
- may skip
- somersaults
- may learn to skate and swim
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expected fine motor skills of a 5 year old
- prints some letters
- draws person with body and at least six parts
- dresses/undresses without assistance
- can learn to tie laces
- uses fork, spoon, and knife (supervised) well
- copies triangle and other geometric patters
- mostly cares for own toileting needs
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Maturation of the Organ System (Preschooler)
- Myelination of the spinal cord allows for bowel and bladder control to be complete; small intestine grows in length.
- Respiratory structures continue to grow in size; number of alveoli increase.
- Eustachian tubes remain short and straight.
- Heart rate decreases; blood pressure increases slightly; innocent heart murmur may be heard.
- 20 deciduous teeth should be present.
- Urethra remains short in children, making them susceptible to urinary tract infections.
- Bones increase in length and muscles strengthen and mature.
158
Psychosocial Development of the Preschooler
- In Erikson’s stage of development: initiative versus guilt
Preschooler is an inquisitive and enthusiastic learner
Feels sense of accomplishment by succeeding in activities
Feeling pride in accomplishment stimulates initiative
Overextending self can result in sense of guilt
- Superego (conscious development) is completed and is basis for moral development
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Social Skills Developed by the Preschooler
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Cooperation
Sharing (of things and feelings)
Kindness
Generosity
Affection display
Conversation
Expression of feelings
Helping others
Making friends
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Emotional and Social Development of the Preschooler
FRIENDSHIPS
Preschoolers learn how to make and keep a friend
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Emotional and Social Development of the Preschooler
TEMPERAMENT
- Indicator of parent’s expectation of child’s behavior
| - Determines child’s task orientation, social flexibility, and reactivity
162
Emotional and Social Development of the Preschooler
FEARS
Preschoolers exhibit variety of fears
| Parents should acknowledge child’s fears
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Cognitive Development of the Preschooler
- Piaget’s theory
Preoperational stage
- Magical thinking
Believes thoughts are all-powerful
- Imaginary friend
Creative way to sample activities and behaviors and practice conversation skills
- Transduction
Extrapolates from one situation to another
- Animism
Attributes life-like qualities to inanimate objects
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Language Development OF A PRESCHOOLER
- Symbolic thought
- Do not understand the concept of death
- Acquisition of language allows for child to express thoughts and creativity
- Transition in this period from the use of telegraphic speech at age 3 years to the adult-like structure of sentences at age 5 years
165
Sample Nursing Diagnoses for Issues Related to Growth and Development
- Delayed growth and development
- Imbalanced nutrition, less than body requirements
- Interrupted family processes
- Readiness for enhanced parenting
- Risk for caregiver role strain
- Risk for delayed development
- Risk for disproportionate growth
- Risk for injury
166
Issues Involved in Promoting Growth and Development of the Preschooler
- Building self-esteem
- Maintaining routine and ritual
- Setting limits and remaining consistent with them
- Knowing signs of developmental delay
167
Focus of Nursing Care Plan to Promote Growth and Development of Preschooler
- Promoting growth through play
- Promoting early learning
- Promoting language development
- Choosing a preschool/starting kindergarten
- Promoting safety
- Promoting nutrition
- Promoting healthy sleep and rest
- Promoting appropriate discipline
168
Risks of Overweight and Obesity
Hypertension
Hyperlipidemia
Insulin resistance
169
Developmental Issues for Preschoolers
Lying
Sex education
Masturbation
170
Physiologic Growth of the School-Age Child
- Grow an average of 2 in per year
- Increase in height by at least 1 ft
- Increase weight by 4 to 6 lb
- Secondary sexual characteristics appear
171
Organ System Maturation (School-Age Child)
- Neurologic system: brain and skull grow very slowly; shape of head is longer; growth of facial bones changes facial proportions
- Respiratory system: continues to mature with development of lungs and alveoli; respiratory rates increase; respirations diaphragmatic in nature
- Cardiovascular system: blood pressure increases and pulse rate decreases
- Immune system: matures to adult level around 10 years old; fewer infections experienced
- Gastrointestinal system: deciduous teeth replaced by permanent teeth; fewer gastrointestinal upsets; stomach capacity increases; caloric needs are lower
- Genitourinary system: bladder capacity increases (age in years plus 2 oz); prepubescence occurs
- Musculoskeletal system: greater coordination and strength; muscle still immature and can easily be injured
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Piaget’s Stage of Cognitive Development of Concrete Operational Thoughts (7 to 11 Years)
- Assimilates and coordinates information about the world from different dimensions
Sees things from another person’s point of view
- Thinks through an action, anticipates consequences and the possibility of having to rethink the action
- Stores memories of past experiences to evaluate present situations
- Divides things into different sets and identifies relationships to each other
- Understands the principle of conservation: matter does not change when its form changes
173
Erikson’s Theory
- Industry versus inferiority
- Developing sense of self-worth
- Developing cognitive and social skills
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Benefits of Physical Activity for the School-Age Child
- Cardiovascular fitness
- Weight control
- Emotional tension release
- Development of leadership and following skills
175
Language and Communication Skills (School-Age Child)
- Vocabulary expands from 8,000 to 14,000 words.
- Culturally specific words are used.
- Reading efficiency improves language skills.
- More complex grammatical forms are used.
- Development of metalinguistic awareness occurs.
- Metaphors are beginning to be understood.
176
Emotional and Social Developmental Issues (School-Age Child)
- Temperament
- Self-esteem development
- Body image
- School-age fears
- Peer relationships
- Teacher and school influences
- Family influences
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Sensory Development of the School-Age Child
- All senses are mature.
- Typical child has 20/20 vision acuity.
- Ocular muscular control, peripheral vision, and color discrimination are developed by age 7.
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Vision Problems Frequently Identified in School-Age Children
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- Amblyopia (lazy eye)
Causes
Cross eyed
Nearsightedness
Farsightedness
Astigmatism
- Uncorrected refractive errors or other eye defects
- Malalignment of the eyes (strabismus)
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179
Cultural Influences on Growth and Development (School-Age Child)
Habits
Beliefs
Language
Values
180
Safety Issues for the School-Age Child
- Car safety
- Pedestrian safety
- Bicycle and sport safety
- Fire safety
-
Water safety
- Abuse in children
181
Promoting Appropriate Discipline (School-Age Child)
- Children learn the natural and logical consequences of discipline.
- Parents should teach children rules established by the family, values, and social rules of conduct.
- Discipline should focus on the development of the child.
- Parents should discipline with praise.
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Factors Determining Type and Amount of Discipline
- Developmental level of both the child and the parents
- Severity of the misbehavior
- Established rules of the family
- Temperament of the child
- Response of the child to rewards
183
Developmental Concerns (School-Age Child)
- Television and video games
- School phobia
- Latchkey children
- Stealing, lying, cheating
- Bullying
184
Promoting Sleep and Rest (School-Age Child)
- 12 hours of sleep required
- Should have bedtime expectations and wake-up times
- Night terrors and sleepwalking may occur but should resolve by age 8 to 10 years
185
Physiologic Growth and Development (Adolescent)
- Rapid growth occurs with dramatic changes in body size and proportions second only to growth in infancy.
- Sexual characteristics and reproductive maturity occur.
- Puberty begins in girls around 9 to 10 years old and in boys around 10 to 11 years old.
- Adolescents represent varying levels of identity formation.
186
Puberty in Adolescent
- Girls enter earlier than boys
- Girls 9 to 10 years old
- Boys 10 to 11 years old
187
Changes in Adolescence
- Secretion of estrogen in girls and testosterone in boys stimulates physical sexual changes.
- Physical development, hormonal changes, and sexual maturation occur during puberty.
- Peak height velocity occurs at about 12 years of age in girls and 14 years of age in boys.
- Muscle mass increases in boys and fat deposits increase in girls.
188
Organ System Maturation (Adolescent)
- Neurologic system: growth of myelin sheath enables faster neural processing.
- Respiratory system: increase in diameter and length of the lungs; respiratory volume and vital capacity increase.
- Cardiovascular system: size and strength of heart increase; systolic blood pressure and heart rate increase.
- Gastrointestinal system: full set of permanent teeth; liver, spleen, kidneys, and digestive tract enlarge.
- Musculoskeletal system: ossification of skeletal system is incomplete until late adolescence in boys and occurs earlier in girls; shoulder, chest, and hip breadth increase.
- Integumentary system: skin is thick and tough; sebaceous glands are more active; sweat glands function at adult level.
189
Theories of adolescence
- Erikson’s theory (identity versus role confusion) states that during adolescence teenagers have the task of developing their own sense of identity by revisiting each of the previous stages of development
- Piaget’s theory states that the adolescent progresses from a concrete framework of thinking to an abstract one in the formal operational period
- Kohlberg’s theory states that adolescents are experiencing the postconventional stage of moral development
190
Language Skills of adolescence
- Develop and be refined during adolescence and adolescents have improved communication skills, using correct grammar and parts of speech.
- Use of slang and how it can affect communication with people other than peers.
191
Change in Relationships ADOLESCENTS
- Families and parents of adolescents experience changes and conflict that require adjustments and the understanding
- The adolescent–family relationship is essential for the nurse when caring for this population
- Peer groups play an essential role in the identity of the adolescent
192
Safety Concerns for Adolescents
- Unintentional injuries
- Motor vehicle safety
- Firearm safety
- Water safety
193
Nutritional Requirements FOR ADOLESCENTS
- Increased due to accelerated growth and sexual maturation
| - Increased calories, zinc, calcium, iron for growth
194
Information Included in Nutritional Assessment for an Adolescent
- Evaluation of foods from the different food groups that the adolescent eats each day
- The number of times that fast foods, snacks, and other junk food are eaten per week
= This assessment will help the nurse to guide the adolescent in making better food choices at home and in fast-food establishments.
195
Sexuality and Influence of Dating
Develop an interest or romantic attractions during adolescence related to physical development and body changes, peer group pressure, and curiosity
196
Risks of Being Involved in an Unhealthy Romantic Relationship
- Dating violence
- Risky sexual activity (STIs)
- Premature pregnancy
197
Areas of Focus to Encourage Growth and Development in the Adolescent
- Sports and physical fitness
- Learning and participation in school activities
Safety issues
- Proper nutrition and healthy eating habits
- Healthy sleep and rest
- Personal care
- Healthy sexual life
- Appropriate discipline
198
Promoting Proper Hygiene for Adolescents
- Encourage frequent bathing and deodorant use.
- Encourage washing face two to three times a day.
- Discourage squeezing acne lesions and vigorous scrubbing of face.
- Encourage frequent shampooing of hair.
- Teach care for body piercings and tattoos.
- Discourage suntanning.
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Caring for the Hospitalized Adolescent
- Provide opportunities for adolescent to maintain independence.
- Allow adolescent to participate in decisions.
- Encourage socialization with friends through phone, e-mail, and visits when possible.
200
Developmental Concerns for the Adolescent
- Violence
- Suicide
- Homicide
- Substance use
201
Common Substances Abused by Children and Adolescents
- Alcohol and prescribed medications
- Hallucinogens, sedatives, analgesics
- Anxiolytics
- Steroids
- Inhalants (inhaling fumes of common household products)
- Stimulants, opiates
- Various club drugs such as ecstasy, GHB, and LSD
202
Topics for Discussion to Discourage Substance Abuse
- Short- and long-term effects of alcohol, tobacco, and drugs on health
- Risk factors and implications for unintentional injuries and sexual activity
- The how and why of chemical dependency
- Impact of substance abuse on society
- Importance of maintaining a healthy lifestyle
- Importance of resisting peer pressure to use drugs and alcohol
- Importance of having confidence in teen’s own judgment
