Exam 1- Health Promotion in the Toddler, Preschooler, School Aged Child, and Adolescent Flashcards

(116 cards)

1
Q

toddler age range

A

12 months through 36 months

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2
Q

Toddler – Physical Development

A

Physical growth – 5 lb./yr weight 3 in/yr Ht

Physiologic anorexia

Anterior fontanel closes 12 to 18 months

Achieves 50% of adult height by 2 years

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3
Q

Toddler – Gross Motor

A

Walking by 15 months

Climbing on anything

Removing clothing

Stoops and recovers

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4
Q

Toddler – Gross Motor

A

By 18 months

Runs clumsily, falls often

Walks up stairs with hand held

Jumps in place with both feet

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5
Q

Toddler – 24 mo – Gross Motor

A

Throws ball over hand. Kicks ball.

Goes up and down stairs with 2 feet on each step

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6
Q

Toddler – Gross Motor

A

By 30 months –
Jumps from chair, steps, anything
Stands on one foot momentarily

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7
Q

Fine Motor

A

Scribbles
Can use a spoon and toothbrush, but messy
2 yr. wash and dry hands

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8
Q

Toddler- Negativism and Ritualism

A

Really want to be an adult

Ask them to do something and they will say “no”

Ask them to help you the adult do something they are doing, and you will get a Big Yes

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9
Q

Critical Tasks of Toddler Period

A

Recognition of self as a separate person with own will

Control of impulses and acquisition of socially acceptable ways to communicate wants and needs

Control of elimination

Toleration of separation from parent

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10
Q

Preoperational Thinking

A

Egocentrism – views everything in relation to self and is unable to consider another’s point of view

Animism– Believes that inert objects are alive and have wills of their own

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11
Q

Preoperational

A

Irreversibility – Cannot see a process in reverse order. Can not follow a line of reasoning back to its beginning.

Magical thought – wishing something will make it happen

Believe that their thoughts are all powerful

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12
Q

Preoperational

A

Centration – Tends to focus on one aspect of an experience. May have difficulty putting together a puzzle. Focuses on dominant characteristics of an object

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13
Q

Moral and Spiritual

A

Kohlberg
Preconventional or Premoral phase
Whether an action is good or bad depends on whether it is rewarded or punished

Fowler
Spirituality is based on images and imagination

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14
Q

Language/communication

A

15 – 18 mo – Putting two words together (25% intelligible)

Understands simple directions

2 – 3 word phrases by 2 years (50% intelligible)

3 – 4 word sentences by 3 years (75% intelligible)

Own first and last name can be stated by 2 ½ to 3 years

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15
Q

Communicating with the Toddler

A

Ask parents what his words for things like urination are

Tell exactly what you are going to do just before you are going to do it

A combination of words and gestures for expressing wants–Holographic speech

Are learning to name body parts

Concerned about body
Boo boos
Male vs. female

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16
Q

Well-Child Visit

A

Blood Lead Level at 1 year & 2 year visit
Hgb/Hct
Vision – cover, uncover test

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17
Q

Parenting Issues – Toddler years

A

Discipline
Toilet Training
Temper Tantrums

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18
Q

Discipline

A

Consistent limits

Positive reinforcement

Immediate consequences

Redirection or distractions

Time outs: 1 minute per year of age

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19
Q

Readiness for toilet training

A

Can remove own clothing

Is willing to let go of a toy when asked

Has been walking well for one year

Notices when diaper is wet

Communicates need to go to bathroom

Wants to please parent by staying dry

Family not under major stressors

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20
Q

Temper Tantrums

A

Limited language leads to frustration

Anticipate

Inconsistent parental practices increase frequency of tantrums

Isolate safely and ignore

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21
Q

Anticipatory Teaching

A

Regular meal times with utensils that fit, with family

Soft toothbrush, non-fluoride toothpaste

Sleep about 12 – 14 hr/day, 1 nap

Limit TV viewing to < 1 hr day

Bedtime routine

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22
Q

Nutrition

A

Toddlers have the highest number of taste buds and the higher degree of taste sensitivity.

Eating jags

1 Tbsp of solid food per year of age

Ritualism = regular meal times

Whole milk at 1 year – 24 – 30 oz/day

100% juice – 4 – 6 oz/day – Cup only

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23
Q

Domestic mimicry –Symbolic Play

A

Imitating parent of same sex in household tasks – domestic mimicry

Deferred imitation is imitating the parent after they have left their sight

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24
Q

Toddler – Age Appropriate Toys

A

Noise-making, push-pull toys, riding toys, work bench, toy hammers, musical anything, drums, pots and pans

blocks, puzzles with very few large pieces

finger paints, crayons, clay

dolls/stuffed animals

Toy telephones

Storybooks with pictures

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25
Acetaminophen Poisoning
Most common accidental drug poisoning in children Toxic dose is 150mg/kg or greater in children Multiple formulation and concentrations make chronic acetaminophen toxicity a significant problem
26
Acetaminophen Poisoning
Treatment: Antidote N-acetylcysteine (Mucomyst) can usually be given orally Dilute with fruit juice or soda Give loading dose, then 17 maintenance doses
27
“The US Food and Drug Administration (FDA) issued an important warning related to the safety of acetaminophen. The FDA recommended that healthcare professionals discontinue prescribing and dispensing prescription combination drug products that contain more than 325 mg of acetaminophen per tablet, capsule, or other dosing formulations.”
true
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Lead Blood Levels
Blood test done if infant is at risk at any time Universal Lead Serum Test is done at 1 year and 2 years
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Lead Poisoning
Children who are iron deficient absorb lead more readily than those with sufficient iron stores Lead interferes with the binding of iron onto the heme molecule
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Long-term neurocognitive signs of lead poisoning
Developmental delays Lowered IQ (intelligence quotient) Reading skill deficits Visual-spatial problems Visual-motor problems Learning disabilities
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Hospitalization and Toddler Interferes with the developmental task of developing a sense of control and autonomy
Major Fears Loss of Control Separation
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Nursing supportive Interventions for Toddler and Family
Minimize separation from parents Explain and maintain consistent limits Simple brief explanations Ask about home routines & rituals
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Nursing supportive interventions for Toddler and Family
Teach parents to explain their plans to the child (“I will be back after your nap.”) Provide sensory play (water play, finger painting) Trips to the playroom – mobility is very important to their development Expect regression
34
Normal Vital Signs for Toddlers
Heart Rate: 90 – 140 Respiratory Rate: 24 – 40 Systolic BP: 80 – 112 Diastolic BP: 50 – 80
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Preschool – 3 yr – 6 yr
A Powerhouse of gross motor activity. Play and fantasy are important. Has a fear of abandonment.
36
Physical Development
Growth still about the same as in the toddler period. 5 lb/yr (2.25kg) Weight Average wt. of 3 yr. old is 32 lb. ( 14 – 15 kg) 2 -3 inches Ht per year Teeth – now at age 3 has all 20 primary teeth May have achieved night time bowel and bladder control
37
Preschool Gross Motor
Runs well A 3 year old can ride a tricycle Hops on one foot at about 4 yr Walks up and down stairs well

38
Preschool Fine Motor
Uses scissors at 4 years Ties shoelaces at 5 years Washes hands Scribbles and draws. Important for learning to read.
39
Psychosocial
Starting to develop an ability to separate from parents for a while Preschoolers much more sociable and willing to please than toddlers
40
Kohlberg
Preschoolers: Premoral (or Preconventional) before the age of 4yr – based on punishment or reward Have a concrete sense of justice and fairness
41
Language
Uses 3 and 4 word sentences. (the age + 1 = # of words in sentence) 3yr old + 1 = 4 word sentences Vocabulary increases from 300 words at 2 yr of age to 2100 word at 5 yr Bilingual children reach language milestones at the same time as monolinguals By 4 yr should be counting and naming colors
42
Speech
Most critical period for speech development occurs between 2 and 4 years Stammer as they try to say a word they are already thinking of – developmental stuttering
43
Communication with Preschooler
Simple sentences Careful with what words you use Use play in explaining Starting to speak in full sentences
44
Social/Emotional
Imaginary playmates Play very important Aggressiveness at 4 years is replaced by more independence at 5 years.
45
Sex education
Sexual curiosity Masturbation is normal Interested in anatomical differences Find out what children know and think Be honest, use correct names for anatomical parts
46
Development of gender identification
Gender identification – identify with same sex parent while developing strong attachments to opposite sex parent Gender identification occurs around 3 yr.
47
Therapeutic play
Provides an emotional outlet Pre-op teaching Help reduce fear
48
Preschooler Toys
3 year old – Rides tricycle– needs helmet 4 year old – climbs and jumps and skips 5 year old – skips on alternate feet; ties shoes; beginning of cooperative play Imitative of adult patterns and roles. Offer playground materials, housekeeping toys, coloring books,
49
Toys for the hospitalized preschooler
``` Coloring books Puzzles Cutting and Pasting Dolls Building blocks Clay Pretend medical equipment ```
50
Well child visit for Preschooler
Hgb done between 3 & 5 yr Normal: Hgb 11.5 – 14.5 g/dL Lead screening if not done at 1 & 2 yr. or at risk Urinalysis – once between 15 mo. & 5 yr Bedwetting – if have been dry at night, then start wetting bed again, usually due to UTI
51
Anticipatory Teaching
Sexual curiosity, anatomic explorations, masturbation common and normal Sleep – 10 – 12 hours in 24 hour period Sleep problems common because of active imagination
52
Sleep problems
Nightmares- Scarey dream followed by full waking Occurs in REM sleep in second half of night Crying and aware of presence of another person Professional counseling for recurrent nightmares Night Terrors- Partial arousal from very deep sleep Non-REM sleep in first few hours of sleep Screaming, not aware of another person’s presence Night terrors normal, and no intervention needed
53
Nightmares =
counciling
54
Night Terrors
No counciling
55
Limit TV watching to 1 – 2 hours
Extensive television viewing is associated with sleep problems in preschoolers
56
Vision Screening
Vision screening begins at 3 years “Tumbling E” or Lea symbol chart Amblyopia needs to be detected and treated before the age of 4yr.
57
Parenting Issues -- Preschool
Balancing the child’s need to develop independence and initiative with the need to set limits Ignore bad behavior & reward good behavior Time Out – 1 minute per year of age
58
Safety
Water – Highest risk for drowning is in preschool period Fire – stop,drop,roll Sports Safety– helmets Car Seat – Keep your child rear-facing as long as possible. Should be rear-facing till wt. and ht. limit of car seat is reached. Booster seat when outgrows are seat
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Prevention of sex abuse
Teaching children normal, healthy boundaries of their bodies Tell someone
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Diet and Nutrition
Milk 2% is still 2 – 3 cups/day Juice (100%) still limit 4 – 6 oz /day Calcium needs for children 1 – 3 yr is 500mg/day and for children 4 – 8 yr is 800 mg/day
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Dental
First dental exam at 3 yr. Brush teeth 2 x day See dentist every 6 months Fluoride supplementation
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The preschool child and hospitalization
Major fears Bodily injury and being abandoned. Fear of anything that he views as a hostile invasion of his body.
63
Hospitalization & Preschooler
Follow home routines Parents close and involved Tell child that he did not cause the illness Accept regression and explain to parents
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Normal Vital Signs for Preschoolers
Heart Rate: 80 – 110 Respiratory Rate: 22 – 34 Systolic BP: 82 – 110 Diastolic BP: 50 – 78
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School Age
6 – 12 year
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Physical
Slow steady growth - -Wt. gain: 5 ½ lb/yr - --Ht. : 2 in/yr Growth spurt at 10 – 12 hr for girls at the onset of puberty Two years later for boys around 12 – 14yr
67
Physical
Enlarged tonsils and adenoids are common during these years and are not always an indication of illness. IgA & IgG levels are at adult levels at 10 yr.
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Motor
Constant activity – Gross motor Musical instruments & Eye-hand coordination – Fine motor development
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Sensory
Eyes fully developed by 7 yr. Growth spurt in eyes leads to myopia Yearly visual screenings – Using Snellen chart
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School Age Child Erikson’s Stage is
Industry vs. Inferiority Mastering useful skills and doing them well are important Competence
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School Age Child
Egocentric thinking is replaced by social awareness of others Socialization with peers becomes important Parents still have a strong influence
 Relative period of calm
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Cognitive Concrete Operations:
1. Reversibility 2. Conservation - Milk glasses or 1 lb of rocks/feathers 3. Classification & Logic 4. Humor
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Spiritual Development
Follows family’s religious practices Religious concepts must be presented in concrete terms God is viewed in human terms
74
Moral Development (Kohlberg)
Conventional Stage of Moral Development --Younger school age children obey authority --And follow rules --Views are black and white
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Anticipatory Guidance
Resistant to baths and showers, brushing teeth, everything Then showers all the time Sleep – Reduces from 12 hr at 6yr to 9 or 10 hr for a 12 year old
76
Promoting Self Esteem
Give child household responsibilities Emphasize child’s strengths Do not do their homework or science project for them Allow children to make mistakes Consistency
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Health promotion
Need a health care visit about every 2 years Scoliosis screening Nutrition -- There is increase in appetite What did you eat for breakfast, for lunch
78
The vitamins most often consumed in less than appropriate amounts by preschool and school-age children are:
Vitamin A Vitamin C Vitamin B6 Vitamin B12
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Obesity
Genetic, cultural, environmental, socioeconomic Unstructured meal, fast-food Lack of exercise Food as reward
80
Limit TV to 2 hr or less a day
true
81
One variable that did modify the interaction between violent video games, aggressive cognitions, and aggressive behaviors was age.
Games had a greater impact on aggressive cognitions among younger children.
82
Dental
Loss of primary teeth and eruption of permanent teeth – will replace about 4 teeth per year until 12 years Fluoride toothpaste, flossing Dental sealants Mouth protectors Dangers of smokeless tobacco
83
Safety
``` Car Seats Firm limits and rules Helmets, knee pads, etc. Water safety Self care children Gun safety ```
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Car Seats -- 8 – 12 years
Keep child in a booster seat until big enough to fit seatbelt. Seat belt fits properly when the lap belt lies snugly across the upper thighs, not the stomach. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face.
85
Firearm Safety
Avoid having firearms in the house Lock ammunition and firearm in separate cabinets Talk about firearms – what to do if you find a gun at school or at a friend’s house
86
Leading cause of death in children 5 – 14yr
1. Accidents – Most accidents occur between 3p & 6pm 2. Malignant neoplasms 3. Congenital anomalies 4. Assault/homicide 5. Suicide/self-harm
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Hospitalization of the school aged child
FEARS Loss of control Body injury Failure to live up to expectations Death 1. Provide choices 2. Provide concrete explanations 3. Contact with peers 4. Emphasize normal things the child
88
By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible.
true
89
Toys for school-age child
``` Board games Card games Hobbies, collections Puzzles Video games ```
90
Communicating with School Age
Audiovisual aids work well Drawing Drawing is a very valuable form of communication Conversation Ask about school and friends Expanding vocabulary Pages 125 & 126
91
School-age
Cooperative play and sports Repair, building, mechanical activities Table games
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Adolescence 12 - 18 yr
Developing a sense of identity. Developing independence from family. Establishing meaningful relationships with peers
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Physical
Rapid – Peak height velocity (PHV) Girls – 12 yr Boys – 14 yr Growth in ht for girls ceases about 2 – 2 ½ yr after menarche Girls – growth and sexual maturation occur about 2 years earlier than boys ------Increase fat deposits Boys –Muscle mass
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Gynecomastia
May occur with normal achievement of male puberty and resolves within 1 year Can be caused by anabolic steroid use or endocrine disorders Testosterone supplementation may aggravate gynecomastia
95
Early Adolescence
11 – 14 years Characterized primarily by the changes in puberty Preoccupied with rapid body changes Decline in self-esteem Imaginary audience, Personal fable
96
Middle Adolescence
15 – 17 years Conformity 46.7% sexual intercourse experience Peer orientation of peak importance, and acceptance by peers is total focus Abstract thinking – Idealistic, political & social concerns
97
Late adolescence
18 – 21 yr Idealistic Emancipation Transition into adulthood
98
Spiritual
Beliefs become more abstract Kohlberg stage 4 and 5 Question family’s values and religion
99
Cognitive
New findings show that the greatest changes to the parts of the brain that are responsible for functions such as self-control, judgment, emotions, and organization occur between puberty and adulthood. Overproduction, then pruning of neurons in response to puberty.
100
Leading cause of death 15 – 19 yr.
1. Accidents – 40% of all teen deaths is the U.S. are the result of motor vehicle accidents 2. Homicide 3. Suicide 4. Malignant neoplasms 5. Heart diseases
101
Parenting Issues
Discipline – focus on encouraging teen to make decisions and understand consequences Save battles for important things
102
Communicating with adolescents
Ensure confidentiality and privacy Interview alone. And first. May interview parents afterwards. Adolescents will share more information when it is gathered during a casual conversation. Explain limits of confidentiality (abuse,suicide) Open ended questions -- Direct questions may illicit little information
103
Adolescent communication cont’
In education, give details, include audiovisual material Never talk down to Able to comprehend adult concepts. When teaching adolescents, the focus on the here and now – “How will this affect me today?”
104
Warning Signs of Suicide
preoccupation with death and focused on morbid thoughts wants to give away cherished possessions loss of interest/energy changes in sleep recurrent stomach aches/ headaches reckless behavior anti social sudden cheerfulness after depression
105
Diet
Weight and fat deposition that is normal in puberty may lead to body image problems and eating disorders. Nutritional requirements are at their peak during adolescence Health promotion especially in adolescent girls should provide teaching about normal body changes
106
Vegetarian/Vegan
Benefits: Low-fat, high fiber Reduce risk of obesity, Type 2 Diabetes, Cardiovascular disease Economical Disadvantages: Vegan – low Vit. D, Vit. B12, Calcium, and omega-3 fatty acids, iron, and zinc Vegetarian – Vit. B12
107
Eating Disorders
Obesity Anorexia nervosa Bulimia
108
Alcohol
Studies of 15 and 16 year olds showed cognitive impairments in teen alcohol abusers, compared with non-abusing peers, even weeks after they stop drinking. This suggests that abuse of alcohol by teens may have long-term negative effects
109
Marijuana
Early, long term use linked with drop in IQ Synthetic marijuana responsible for increased incidence of kidney failure in adolescents
110
Smoking Statistics
In 2013, 22.9% of high school students reported current use of a tobacco product, including 12.6% who reported current use of two or more tobacco products. More students using smokeless tobacco or cigars
111
Antismoking Campaigns
Peer-led programs Emphasize social consequences rather than long-term health problems Use of multimedia images School and community settings Begin in elementary school and continue through high school
112
Hospitalization and the adolescent
Major fears: Loss of control Altered body image Separation from peer group
113
Supportive interventions for adolescents
Hospitalization of adolescents disrupts school and peer activities; they need to maintain contact with both. Alteration in body image can be devastating Teaching about procedures should include time without the parents present. When parents are present, direct questions to the adolescent , not the parents
114
Supportive interventions for adolescents
Realize risk taking, rebelliousness,etc. is normal in adolescence Encourage socialization with peers Encourage increased responsibility for care and management of the disease or condition Emphasize good appearance, stylish clothes Encourage activities appropriate for age (driver’s license, etc.)
115
Developmental Care for Chronically Ill Adolescent
Privacy Encourage to wear street clothes Use scientific and medical terminology to prepare for procedures Encourage questions about appearance and future with illness Encourage peers to call and visit often
116
Concepts of Bodily Injury by age
Infants: After 6 months, their cognitive development allows them to remember pain. Toddlers: They fear intrusive procedures Preschoolers: they fear body mutilation School-age children: They fear loss of control of their bodies Adolescents: Their major concern is change in body image.