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

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

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
Q

Acetaminophen Poisoning

A

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

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26
Q

Acetaminophen Poisoning

A

Treatment:
Antidote N-acetylcysteine (Mucomyst) can usually be given orally

Dilute with fruit juice or soda

Give loading dose, then 17 maintenance doses

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27
Q

“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.”

A

true

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28
Q

Lead Blood Levels

A

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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29
Q

Lead Poisoning

A

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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30
Q

Long-term neurocognitive signs of lead poisoning

A

Developmental delays

Lowered IQ (intelligence quotient)

Reading skill deficits

Visual-spatial problems

Visual-motor problems

Learning disabilities

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31
Q

Hospitalization and Toddler

Interferes with the developmental task of developing a sense of control and autonomy

A

Major Fears
Loss of Control
Separation

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32
Q

Nursing supportive Interventions for Toddler and Family

A

Minimize separation from parents

Explain and maintain consistent limits

Simple brief explanations

Ask about home routines & rituals

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33
Q

Nursing supportive interventions for Toddler and Family

A

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

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34
Q

Normal Vital Signs for Toddlers

A

Heart Rate: 90 – 140
Respiratory Rate: 24 – 40

Systolic BP: 80 – 112
Diastolic BP: 50 – 80

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35
Q

Preschool – 3 yr – 6 yr

A

A Powerhouse of gross motor activity.

Play and fantasy are important.
Has a fear of abandonment.

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36
Q

Physical Development

A

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

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37
Q

Preschool Gross Motor

A

Runs well

A 3 year old can ride a tricycle

Hops on one foot at about 4 yr

Walks up and down stairs well


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38
Q

Preschool Fine Motor

A

Uses scissors at 4 years

Ties shoelaces at 5 years

Washes hands

Scribbles and draws. Important for learning to read.

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39
Q

Psychosocial

A

Starting to develop an ability to separate from parents for a while

Preschoolers much more sociable and willing to please than toddlers

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40
Q

Kohlberg

A

Preschoolers: Premoral (or Preconventional) before the age of 4yr – based on punishment or reward

Have a concrete sense of justice and fairness

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41
Q

Language

A

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

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42
Q

Speech

A

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

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43
Q

Communication with Preschooler

A

Simple sentences
Careful with what words you use
Use play in explaining

Starting to speak in full sentences

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44
Q

Social/Emotional

A

Imaginary playmates

Play very important

Aggressiveness at 4 years is replaced by more independence at 5 years.

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45
Q

Sex education

A

Sexual curiosity

Masturbation is normal

Interested in anatomical differences

Find out what children know and think

Be honest, use correct names for anatomical parts

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46
Q

Development of gender identification

A

Gender identification – identify with same sex parent while developing strong attachments to opposite sex parent

Gender identification occurs around 3 yr.

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47
Q

Therapeutic play

A

Provides an emotional outlet
Pre-op teaching
Help reduce fear

48
Q

Preschooler Toys

A

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
Q

Toys for the hospitalized preschooler

A 
Coloring books
Puzzles
Cutting and Pasting
Dolls
Building blocks
Clay
Pretend medical equipment
50
Q

Well child visit for Preschooler

A

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
Q

Anticipatory Teaching

A

Sexual curiosity, anatomic explorations, masturbation common and normal

Sleep – 10 – 12 hours in 24 hour period

Sleep problems common because of active imagination

52
Q

Sleep problems

A

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
Q

Nightmares =

A

counciling

54
Q

Night Terrors

A

No counciling

55
Q

Limit TV watching to 1 – 2 hours

A

Extensive television viewing is associated with sleep problems in preschoolers

56
Q

Vision Screening

A

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
Q

Parenting Issues – Preschool

A

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
Q

Safety

A

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

59
Q

Prevention of sex abuse

A

Teaching children normal, healthy boundaries of their bodies

Tell someone

60
Q

Diet and Nutrition

A

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

61
Q

Dental

A

First dental exam at 3 yr.

Brush teeth 2 x day

See dentist every 6 months

Fluoride supplementation

62
Q

The preschool child and hospitalization

A

Major fears

Bodily injury and being abandoned.

Fear of anything that he views as a hostile invasion of his body.

63
Q

Hospitalization & Preschooler

A

Follow home routines

Parents close and involved

Tell child that he did not cause the illness

Accept regression and explain to parents

64
Q

Normal Vital Signs for Preschoolers

A

Heart Rate: 80 – 110

Respiratory Rate: 22 – 34

Systolic BP: 82 – 110
Diastolic BP: 50 – 78

65
Q

School Age

A

6 – 12 year

66
Q

Physical

A

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
Q

Physical

A

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.

68
Q

Motor

A

Constant activity – Gross motor

Musical instruments & Eye-hand coordination – Fine motor development

69
Q

Sensory

A

Eyes fully developed by 7 yr.

Growth spurt in eyes leads to myopia

Yearly visual screenings – Using Snellen chart

70
Q

School Age Child

Erikson’s Stage is

A

Industry vs. Inferiority

Mastering useful skills and doing them well are important

Competence

71
Q

School Age Child

A

Egocentric thinking is replaced by social awareness of others

Socialization with peers becomes important

Parents still have a strong influence

Relative period of calm

72
Q

Cognitive

Concrete Operations:

A
  1. Reversibility
  2. Conservation - Milk glasses or 1 lb of rocks/feathers
  3. Classification & Logic
  4. Humor
73
Q

Spiritual Development

A

Follows family’s religious practices

Religious concepts must be presented in concrete terms

God is viewed in human terms

74
Q

Moral Development (Kohlberg)

A

Conventional Stage of Moral Development

–Younger school age children obey authority

–And follow rules

–Views are black and white

75
Q

Anticipatory Guidance

A

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
Q

Promoting Self Esteem

A

Give child household responsibilities

Emphasize child’s strengths

Do not do their homework or science project for them

Allow children to make mistakes

Consistency

77
Q

Health promotion

A

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
Q

The vitamins most often consumed in less than appropriate amounts by preschool and school-age children are:

A

Vitamin A
Vitamin C
Vitamin B6
Vitamin B12

79
Q

Obesity

A

Genetic, cultural, environmental, socioeconomic

Unstructured meal, fast-food

Lack of exercise

Food as reward

80
Q

Limit TV to 2 hr or less a day

A

true

81
Q

One variable that did modify the interaction between violent video games, aggressive cognitions, and aggressive behaviors was age.

A

Games had a greater impact on aggressive cognitions among younger children.

82
Q

Dental

A

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
Q

Safety

A 
Car Seats
Firm limits and rules
Helmets, knee pads, etc.
Water safety
Self care children
Gun safety
84
Q

Car Seats – 8 – 12 years

A

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
Q

Firearm Safety

A

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
Q

Leading cause of death in children 5 – 14yr

A
  1. Accidents – Most accidents occur between 3p & 6pm
  2. Malignant neoplasms
  3. Congenital anomalies
  4. Assault/homicide
  5. Suicide/self-harm
87
Q

Hospitalization of the school aged child

A

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
Q

By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible.

A

true

89
Q

Toys for school-age child

A 
Board games
Card games
Hobbies, collections
Puzzles
Video games
90
Q

Communicating with School Age

A

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
Q

School-age

A

Cooperative play and sports

Repair, building, mechanical activities

Table games

92
Q

Adolescence 12 - 18 yr

A

Developing a sense of identity.
Developing independence from family.
Establishing meaningful relationships with peers

93
Q

Physical

A

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

94
Q

Gynecomastia

A

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
Q

Early Adolescence

A

11 – 14 years

Characterized primarily by the changes in puberty

Preoccupied with rapid body changes

Decline in self-esteem

Imaginary audience, Personal fable

96
Q

Middle Adolescence

A

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
Q

Late adolescence

A

18 – 21 yr
Idealistic
Emancipation

Transition into adulthood

98
Q

Spiritual

A

Beliefs become more abstract

Kohlberg stage 4 and 5

Question family’s values and religion

99
Q

Cognitive

A

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
Q

Leading cause of death 15 – 19 yr.

A
  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
Q

Parenting Issues

A

Discipline – focus on encouraging teen to make decisions and understand consequences

Save battles for important things

102
Q

Communicating with adolescents

A

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
Q

Adolescent communication cont’

A

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
Q

Warning Signs of Suicide

A

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
Q

Diet

A

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
Q

Vegetarian/Vegan

A

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
Q

Eating Disorders

A

Obesity
Anorexia nervosa
Bulimia

108
Q

Alcohol

A

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
Q

Marijuana

A

Early, long term use linked with drop in IQ

Synthetic marijuana responsible for increased incidence of kidney failure in adolescents

110
Q

Smoking Statistics

A

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
Q

Antismoking Campaigns

A

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
Q

Hospitalization and the adolescent

A

Major fears:

Loss of control
Altered body image
Separation from peer group

113
Q

Supportive interventions for adolescents

A

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
Q

Supportive interventions for adolescents

A

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
Q

Developmental Care for Chronically Ill Adolescent

A

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
Q

Concepts of Bodily Injury by age

A

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.

Pediatrics (24 decks)

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