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

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Flashcards in Exam 1- Health Promotion in the Toddler, Preschooler, School Aged Child, and Adolescent Deck (116)
1

toddler age range

12 months through 36 months

2

Toddler -- Physical Development


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

3

Toddler – Gross Motor

Walking by 15 months

Climbing on anything

Removing clothing

Stoops and recovers

4

Toddler – Gross Motor

By 18 months

Runs clumsily, falls often

Walks up stairs with hand held

Jumps in place with both feet

5

Toddler – 24 mo – Gross Motor

Throws ball over hand. Kicks ball.

Goes up and down stairs with 2 feet on each step

6

Toddler – Gross Motor

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

7

Fine Motor

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

8

Toddler- Negativism and Ritualism


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

9

Critical Tasks of Toddler Period

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

10

Preoperational Thinking



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

11

Preoperational

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

12

Preoperational

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

13

Moral and Spiritual

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

14

Language/communication

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

15

Communicating with the Toddler

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

16

Well-Child Visit

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

17

Parenting Issues – Toddler years

Discipline
Toilet Training
Temper Tantrums

18

Discipline

Consistent limits

Positive reinforcement

Immediate consequences

Redirection or distractions

Time outs: 1 minute per year of age

19

Readiness for toilet training

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

20

Temper Tantrums

Limited language leads to frustration

Anticipate

Inconsistent parental practices increase frequency of tantrums

Isolate safely and ignore

21

Anticipatory Teaching

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

22

Nutrition

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

23

Domestic mimicry --Symbolic Play

Imitating parent of same sex in household tasks – domestic mimicry

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

24

Toddler – Age Appropriate Toys

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

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

28

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

29

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

30

Long-term neurocognitive signs of lead poisoning

Developmental delays

Lowered IQ (intelligence quotient)

Reading skill deficits

Visual-spatial problems

Visual-motor problems

Learning disabilities

31

Hospitalization and Toddler


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

Major Fears
Loss of Control
Separation

32

Nursing supportive Interventions for Toddler and Family

Minimize separation from parents

Explain and maintain consistent limits

Simple brief explanations

Ask about home routines & rituals

33

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

35

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

59

Prevention of sex abuse

Teaching children normal, healthy boundaries of their bodies

Tell someone

60

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

61

Dental

First dental exam at 3 yr.

Brush teeth 2 x day

See dentist every 6 months

Fluoride supplementation

62

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

64

Normal Vital Signs for Preschoolers

Heart Rate: 80 – 110

Respiratory Rate: 22 – 34

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

65

School Age

6 – 12 year

66

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.

68

Motor


Constant activity – Gross motor

Musical instruments & Eye-hand coordination – Fine motor development

69

Sensory

Eyes fully developed by 7 yr.

Growth spurt in eyes leads to myopia

Yearly visual screenings – Using Snellen chart

70

School Age Child

Erikson’s Stage is

Industry vs. Inferiority

Mastering useful skills and doing them well are important

Competence

71

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

72

Cognitive


Concrete Operations:

1. Reversibility

2. Conservation - Milk glasses or 1 lb of rocks/feathers

3. Classification & Logic

4. Humor

73

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

75

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

77

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

79

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

84

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

87

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

92

Adolescence 12 - 18 yr

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

93

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

94

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.