Lecture 01 Family Centered Nursing Care of Child/Adole 1&2 Flashcards

Question

What's the psychosocial development of a toddler? (3)

Answer 1

1. Self-Concept Development 2. Body Image Changes –Body Parts –Gender Identity 3. Erikson: Autonomy vs Shame and Doubt

Answer 2

Piaget: Sensory-motor continues to 18/24 months * Object Permanence Fully Developed * Egocentric * Learn to separate from mother * Memories of events r/t self * Begin to control socially unacceptable behavior * Learning sex role distinctions based on culture **•Lacks concept of conservation (example ?)**

Answer 3

Language 2-3 word phrases (use of short sentences) * Family understands speech (2 years) * Strangers understand speech (3 years) * Understanding of language exceeds ability to verbalize * Inability to transfer knowledge to new situations:

Answer 4

* Appetite decreases * Picky eater * Needs high protein diet for brain development * Needs snacks * Table food by 12 to 15 months (majority food) * Whole milk with vitamin D (limit 1 quart/day) * Limit juice (4 to 6 oz/day) * ‘Dental (brushing, fluorination, bottles, sweets) Dental visit recommended at 2-years

Answer 5

Parallel and Solitary Play * Minimal sharing/cooperation * Special toy/blanket * Learning what is his/hers * Parallel play; side by side with little cooperation * Toys, manipulative, blocks, shapes, crayons, books, telephones, kitchen sets

Answer 6

Toilet Training * Freud’s Psychosexual Anal Stage * Major task of toddlers with readiness between 18 months and 2 years after child is walking (voluntary control of anal & urethral sphincters achieved) * Refer to Perry (2014) p. 931, Assessing Toilet Training Readiness

Answer 7

–This is a natural response of jealousy and resentment –Response to changes in toddlers life –Anticipatory guidance with parents indicated –May see regression

Answer 8

–Expression of independence may be exhibited through violent objection to discipline (kicking, screaming & breath holding) –Anticipatory guidance with parents

Answer 9

– “NO” is an expression of self-control and independence. – Provide choices that do not provide for a “no” answer

Answer 10

–Reverting to previous patterns of functioning usually related to stress or discomfort (thumb sucking, bed wetting, ‘baby talk’) –Common with toddlers especially in illness, hospitalization, separation, birth of sibling –Illness & hospitalization may cause regression

Answer 11

Kids falling ## Footnote * Highest incidence death occurs ages 1 to 4 (outside of adolescent age group). * Freedom achieved through locomotion and lack of awareness of unsafe behaviors results in very high injury risk * Refer to Perry (2014) Table 32-4, Injury Prevention During Early Childhood * Injuries include: Motor Vehicle Related, Drowning, Burns, Poisoning, Falls, Choking & Bodily Damage

Answer 12

Norms * Separation anxiety peaks * Vocabulary increases however understanding language exceeds ability to verbalize * Toddlers becoming independent from parent/caretaker * Daily routines of waking, sleeping, eating and play are established * Development focused on mobility and learning to communicate

Answer 13

* Parents as partners/participants in care * Address stranger anxiety (ex: exam on parent lap) * Exam/assessment start with least intrusive * Encourage use of comfort/transitional objects (blanket, stuffed animal, family pictures) * Incorporate home routines into care * Maximize mobility, play and control opportunities * Prepare toddler for “routine” care and procedures * Maximize comfort and pain reduction measures * Maximize consistency (staff & hospital routine/procedures) * Maintain safety measures • •

Answer 14

Motor Increased strength and agility 3-year-old 3 wheels (tricycle), copies a circle 4-year-old skips/hops one foot, throw ball overhand, copies a square 5-year-old can recite phone number, jumps rope, balance on 1 foot, walks backwards

Answer 15

* Appetite gradually decreases * Food preferences * Appetite sporadic & inconsistent

Answer 16

•Explore physical world taking on new activities –Imagination –Enterprise –Guilt with perceived misbehavior or failure to accomplish a task

Answer 17

* Develop a conscience * Social Acceptability

Answer 18

* Misconceptions: fantasies & fears * Begin to recognize differences * Poorly defined body boundaries (example ?)

Answer 19

* Less separation and stranger anxiety * Pretend play helps differentiate reality from fantasy

Answer 20

Piaget: Pre-operational Thought (2 to 7) * Intuitive Thought (unaware how gained information) * Predominate egocentricity to beginning social awareness * Thinking based on visual appearances –Magical thinking (thoughts are all-powerful) –Animism (equipment is alive) –Centration (focus on one aspect of object without considering whole) •Concept of time related to routine events (ex: meals, bedtime)

Answer 21

Language 3 years * Understood by non-family members * Stuttering common especially when stressed

Answer 22

Personal-Social * Imaginary friends * Imitates caregivers * Domestic role playing * Sexuality –Knows own sex and that of others –Masturbation normal

Answer 23

Injury Prevention/Safety * Accidents remain leading cause of death * MVA & Burns * Improved gross & fine motor skills, listening to parental instructions and awareness of dangers

Answer 24

Norms * Gross motor skills VIP running, jumping climbing * Difficulty distinguishing reality from fantasy (magical thinking) * Poorly defined body boundaries * Egocentric (experiences from own perspective) (events are their fault) * No understanding of cause & effect * Illness seen as punishment * Family important. Separation anxiety remains strong * Continued independence * Communication skills increasing, asks questions * Likes consistency in daily routines

Answer 25

Hospitalization/Illness * Mobility * Fears * Body Image/Esteem * Independence * Routine

Answer 26

* Parents as partners/participants in care * Maintain link with home * Decrease immobility as much as possible & maximize control of situation * Prepare for “routine” care & procedures in simple concise manner & use of hands on play with medical equipment * Provide concrete explanations/hands on for unfamiliar equipment, environment, procedures (fantasy thinking may make hospital environment/routine bizarre/frightening) • •

Answer 27

**•Address fears of bodily injury/mutilation and pain** **–Major fear in preschooler** –Avoid intrusive procedures * Allow choices and participation in care * Bandages/Band-Aids * Allow child to express feelings of anger, fear, and frustration in an acceptable manner * Provide praise and rewards * Continue home routines (bedtime rituals, schedule) * Music and Pet therapy Let them know what behavior is acceptable (can’t bite but can squeeze hand)

Answer 28

•Pre-adolescent years (10-13) rapid growth boys & girls –Growth spurt age 9-10 girls & 12 for boys (girls surpass boys in weight & height) –Rapid growth in height and weight •Dentition –Permanent teeth erupt

Answer 29

Moral Development * Internal set of standards * Obeying rules of correct behavior is important * Behavior that pleases others is considered good

Answer 30

•Develop logical & coherent thought –Take incident and generalize from it –Systematic way of solving problems •Able to sort, classify, order & organize facts

Answer 31

* Motor Vehicle Accidents Pedestrian or passenger most common cause of serious injury or death * Bikes, skate boards, in line skates, ATV’s (not recommended for children less than 16 years per AAP) (Perry pp.1001) * Firearms

Answer 32

1. Increased use of drug, alcohol, and tobacco in this age group. 2. Obesity 3. Anorexia

Answer 33

* Give child as much control as possible * Parents as partners/participants in care * Involvement in unit activities with other children & provide “free time” * Encourage expression of feelings related to illness/hospitalization (play, journal, art/drawing, verbalizing) * Validate fears & anxieties; Mutilation fears remain * Encourage participation in daily activities

Answer 34

Norms * Performs many physical activities * Beginning to understand cause & effect * Social dependence on peers strong * Continues to learn ways to express feelings verbally and with play * Dependent on home/school routines * Developing self-esteem; likes praise & rewards * Striving for independence

Answer 35

11 to 21 years

Answer 36

Physical Progressive Tanner stages (male & female) * Puberty onset; age 10 (girls), 12 (boys) * Major growth spurt (height & weight) (Most rapid after 1st year) * Develops secondary sex characteristics

Answer 37

Motor * Gross motor reaches adult levels * Fine motor continues development * Strong, but awkward * May be unsure how to handle wt./ht increases •

Answer 38

Erikson: Identity vs. Role Confusion * Developing a sense of self * Exploring alternatives while attempting to understand ‘self’ as related to peers, family & society

Answer 39

* Decisions based on standards; social responsibility recognized * Able to consider 2 different moral approaches to problems and decisions

Answer 40

Personal-Social * Identity issues * Status * Relationships

Answer 41

Body Image * Major concern * Impact Media * Depression and Eating Disorders

Answer 42

Piaget: Formal Operations * Thinking at adult level * Consider alternative outcomes in abstract way * Ability to think in abstract terms & use abstract symbols * Future Oriented

Answer 43

Injury Prevention/Safety: * Accidents leading cause death in adolescents (MVA) * Homicide & Suicide 2nd & 3rd leading cause death * Risk Factors? * Drivers Education * Drug & Alcohol abuse education

Answer 44

Concerns Related to Normal Growth & Development * Relationships with Family & Peers * Body Image & Self Concept * Sexuality, STD’s & Pregnancy

Answer 45

•Nutrition –Needs up to 3,500 cal/day –Hugh appetite (rapid growth & high energy levels) –Junk food may be major source calories Anorexia nervosa & bulimia (more common girls)

Answer 46

Norms * Less interest in parental activities * Mood swings * Preoccupation with self * Intense same sex relationships * Increased cognition, fantasy world, vocational goals, privacy need, lack impulse control

Answer 47

Norms * Reacceptance of parental values/advice * Acceptance of pubertal changes and feelings * Peer group less important & more time with intimate relationships * Practical, realistic vocational goals * Ability to compromise and set limits

Answer 48

* Encourage expression of feelings * Family participation and peer visitation * Continue schooling as appropriate * Offer choices and involve as much as possible in decision making & daily routine * Encourage self care * Be sensitive to the importance of personal appearance * Provide clear, honest information & explanations * Provide privacy (physical and personal information) –Health assessment must include private time with adolescent • • •

Answer 49

•Major stress for infants and toddlers between 6 months to 30 months is separation from parent or familiar caretaker

Answer 50

* Allow the child to express fears and ask questions * Give choices when they exist * Do NOT lie to a child * Be honest * Use creative communication techniques. Perry (2014) Box 29-4 and Guidelines p. 775

Answer 51

* May experience jealousy, insecurity, resentment, confusion & anxiety * May not understand why ill sibling getting attention * May feel abandoned or ignored by parent * May feel they caused illness ***•May have same level of stress as ill child***

Answer 52

* Unrelieved pain has negative physical & psychological consequences * Prevention is better than treatment * Assessment and treatment of pain is a collaborative process between nurse and child/family * Pain reduction is a realistic goal

Answer 53

* Infants don’t feel pain * Young children will “forget” pain * Children tolerate pain better than adults * Narcotics should be avoided in infants/children because of respiratory depression & are more addicting than in adults * Children will tell you when they are in pain * Pain is “obvious” * Children become accustomed to pain or painful procedures •

Answer 54

Toddler * Reacts to any intrusive procedure as if painful (BP, Temp, exam) * Intense emotional/physical resistance * Can talk about pain; take complaints seriously * Can’t describe pain, but can localize * Does NOT know how to fake or imagine pain

Answer 55

Preschool Aged * Age 4, degree self-control * Can localize and describe * Begin to realize pain may be temporary and will feel better later * May use illness to avoid unpleasant activities * Recurrent abdominal pain frequently seen as response to anxiety (beginning school)

Answer 56

School Aged * Verbalizes pain, location, description, intensity * Response is more ‘adult like’ * Tolerance levels very individualized * May still feel guilt about being ill * May be more cooperative

Answer 57

Adolescent * May see much self control * Can verbalize pain * May be reluctant to verbalize pain * Pain tolerance very individualized * Aware of effects & uses pain meds * Able and willing to request pain meds

Answer 58

* What type of pain has the child experienced in the past? * How do you know when the child is in pain? * What has worked in the past to manage the child’s pain?

Answer 59

Infant to age 6

Answer 60

Age 6 and older

Answer 61

Older school age/ adolescent

Answer 62

* Parental Support * Holding/Rocking * Comforting Environment * Therapeutic Communication * Positioning * Age Appropriate Distraction & Play (comfort boxes) * Relaxation techniques * Guided Imagery

Answer 63

•Psychological Effects (Perry pp. 1534-1536) –Outlet for emotions, anxiety and impulse control –Physical growth and development –Sensory depravation –Language and speech development –Depression, alterations in self-esteem and regression can occur –Outlets for fears, anxiety, monotony and boredom need to be identified – –

Answer 64

* Continue infant techniques * Expect resistance & negativism * Give simple & easy to follow instructions * Allow child to handle equipment, practice on doll/parent/nurse * Explanations are sensory based (see, hear, feel..) * Use distraction (bubbles, music, books, videos) * Keep frightening objects out of view; be prepared * Allow choices whenever possible * Provide comfort objects (doll, blanket) * Limited time concept; prep just before procedure and keep it short & simple

Answer 65

* Continue to stress sensory aspects of experience * Positioning for comfort **•Focus on playing with equipment, how it works, what it feels like (alcohol prep is wet & cool)** •Be very careful with the language you use **•Major fear is bodily harm, mutilation & castration** * May think equipment is alive * Child may see procedure as punishment **•Bandages very important for body integrity** * Find ways for the child to “help with procedure” & praise for efforts * Preparation occurs shortly before procedure * Post procedure with dolls /equipment * Child Life Prepping for IV Insertion 2:23 •

Answer 66

* Increased language skills allow for explanations with correct terminology, use of diagrams, pictures * Explain use of equipment in terms of function * May fear ‘loss of blood’ with phlebotomy * Help child maintain self-control (deep breathing, counting) & sense of “industry” (help with procedure, decision making) * Preparation can occur in advance of procedure & with longer teaching sessions **•Allow time for questions & concerns; but without undo “delay tactics”** * Provide privacy, offer praise & accept regressive behavior * May need and want support; often do not request

Answer 67

* Parental involvement * Stranger Anxiety * Comfort measures (pharmacological & non pharmacological) * Positioning for Comfort * Use of treatment room * Older infants do remember unpleasant people, places & equipment –

Answer 68

* May include discussion of benefits & long term consequences * Encourage expression of fears, and alternatives **•Involve in decision making as much as possible (parents present, timing)** * Provide suggestions to maintain control (imagery, relaxation, music) * Accept regression; remember adolescent may look like an adult but they do not have adult coping mechanisms * Privacy * Preparation can occur ahead of time

Answer 69

Young Children * Aloofness toward primary caretaker * Dependency behaviors –Clinging to caretaker –Demanding attention –Opposing any separation •Other Behavioral Changes –New fears –Bed time fears, night waking –Increased activity –Tantrums –Food pickiness –Blanket/toy attachment –Regression in newly acquired skills

Answer 70

Older Children * Emotional coldness versus intense demanding dependence * Anger toward caretaker * Jealousy especially towards siblings

Lecture 01 Family Centered Nursing Care of Child/Adole 1&2 Flashcards

(99 cards)