Module 1 - Growth and development Flashcards
Developmental periods (5)
Prenatal
Infant 0-1
Early childhood 1-5
Middle childhood 5-12
Adolescence 12-18
Neonate
0-30 days
Neuro/HEENT differences
two fontanels - anterior, posterior –> greater compensation for ICP, risk of brain injury
blood brain barrier not fully developed –> increased r/o infection
large tongue - r/o obstruction
narrow, funnel shaped airway w/ narrow cricoid cartilage –> greater r/o airway obstruction, difficult intubation
large head w/ weak neck muscles –> fall injury, neck muscle injury
large occipital bone –> greater r/o upper cervical injury. different place required for CPR (thoracic thrust)
blurry vision but hearing well-developed
neck muscles/excess lymphoid tissue –> block airway
higher pain threshold than adults
Respiratory differences
obligate nose breathers until 6 months
smaller airways/lower tidal volume –> less ability to compensate. greater r/o aspiration/obstruction
higher O2 requirements d/t higher BMR
diaphragm = major breathing muscle –> abdominal breathers
shorter trachea –> greater r/o displacement
horizontal rib placement –> lower tidal volume as rib cage moves up/down rather than up/out
carilaginous airway –> more likely to collapse (hyaline cartilage = greater water content)
thin chest wall –> difficulty auscultating. greater r/o internal injury
Cardiovascular differences
greater circulating blood volume (90 mL/kg)–> higher sensitivity to small fluid losses
lack of contractile tissue –> inability to increase stroke volume. increase CO by increasing HR
greater % body weight is water (80%)
bradycardia when hypoxic
hypotension - LATE sign of decompensation
smaller vasculature –> more difficult vein access. may use bones
superficial blood vessels –> peripheral shunting = mottled appearance
How much blood loss will an infant begin to decompensate?
Remain normotensive until large intravascular volume lost ~25%
GI differences
smaller stomachs, greater gastric emptying –> more stools, dehydrate faster
small intestine longer than adults –> less able to absorb amino acids & hold onto fluids
liver/spleen larger than adults –> greater r/o injury
small glycogen storage = r/o hypoglycemia –> increased r/o brain injury
upper/lower esophageal sphincters not fully developed –> r/o reflux, vomit
tight junctions b/w cells in brush border not fully developed –> increased r/o infection
thin, weak abdominal wall –> greater r/o internal injury
Which DOH is most important for children?
nutrition
GU differences
immature kidneys + less responsive to hormones ADH/aldosterone –> greater diuresis
Can vital signs of infants be irregular?
Yes this is normal. However, apnea >15 seconds is abnormal. Unexplained tachycardia should always be investigated (early sign of cardiac issues)
What is a late sign of cardiac decompensation?
hypotension
What is an early sign of cardiac compensation?
tachycardia
MSK differences
open fontanels
growth plate not yet fused –> fractures more difficult to detect d/t pliable bone
high surface area : low mass ratio
long bones very vascular –> can be used for venous access
strong ligaments
SCIWRA
spinal cord injury without radiographic abnormality
PAT
Pediatric assessment triangle
appearance
work of breathing
circulation
ABCDE
airway
breathing
circulation
disability
environment
Piaget Cognitive stages
Sensorimotor (0-2)
Preoperational (2-7)
Concrete operational (7-11)
Formal operational (12+)
Erickson 1-5 psychosocial stages
“the main action sally initiative got inferno into immense regret”
trust vs. mistrust
autonomy vs. shame
initiative vs. guilt
industry & inferiority
identity & role confusion
Trust vs. mistrust
0-1
trust b/w caregiver & child
Autonomy vs. shame
1-3
control over bodily function & activity
Guilt vs. initiative
3-6
testing limits of self-assertion & purposefulness
balance of self-initiative & rights of others –> developing understanding of boundaries
Inferiority vs. industry
6-12
sense of mastery & competence
self-esteem through accomplishment
Sensorimotor
0-2
infants think/experience world through physical senses
develop object permanence
Pre-operational
2-6
egocentric –> inability to see POV of others
concrete and tangible
use of language & symbols
