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measurements of the prevalence of a specific illness in the population at a particular time, generally presented as rates per 1,000, may denote acute illness, chronic disease, or disability, increasing morbidity occurs in homeless children, children living in poverty, LBW children, children with chronic illness, foreign-born adopted children, and children in daycare centers
morbidity
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the incidence or number of individuals who have died over a specific period, generally presented as rates per 100,000
mortality
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the number of deaths during the first year of life per 1,000 live births
infant mortality rate
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the number of deaths during the first 28 days or less of life
Neonatal mortality
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the number of deaths during 28 days to 11 months of life
Postneonatal mortality
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caring, well-defined boundaries separate the nurse from the child and family, boundaries are positive and professional and promote the family’s control over the child’s health care, open communication is maintained
Therapeutic relationship
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recognizes the family as the constant in a child’s life, health care personnel must support, respect, encourage, and enhance the strength and competence of the family by developing a partnership with parents
family-centered care
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professionals enable families by creating opportunities and means for all family members to display their current abilities and competencies and to acquire new ones to meet the needs of the child and family
enable family centered care
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describes the interaction of professionals with families in such a way that families maintain or acquire a sense of control over their family lives and acknowledge positive changes that result from helping behaviors that foster their own strengths, abilities, and actions
empowerment of family centered care
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-attachment to parent
-stranger anxiety
-sensorimotor phase of learning
-increased m. control
-imatation of gestures
expected behavior of an infant during procedure
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-egocentric thought (explain procedure from tactile perspective)
-negative behavior-animism (keep frightning objects out of view)
-limited language skills
-limited concept of time
-striving for independence
expected behavior of a toddler during procedure
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-egocentric thought
-increased language skills
-limited concept of time and frustration tolerance
-illness and hopsitalization viewed as punishment
-animism-fears of bodily harm
-striving for initiative
expected behavior of a preschooler during procedure
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-concrete thought
-interest in acquiring knowledge
-improved concept of time
-increased self control
-desires participation
-developing relationships with peers
expected behavior of a school age during procedure
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-abstract thought, want explanations
-conscious of appearance
-concerned with present rather than future
-striving for independence
-developing peer relationships
expected behavior of an adolescent during procedure
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interval scale that includes five categories of behavior
what are the five? and how are they scored?
FLACC pain assessment tool
For ages 2 months - 7 years
- Facial expression
- Leg movement
- Activity
- Cry
- Consolability
each valued 0-2 for a possible total of 10
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Reaction of parents to child's illness
- -seriousness of the threat to the child
- -previous experience with hospitalization
- -procedures involved in dx and tx
- -available support system
- -personal ego strengths
- -coping abilities
- -additional stresses on family
- -cultural and religious beliefs
- -communication patterns among family
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Infants during assessment
- -quiet when cuddled, patted, and other physical contact
- -respond to gentle handling, quiet, calm speech
- -more at ease upright than horizontal and with parents visable
- -gain cooperation using distraction
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early childhood children during assessment
- -let them touch and examine equipment
- -keep unfamiliar equipment out of view until needed
- -let them play with BP bulb
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school aged children during assessment
- -prefer child to sit
- -explain purpose of equipment and significance of procedure, teach about body function and care
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Adolescence aged children during assessment
- -give the option of parent being in room
- -sitting position
- -respect privacy, explain findings, emphasize what is found and what is normal
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Physical development
weight changes the first six months
gain 5-7 ounces weekly until 5-6 months
weight gain slows second 6 months
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Physical development
1 month
gain 1 inch monthly first 6 months
head circumference increases 1.5 cm monthly first 6 months
reflexes present and strong, obligatory nose breathing
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Physical development
2 months
posterior fontanel closed
crawling reflex disappears
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Physical development
3 months
primitive reflex fading
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Physical development
4 months
drooling begins
moro, tonic and rooting reflexes disappeared
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Physical development
5 months
begining signs of tooth eruption
birth weight doubles
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Physical development
6 months
growth rate declines
weight gain 3-5 ounces weekly for next 6 months
teething may begin
chewing and biting occur
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Physical development
7 months
eruption of upper incisors
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Physical development
8 months
begins to show regular patterns in bladder and bowel elimination
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Physical development
9 months
eruption of upper lateral incisor
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Physical development
10 months
able to raise head
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Physical development
11 months
eruption of lower lateral incisor
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Physical development
12 months
birth weight triples
length increased by 50%
head and chest circumfrence is equal
has 6-8 teeth
anterior fontanel almost closed
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Physical development
15 months
steady growth in ht and wt
head circumfrence 48 cm
wt 11 kg
ht 78.7 cm
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Physical development
18 months
picky eaters
anterior fontanel closed
able to control sphincters
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Physical development
24 months
head circumference 49-50 cm
chest circumference exceeds head
gain 4-6 lbs per year
grow 4-5 in per year
beginning daytime control of elimination
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Physical development
30 months
birth weight quadrupled
primary dentition of 20 teeth completed
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Physical development
Pre-schoolers
(avg wt of 3,4,5 yr olds)
rate of growth slows
- avg wt:
- 3 yrs- 14.5
- 4 yrs- 16.7
- 5 yrs- 18.7
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Physical development
accomplishments of a 3 yr old
grow about 3 in a yr
ride a tricycle
catch a ball
build towers of 6-9 blocks
stand on one foot, walk on tip toes, jump horizontally
paint in circular and horizontal motions
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Physical development
accomplishments of a 4 yr old
run on tip toes, gallop, pump on a swing, hop on one foot, begin to skip
throw a ball overhand, small m. control
can make representational pictures
can dress and undress themselves
cut a line with scissors
active and aggressive in their play
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Physical development
School aged child
gain 4-7 lbs per year
baby teeth begin to be lost
girls develop secondary sex characteristics and begin menstruation
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Physical development
School Aged child
6 years old
ht and wt gain slowly
loses first tooth
constantly active
hand as a tool
vision reaches maturity
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Physical development
School Aged child
7 years old
grow at least 2 in
weight 17.7-30 kg
more cautious
jaw expands to accomodate permanent teeth
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Physical development
School Aged child
8-9 years old
grow 2 in per year
weight 19.5-39.5 kg
uses cursive writing
dresses self completely
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Physical development
School Aged child
10-12 years old
weight 24.5-58 kg
height 127-162.5 cm
remainder of teeth will erupt
- girls: puberty changes may occur
- boys: slow growth in height, rapid wt gain
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Physical development
Adolescents
development of secondary sex characteristics
fluctuations of wt
all teeth are perminent
heightened emotions, puberty
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Weight measurement accuracy for growth assessment
infants: nearest 10g
children: nearest 100g
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general growth should be between __ and __ percentile for ht, wt, and head circumference
5th and 95th
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6 month old average weight is ___
7.3 kg
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1 year old average weight is ___
9.75 kg
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6 month old average ht is ___
65 cm
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1 year old average height is ___
74 cm
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average head circumference at 6 months age is ___
46 cm
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averages for a 2 year old:
ht-___
wt-___
ht-86..6 cm
wt-12kg
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average for a 6 year old
wt-__
ht-__
wt-21kg
ht-116cm
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averages for a 12 year old
wt-__
ht-__
wt- 40kg
ht- 150cm
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age of even head molding, occipital prominence, systemic facial features and a fused suture
18 months
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Freud's 5 stages of growth and development in order:
-Anal
-Phallic
-Latency
-Genital
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Erikson's 5 stages of growth and development in order:
1.trust vs. mistrust
2.autonomy vs. shame and doubt
3.initiative vs. guilt
4.industry vs. inferiority
5.identity vs. role confusion
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Piaget's 5 stages of growth and development in order:
1.sensorimotor (birth-2yrs)
2.peroperational thought, preconceptual phase (transudctive reasoning) (2-4 years)
3.preoperational thought, intuitive phase (transductive reasoning) (4-7 years)
4.concrete operations (inductive reasoning and beginning logic) (7-11 years)
5.formal operations (deductive and abstract reasoning) (11-15 years)
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age when stranger anxiety is greatest
6-8 months
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walk alone using a wide stance for extra balance
12-13 months
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try to run but fall easily
18 months
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refinement of upright position to improve coordination and equilibrium
2-3 years
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walk up and down stairs
2 years
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jump using two feet
2.5 years
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climb stairs with alternate foot
2
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walking, climbing, jumping
36 months
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skips and hops on one foot and catches ball reliably
4 years
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skips on alternate fee and jumps rope
begins to skate and swim
5 years
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primary form of dehydration in children, occurs when e- and water deficits are present in near balanced proportions, no osmotic force between ICF and ECF. Na level remains between 130-150mEq/L
isotonic (isosmotic or isonatremic)
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occurs when e- deficit needs exceeds the water deficit, leaving serum hypotonic. ICF is more concentrated than ECF and water moves from ECF to ICF to establish equilibrium. tends to be more severe Na level is less than 130mEq/L
hypotonic (hyposmotic or hyponatremic)
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results from water loss in excess of e- loss and is usually caused by proportionately larger loss of water or larger intake of e-. most dangerous and requires more specific fluid. Na is greater than 150mEq/L
hypertonic (hyperosmotic or hypernatremic)
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three principles in providing atraumatic care
-prevent childs seperation from family
-promote sense of control
-prevent bodily injury and pain
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considered to be the leading cause of neonatal death in the US
LBW
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the leading cause of death in children over 1 year (mostly MV)
injuries
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____ and ____ are important determinants in the prevalence of injuries at a given age
developmental stage and environment
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follows light to midline at ____mo
1 month
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posterior fontanel closes and crawling reflex disappears at ___ mo
2 months
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at 2 mo, infants need ___ to help prevent ricketts and vit d deficiency
200 units of vit d
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at 2-3 mo it is common for a child to have ___ ___ as a result of hematopoetic changes
physiologic anemia
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primitive reflexes begin to fade at ____ mo
3 months
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visual acuity- binoculr (fusion) develops at ___, and well est at ___
develops at 6 weeks
est at 4 months
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drooling begins, moro, tonic neck and rooting reflexes have disappeared at ___ mo
4 months
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___ begins at 4 mo b/c of poorly coordinated swallow refelx
digestive process begins
drooling
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the infant should be transitioned to solid foods around ___ mo
4-6 months
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which of the following characteristics best describes fine motor skills of a 5 mo old infant
able to grasp object voluntarily
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maternal iron stores are present in the newborn for ___ mo
5-6 months
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at __ mo able to roll; back to abd.
at __ mo able to roll; abd to back
5 months
6 months
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age which chewing and biting occur
6 months
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any child who displays head lag at __ mo should have a dev. and neuro eval
6 months
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teething may begin w/ eruption of lower central incisors at ___ mo
6 months
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infants gain __ oz weekly until approx 6 mo
5-7 oz
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seperation anxiety becomes prominent when attachtment has happend around __ mo
6-8 months
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depth perception of an infant develops at __ mo
7-9 months
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reg patterns in bladder and bowel elim and parachute reflex appears
8 months
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at ___ mo old, the infant is able to comprehend meaning of "no" and obey simple commands
9-10 months
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anterior fontanels almost closed, lumbar curve develops and babinski reflex disappears at ___ mo
12 months
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at 1 yr, infants wt has ___
tripled
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voluntary control of the anal and urethral sphincters is achieved by age ___
2 years
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potty training should begin b/w ___ and ___ mo
girls are ready ___ to ___ mo before boys
1.5-2 years
2-5 months
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primary dentition complete at ___ mo
30 months
20 teeth
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the measurement of ht, wt, head circumference, proportions, skinfold thickness, and arm circumference in young children
anthropometry
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fever in infants less than 3 months is ___
100.4
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fever in infants 3 to 36 months of age is ___
102
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fever in children older than 3 years old is ___
104
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