pediatrics

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mowgli
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198306
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pediatrics
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2013-05-06 23:05:09
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pedi
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  1. Factors that affect growth and development
    • Genetics
    • environment
    • ational
    • heredity
    • nationality
    • religious & cultural beliefs
    • ordinal position
    • gender (some parents perfer certain gender)
  2. what is critical growth period?
    when env has most max effect on G&D

    • 1st of pregnancy
    • puberty
  3. Major parenting types
    • Authoritarian
    • Authoritative
    • Permissive
  4. Authoritarian parenting style

    effects
    give & take b/w chind & parent discouraged

    • kids usually shy withdrawn
    • lack self esteem

    • if parents with hold affection
    •   - may become rebellious or anti social
  5. Authoritative parenting style

    effects on kid
    • shows respect for each kid & individual
    • parents will explai rule & discuss rules & reasons for rules
    • some negotionation & compermise allowed

    kid inquisitive, assertive, interactive high self esteem
  6. Permissive parenting style

    effects on kid
    • parents have no control over kids
    • inconsistant rules
    • kid allowed to decide if kid wants to follow rules

    • kids feel unloved/unnurtured
    • it rules parents
    • kid learns they can do what they want
    • are disrespectful /often aggressive/ irresponsible /defient/ rebellious
  7. What has greatest influence on Growth and development?
    family
  8. Personality
    unique organization of characteristics that determine individula reccurent/ typical behavior
  9. What grows fastest in infancy
    trunk
  10. Freud
    • id-physical needs / istincts of body
    • ego-conscious self
    • superego- conscience

    • Oral stage-0-2
    • Anal stage 2-3yrs (potty training)
    • Phallic (infant genital) stage 3-6 yrs
    •    -superego starts to dev
    • Latency stage 6-10 yrs
    • Genital stage 11-13yrs
  11. Erik Erikson stages
    • Trust vs mistrust
    • autonomy vs doubt/shame
    • Initiative vs Guilt
    • Industry vs Inferiority
    • Identity Vs Role Confusion
    • Intamacy vs Isolation
    • Generativity Vs Self Absorption
    • Ego vs Despair
  12. Trust vs mistrust
    • Infancy
    • learn whether baby can trust world
  13. autonomy vs doubt/shame
    • toddler
    • gain assurance from learning to perform tasks indipendently
    • caregivers' reacts well-up self esteem
    •                  reacts poorly-shame/doubt
  14. Initiative vs Guilt
    preschool 3-6 yrs

    • improved physical coordination
    • expanding social skills
    • want to know rules
    • show off want attention/approval
    • kid dve conscience and accepts punishment-relieves guilt
  15. Industry vs Inferiority
    • School age 6-10 yrs
    • seek achievment
    • learn to interact w/ others
    • like follow through req activities
    • praise helps-build self esteem & avoid feeling of inferiority
  16. Identity Vs Role Confusion
    Adolescent 11-18

    • confused by marked emotional and physical changes
    • peer relationships most important
  17. Intimacy Vs Isolation
    • early adulthood
    • tries to est personal and intimate relationships
    • difficulty in intimate relationships = isolation
  18. Generativity Vs Self Absorption
    • young/middle adult
    • often marriage/family for others may find other means of fulfillment

    • if fulfillment not found become stagnant/ self-absorbed
    • cease to develop socially
  19. Ego integrity vs Despair
    • old age
    • final phase
    • least understood
    •  finding satisfication with
    •  -oneself
    •  -ones achievments
    •  -one's condition
    • w/o regret for past or fear for future
  20. What theorists did cognitive dev
    • Piaget-4 orderly stages
    • Kolkerg 3 levels
  21. Piaget phases
    sensorimotor 0-2yrs

    Preoperational 2-7

    Concrete operations 7-11

    formal operations 12-15
  22. Sensorimotor phase 0-2yrs
    • get all info from senses & motions
    • cause & effect
  23. Preoperational 2-7
    egocentricself centered point of view
  24. Concrete operations 7-11
    • develop ability to begin problem solving in a cocrete, systemic way
    • can classify & organize info about env
    • begin to understand vol/wt can remain the same w/ changing appearance
    • consider another's point of view
  25. formal operations 12-15
    • able to deal w/ ideans, abstract concepts
    • understand philosophies
    • can observe & draw logical conclusions
  26. Kolkerg
    • preconventional level (premoral)
    • Conventional level
    • Post conventional level (principled level)
  27. preconventional level (premoral)
    • stage 0  0-2yr
    •  -egocentric
    •  -decisions based on pleasure

    • stage 1  2-3yrs
    •  -punishement & obedience orientation
    •  - avoid punishment

    • stage 2 4-7 yrs
    • self indulgence
    • morals by what satisfies needs
    • "eye for an eye"
  28. Conventional level
    • school aged
    • aware3 of others feelings
    • live up to expectations
    • stage 3 7-10 yrs
    •  -avoid disapproval

    • stage 4 10-12yr
    • do duty, obey laws
  29. Post conventional level (principled level)
    • stage 5 13-18yrs
    •  -must have attained other levels
    •  -maintain respect of others
    •  -cult accepted values define personal standards
    •  -person's rights mutn't be violated

    • stage 6
    • - not often attained
    •  -does what's right regardless of legal restrictions, cost to self, views of others
    •  -
  30. Moslow's hierarcy from base to top
    • physiological need  - breathing, food, shelter
    • safety and security-health, empl, fam, soc stab
    • love and belonging- friendship, intimacy
    • self-esteem -confidence, achievment,
    • self actualization- morality, experience purpose, inner potential
  31. Safety Do's for hospitailzed kid
    • try to give age appropriate car, keep routine as normal as possible
    • if in crib keep rails up
    • never go from one pt to another with out washing hands
    • always warn kids before procedure-~5min

    • keep cribs away from hazardous objects
    • make sure kids get out of crib periodically
    • routine very important
    • inspect toys for sharp edges

    • apply restraints as needed and correctly
    • use elevator not stars to transport
  32. hospitalized kids don'ts
    don't prop baby bottles ( fluid can run from face into mouths causing ear infection, baby can choke

    don't let kids play with equipment

    never leave meds at bedside and don't give to parents
  33. What does child reation to hospitalization depend on
    • age
    • cognitive development
    • maturation
    • coping skills
    • emotional state
    • culture
    • support
    • **past experience
  34. What is generally hospitalized kids biggest fear
    change of environmet
  35. how can nurses generally help hospitalized kids
    • establish trust
    • get at their eye level
    • limit amount of people during procedure
  36. What are important aspects of nursing care of a hospitalized  child?
    • establish trust
    •   get on a 1st name basis
    • your responsible to protect them from fear
    • facilitate communication and socialization
    • start discharge plan at 1st day they enter
    • warn of procedure-no more than 5 min prior
    • get backgroud nickname/likes/dislikes/etc
    • assess needs of family
    • most teaching is to parents
  37. Stages of separation anxiety
    • 1 protest- don't go
    •    -cries,refuses confort by others, seeks out
    • 2 Dispair
    •  -apathetic listless, given up
    • 3 Denial
    •  -begins taking intrest in surroundings

    seperation anxiety tapers w/ age never fully goes away
  38. what does long term seperation result in?
    • detachment
    • (after serveral months/years)
  39. hospitalized infant
    • major goal assist w/ parent child interactino/attachment b/w infant & parent
    • ok to talk to, cuddling, rock
    • prosedures should be done gently
  40. Hospitalized toddler
    • know /understand/aware of more
    • more seperation anxiety-major stress
    • rooming in-parent stays
    • avoid any painful treatment in room
    • no treatment done in play room so don't relate room to fear
  41. Hospitlized pre-schooler
    • tend to be less direct in protesting
    • fear  
    •   -mutilation
    •   -loss of control
    •    -pain/injury
    •    -body intrusion
    •    take some of gained independence away in hosp
    • egocentric
    • magic thinking-(superstion)
    • phys integrity very important
    • not unusual to show regression
    • risk of guilt/shame
    • thrive on routine
  42. hospitalized school age
    6-10yrs
    • seperation anxiety is there but not as bad
    •  used to being away
    • in hosp loose lots of independence
    • bothered more by disease than treatment

    • fear
    • - loss of indipendance
    • -injury/pain
    • -mutulation-not to same degree as preschlr
    • -any exam to genitals
    • upset w/ exam around genetals- fear/ want everything explained
    • concerned of
    •  - bodily injury/disability or death

    8-9 realize finality of death

    • understand hospital is temoprary
    • understand cause/effect
  43. fears of hosp adolescent
    • injury
    • loss of control-one of biggest
  44. hospitlized adolescent
    11-18yrs
    • loss of independence
    • hospitalization disrupts life, school, independence & lifestyle
    • want to get out ASAP
    • peer groups very important
    • most important -physical appearance-dont want to look differant
    • won't show pain or fear
  45. nurse care of hosp adolescent
    • give as much control as posible will lower power struggle
    • need to understand their needs so can teach and act accordingly

    they want to appear in control

    high risk taking behavior
  46. What happens if hosp adolescent don't have contact w/ peers
    • sourse of anxiety
    • feel isolated
  47. spec fears ring
    stress related to seperation, fear body  intrustion
    r/t hosp
    • after 6m can be frusterating
    • stress r/t separtion, fear, body intrusion
  48. what info should you request for hosp kid
    • background info,
    • health hist,
    • nickname,
    • likes& dislikes,
    • habits
  49. basic needs of hosp kids
    explain why in hosp based on lvl of understanding

    • whole family is affected
    •    may be financial burden
    • need to asses family
    • orient pt & family to room
    • encourage positive parenting
    • keep siblings that want to know informed
    • observe parenting encourage pos parenting
    • pt may get angry/regress
    • most teaching to parent
  50. pain in kids
    • picture pain scale
    • always asses pain level
    • use phys & behavioral responses to pain
    •   behavior-facil expres, guarding, body movement
    • kids don't admit they are in pain
    • automnomic response of body up BP, resp, etc
    •   -
  51. Types of play
    • solitary
    • parallel
    • cooperative

    • associative
    • on looker
  52. parallel play
    • play around not w/ each other
    • 1-2yrs old
  53. cooperative play
    play w/ each other some than revert back to parallel play

    3-5 yrs
  54. solitary play
    • play by selves
    • infancy to toddler
  55. associative play
    • toddler to preschool
    • includes group play
    • w/ or w/o rules
  56. on looker play
    • starts in toddler to grown up
    • enjoy watching kids play
  57. Assessment in kids
    • should be thurough
    • also do neuro & glaslow-coma scale
    • w/ kids may be able to go by behaviior
  58. pys asses in kids
    • 1st ext trust
    • env should be quiet
    • do syst asses
    • age & dev level important
  59. infant pt assesment/nurse care
    • 1-6 mo
    • in mom's arms when able
    • asses reflexes as approp
    • do uncomfortable last
    • look for abd Ortolani’s sign (hip click)


    • 6-12 mo same but learned fear sometimes need to distract them
    • start to id strangers
  60. toddler pt nurse care
    • fearful clingy to parent
    • let parent help
    • sit by parent
    • use toys to distract if needed
    • explain actions
    • get at their eye level
  61. preschooler pt nurse care
    • more cooperative
    • allow pt to hold tools & undress self
  62. school age pt nurse care
    • involve in assessment
    • ask ? they can answer
    • answer their questins
    • parents should be in room for supprt
    • leave underwear on
  63. adolescent pt nurse care
    • 11-18 yrs
    • more in adult mode
    • be honest
    • don't talke down to them
    • let adolescent ask ? as needed
    • pt decide if want parent theri
    • syst asses & explain
  64. best time to asses infants/kids
    in bath
  65. where do you get vital signs
    newborn/infant/small kid----apical pulse

    • Resp
    •  observe for abn movement
  66. BP
    Bp can use any where w/ artery except neck
  67. Temp
    • initially do recal temp @ birth
    • if axilary temp make sure temp i axila
    • w/ recal older kids lay on side
    •  -make sure knees bet if doing rectal on young kids
  68. head circ
    • look for hydroceph
    • don on all kids >36mo of age
  69. urine collec
    • une U bag on newborns
    • -w/ female open labia stick over middle

    if use cath depending on age   8-10 french
  70. stool spec
    • parasite- need to send to lab STAT
    • take accordig to age
    • explain(be spec) why

    need to know type test / why
  71. admit meds
  72. preschool understand inink caused death fromg of death
    • very egocentric
    • may t
  73. Post op
    • make sure kid is breathing
    • airway 1st
    • vs/no bleeding from incision
    • always asses pain level
    • diet as ordred
    • ambulate ASAP
  74. PreOp
    • preop sedation & analgesics as ordered
    • some preops are ordered @ a certain time
    •   or is preop on cal-dr call in
  75. Injection sites
    • infant -<3yr-  vastus lateralus
    • >3 yr^ walking fo past year -- ventrogluteal
    • < 6 deltoigluteal
    • =/>6yr deltoid   .5ml/site
  76. TPN
    • use filter check blood sugar
    • monitor q hr like adult for complic

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