NS2 Peds Mod 2: Developmental Variability

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NS2 Peds Mod 2: Developmental Variability
2015-01-27 16:48:33
NS2 PEDS Mod2 Part1 NS2P1

NS2 Peds Mod 2: Developmental Variability
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  1. **Health Care for Children
    Children are 25% of the populationUS improved in a number of areas: vaccines, adolescent birth rate and mortality

    Most children are healthy but there are disparities related to race, ethnicities and economic disparities

    Millions of children have no health insurance

    National Child Study will follow 100,000 children in the US from birth to 21 years of age

    Healthy People 2010 primary goals to increase the quality and years of healthy life and eliminate health disparities related to race, ethnicity, and economic status
  2. **Health Promotion
    Many of tomorrow’s leading causes of death, disease and disability can be significantly reduced in children and adolescents by preventing six categories of behavior

    Tobacco use

    Behavior that results in injury and violence

    Alcohol and substance use

    Dietary and hygienic practices that cause disease

    Sedentary lifestyle

    Sexual behavior that causes unintended pregnancy and disease
  3. **Nutrition
    Young children develop eating habits in the firsts 2 to 3 years of life

    The Nurse is instrumental in guiding parents to nutritional food sources

    During adolescence parental influences diminish
  4. **Dental Health
    20% or 1 in 5 of children between 2 and 5 have visible dental caries

    The incidence of this is higher in Latino children

    Preschoolers in low income families are twice as likely to develop tooth decay and half as likely to visit a dentist

    This a preventable disease

    Nurses need to promote dental hygiene from the first tooth eruption, drinking fluoridated water and institute early dental preventative care
  5. **Childhood Health Problems
    Health care for children continues to improve

    Concern for children have increased morbidity of children living in poverty, low birth weight, chronic illness, foreign born adopted children and children in day care

    Children face behavioral social and behavioral problems are referred new morbidity or pediatric social illness

    1 in 5 has mental health problems and 1 in 10 has serious emotional problems that affect daily function

    Examples include type 2 DM, injuries, violence, substance abuse and emotional and mental health problems
  6. **Pediatrics in Community Health
    Focus on promoting and maintain the health of individuals, families and groups Synthesis of public health and nursing
  7. **Levels of prevention
    Primary Prevention include well child clinics, immunization programs and safety programs

    Secondary Prevention focuses on screening and early diagnosis of disease TB, Mental Health Counseling

    Tertiary Prevention focuses on optimizing function for children with disabilities or chronic illness, rehabilitation
  8. **Culture
    As ethnic, racial and cultural diversity in the US population increases it is important for RN’s to become culturally competent

    Culture is a pattern of learned beliefs, values and practices that are shared within a group

    People in one culture differ from those in another culture in the way they think, solve problems and perceive the world

    These characterize children’s outlooks for life
  9. **Social Roles
    Self concept dependent of social roles

    Culture significant influence on self concept

    Social groups in primary groups include families and friends

    Secondary groups include things likes professional organizations and churches

    Parents often unsure on what to teach their children
  10. **Self Esteem and Culture
    Childrens sense of Self esteem influence by culture

    A child’s sense of control may not come from self reliance or rather that of the feelings of worth in his or her family

    Families and cultures influence the criteria child evaluate to their own abilities

    Cultures vary if the instill an internal locus of control

    What is damaging is helpless that results from prejudice
  11. **Ethnicity
    Extend to family structure, food preferences, moral codes and expression of emotion

    To have a place in the group the child learn how to adhere to behavior that is expected in the group

    They take their cues by observation

    In US cultural lines are being assimilated as assimilation and blend into another culture
  12. **Ethnocentrism
    Ones own culture proves right and natural ways to do things

    It is common among dominant ethnic group

    The culturally competent nurse must recognize that their own views may differ from those of the patients they care for

    Nurses must be willing to ask questions
  13. **Socioeconomic Class
    Stronger family relationships are present amount lower socioeconomic because they have few resources and rely on the family for support

    Middle and upper class individuals often have resources that extend outside the extended family
  14. **Poverty
    Children living in poverty has been increasing during the 21st century

    The US is among the highest in the developed world

    In 2006 18% of children in the US were living in poverty

    Poverty is a strong predictor of child’s health and is closely associated with poorer physical development and mental health outcomes
  15. **Homelessness
    There are 1.6 million homeless children in the US

    The majority are less than 5 years and predominantly minorities

    Most homelessness is a direct result of numbers of people in poverty along with the lack for affordable housing

    Other reasons include job layoff’s, parental mental illness, economic crisis

    Another group are runaways victims if physical and sexual abuse
  16. **Migrant Farmworker Families
    One disadvantaged group is migrant farm workers and their children

    In the US there are between 3 and 5 million seasonal workers and their dependents

    There income is well below the poverty line

    The low economic level and the inadequate sanitation

    Children attend a variety of schools over the course of year with no continuity in education or health care

    They also have little parental supervision
  17. **Immigrant Children
    In 2005 21% of children lived in immigrant families

    These children and their families suffer from depression, grief, anxiety related to immigration, separation from extended family and country of origin

    Current laws restrict health benefits and they must wait 5 years to become eligible for comprehensive health benefits
  18. **Religion
    Is an influential factor shaping the culture of the US is the Judeo-Christian faith

    Many immigrants come the US for religious freedom

    The family’s religious orientation dictates o code of morality and attitudes toward education and male and females roles

    May determine the schools the children attend
  19. **Schools
    Next to families schools exert the major force in providing continuity between generations

    Teachers are expected to stimulate and guide students in their intellectual development and to develop problem solving strategies

    Socialization begins in kindergarten

    Some cultural groups do less well in school including African American, Mexican-American, Puerto Rican, and native American children

    These cultural variations can be attributed to high rates of poverty
  20. **Communities
    There are 1 million 6-12 year olds in the US

    Youth receive support from the community


    Boundaries or expectations

    Constructive use of time

    Internal assets in use include:Commitment to learning

    Positive Values

    Social competencies

    Positive Identity
  21. **Peer Groups
    Become increasingly important and children advance through school

    Many conflicts with teachers and parents are based on fear of rejection by peer group

    Peer relationships allow children to deal with hostility and the peer subculture relieves boredom
  22. **Children and Family in North America
    The frontier background of North America and overall orientation and childbearing has lead to an optimistic view of the world

    Children are given greater freedom than more tradition-orientated cultures

    Family Life is characterized by increasing geographic and economic mobility

    Less reliance on tradition, families are fragmentedChildren grow up with a number of adults who differ from one another, but provide impute as role models
  23. **Minority Group Membership
    The US has more racial, ethnic, and religious minority groups than any other county as a result of high immigration and high birth rates of these groups

    Ethnic minorities are become increasingly important because they have more having more children than the Caucasian population

    When minority groups immigrate to another country a certain degree of cultural and ethnic bleeding occur
  24. **Cultural And Religious Influences on Health Care
    Hereditary Factors

    Common foods and drugs may cause health problems in certain ethnic groups

    Lactose intolerance among certain ethnic groups

    Variations in newborns related to ethnic origin

    Typical growth is typically based on middle class Caucasians
  25. **Socioeconomic Factors
    The most overwhelming influence on health is the socioeconomic status

    Higher percentage of lower class individuals are suffering from some health problems at any one time

    Have higher incidence of lead poisoning

    Lower class children less likely to be immunized

    Lack of fund limits health care to serious disorders

    High correlation between poverty and illness

    Poor nutrition to lack of money to buy nutritious foods
  26. **Developmental Influences on Child Health Promotion
    Patterns of Growth and Development are definite and predictable patterns in growth and develop that continuous orderly and progressive

    First pattern cephalocaudal or head toe direction

    Infants get control of head before they get control of feet

    Second is proximodistal or near to far applies to midline to peripheral concept

    These patterns are bilateral and appear symmetrical

    The third trend describes development from simple to more complex
  27. **Bone Growth
    The bones of children possess many unique characteristics

    Bone fractures of growth plate may significantly affect subsequent growth and development

    Factors that influence skeletal muscle injury rates and types in children and adolescents include

    Less protective sports equipment for children

    Less emphasis on conditioning especially flexibilityIn adolescents, fractures being more common that ligamentous ruptures because of the rapid growth rate of the physeal zone of hypertrophy
  28. **Neurologic Maturation
    The brain grows rapidly after birth

    Lymphoid tissues contained in lymph nodes and thymus reach maturity by 6 years of age

    Physiologic Changes take place in all organs and systems

    Metabolism BMR changes through childhood is high during the first year of life and decreases to maturity

    Boys have higher BMR than girls

    Temperature reflects BMR even during the infant and toddler period temperature fluctuations occur
  29. **Sleep and Rest
    Sleep is a protective function of all organisms

    Newborns sleep 17 of 24 hours

    Toddlers take naps by 3 years most children have given up naps

    School age children sleep time declines

    Sleep requirements increase again during adolescents during periods of rapid growth
  30. **Temperament
    The manner of thinking and behaving or reacting

    From birth children demonstrate differences

    Nine characteristics of temperament have been identified in interviews with parents: activity, rhythmicity, approach-withdrawal, adaptability, threshold of responsiveness, insensitivity to reaction, mood, distractibility, and attention span and persistence

    Three types of personality: easy child 40%, difficult child 10%, slow to warm up child 15%

    35% of children either have some, but not all characteristics of one category

    Many normal children demonstrate side range of behavior
  31. **Developmental Personality

    Anal stage, phallic, latency period, genital stage
  32. **Erickson Psychosocial Development
    • Trust vs. Mistrust 0-1 year
    • -mothering person is essential for development of trust.
    • -mistrust develops when trust promoting experiences are deficient

    • Autonomy vs. shame and doubt 1-3 years
    • -they want to do things for themselves, imitation, using newly acquired skills
    • -shame/doubt: when children are made to feel small/self conscious, when choices are disastrous

    • Initiative vs. guilt 3-6 years
    • -Explore the world with all the sense, now have that inner voice/conscience
    • -guilt: children taking goals or activities that are in conflict with those of parents or others, or that their imaginings are seen as bad.

    • Industry vs. inferiority 6-12 years
    • -ready to be workers/produces, they want real achievement
    • -inadequacy/inferior: IF too much is expected of them
    • -competence: "ego quality" from sense of industry

    • Identify vs. role confusion 12-18 years
    • -Identiy: rapid makred physical changes, occupied with appearance
    • -role conrfusion
  33. **Piaget Cognitive Development (pg 851)
    Sensorimotor birth to 2 years

    Preoperational 2-7 years

    Concrete Operations 7-11 years

    Formal operations 11-15 years
  34. **Language Development
    Children born with capacity to develop speech and language skills

    Rate of speech varies from child to child

    Children always understand more than they can speak

    The first part of speech are nouns sometime verbs

    By the time they start school they can speak in simple structurally complete sentences
  35. **Moral Development Kohlberg
    Preconvential level- good or bad, right or wrong, bad or wrong behavior gets punished

    Conventional Level-concerned with conformity or loyalty behavior that meets approval and pleases or helps

    Postconventional-Formal operations correct behavior tends to be defined in terms of general individual rights and standards that have been examined and agreed on by the entire society
  36. **Development of Self Concept
    How individual describes self

    Individuals self concept may or not reflect reality

    In infancy awareness of ones independent existence the process becomes more active during toddlerhood

    School-age children are more ware of differences among people and more sensitive to social pressures

    During early adolescents children focus on physical and emotional changes taking place and peer acceptance
  37. **Body Image
    Feelings about own body

    Any variation from normal can negative impact body image

    Being called skinny, pretty or fat

    Children notice prominent differences in others

    Body image during adolescence is a crucial element in the shaping of identity
  38. **Self-Esteem
    Value one places on self

    As children’s competencies increase and they develop meaningful relationships, their self-esteem rises

    Children assess the following aspects of self


    Sense of control

    Moral worth

    Worthiness of love and acceptance
  39. **Role of play in Development
    Children’s play can be categorized according to content and social character

    Social affective play of infancy

    Sense pleasure play objects in environment

    Skill play infant can grasp sense of pleasure in developing new skills

    Unoccupied behavior daydreaming, fiddling with cloths

    Dramatic or pretend play talking on phone driving

    Games children in all cultures engage in games
  40. **Social Character of Play
    • Onlooker Play
    • Parallel Play
    • Solitary Play

    Associative Play children play together, but no organization or division of labor

    Cooperative Play Organized and children play in groups with others
  41. **Functions of Play
    Sensorimotor Development active play is essential for muscle development

    Intellectual Development through exploration and manipulation children learn colors, shapes, sizes, textures and significance of objects, collections, puzzles

    Creativity children can experiment and try out ideas children feel satisfied trying new things

    Self Awareness though exploration develop an identify that is facilitated through play activity

    Therapeutic Value can express emotions and release unacceptable impulses

    Moral Value right and wrong
  42. **Toys
    Types of toys can support and enhance development

    Positive child parent relations enhances brain development

    Raw material allow children to experiment and exercise own creativity

    Safety toys should be age appropriate and the government doesn’t get involved in toy safety

    Parents should check for Family Centered Care Box on toys
  43. **Selected Factors that impact Development
    Heredity has profound influence on development

    There is high correlation between parent height

    Health and vigor impacted by heredity

    Neuroendocrine factors hormones have significant impact on growth

    Nutrition plays a significant role in development

    Parents are important in sex role identify

    Siblings are first peers
  44. **Socioeconomic Level
    Children from higher socioeconomic levels are taller

    This could be related to lack of education about nutrition by parents in the lower socioeconomic levels

    They may be unable to move from unsafe neighborhoods where there is drug traffic and drive by shootings

    The emotional development of these children resemble those of children living in war zones
  45. **Disease
    Altered growth and development is one of the clinical manifestations in hereditary disorders

    • DwarfismTurners Syndrome
    • Kleinfelters Syndrome
    • Marfan Syndrome
    • Congenital Cardiac Disease
    • Cystic Fibrosis
  46. **Environmental Hazards
    Children are risk from chemical pollution and residue on foods, air pollution, radiation.

    Water, air and food contamination from a variety of sources is well documented

    Lead and asbestos and chemical released in breast milk especially prescribed drugs and nicotine

    Contamination from well-insulated homes
  47. **Stresses of childhood
    Defined as physiologic and an emotion of view

    Stress is demands that throw the child out of balance

    Some children are more susceptible to stress than others

    The concept of an emotional bank where children with a good positive bank can tolerate stress

    Parents and caregivers must be alert for stress

    Spending time with children and having supportive relationships are essential to child’s emotional well being
  48. **Influence of Mass Media
    Media has enormous influence on the developing child

    Images of risky behavior


    Children may identify with characters in reading material, moves and television programs

    Violent Video Games
  49. **Pain Assessment and Management
    Self report measure children at 4-5 can self report

    NPASS for neonates

    FLACC for non verbal infant up to 3 years of age

    Wong Baker Faces Scale for verbal children>3 years

    Using the right scale is essential for pain assessment
  50. **Pain management
    No Pharmacologic Management

    • Assist children with coping techniques
    • Environment and psychological factors impact pain
    • Children should learn to use technique prior to pain
    • Containment, Positioning and non nutritive sucking
    • Kangaroo care
    • Pharmacologic Management
    • Non-opioids Tylenol, ibuprofen
    • Combination of two analgesics act on the pain system on two levels
    • For moderate to severe pain opioids, oxycodone, morphine gold standard for severe pain
  51. **Drugs to relieve anxiety
    Co-analgesics or adjuvant analgesics valium and versed do not relieve pain, but may make the management of pain more effective
  52. **Patient Controlled Analgesia
    5-6 can be taught to push button to administer pain medication

    There are two functions Basal receives continuous dose with no PCA

    Basal plus PCA continuous pain and child can push button when pain increased

    PCA pushes button when requires pain medication
  53. **Evaluation of Effectiveness PCA
    The response to medication should be evaluated 15 to 30 minutes after dose

    Children must be taught that they will have less pain after pain medication

    Several harmful effect occur with unrelieved pain

    Prolongs stress response and adversely impact’s child recovery

    Poorly controlled acute pain can predispose patients to chronic pain syndrome
  54. **Reaction to Illness and Hospitalization
    Often hospitalization is the first crisis a child faces

    Separation Anxiety middle infancy through preschool years protest, despair and detachment

    Evidence shows that when children are separated they are remarkably adaptable and don’t suffer permanent ill effects

    Health care professionals must recognize what the different stages in separation anxiety represent
  55. **Early Childhood
    If separation is avoided they have a great capacity to tolerate other stressors

    Toddlers may plead with their parents to stay

    Preschoolers are more secure personally, but when sick they regress

    They may constantly ask when their parents are coming back
  56. **Later Childhood and Adolescents
    School age children are better able to tolerate separations from parents

    These children have high levels of physical and mental abilities that can’t be met in the hospital

    They miss their friends from school

    Scholl age children need and desire parental guidance and support of parents or other adult

    For adolescents may produce varied emotion

    Loss of peer contact post severe emotional threat

    Deviations within peer groups are poorly tolerated

    Benefit from group associations with other hospitalized teens
  57. **Loss of Control
    Lack of control increases perception of threat

    Infants loving care by nurturing person

    Toddlers striving for autonomy loss of control results from altered routine may initially be withdrawal and regression of development milestones

    Preschools have loss of control by physical restrictions

    Preschoolers egocentric and magical thinking limit their ability to understand events

    They understand explanations only in terms of real events

    School age Children susceptible to events that lack their control
  58. **School Aged
    When allowed to exert some control they are more cooperative

    Boredom is a major obstacles

    Quiet activities such as building Legos, board games, age appropriate video games can allay the boredom
  59. **Adolescents and Loss of Control
    Struggle for independence

    Anything that interferes this poses a threat to their sense of identify

    Patient role fosters dependency

    The nurse must also learn the adolescent language

    They may isolate themselves

    Friends can visit, but they may not meet their emotional needs

    Parents may not be support because this serves to isolate them further
  60. **Effects of Hospitalization on the Child
    May react to the effect of hospital pre-hospitalization, during the hospitalization or after discharge

    Adverse outcomes may be related to the length and number of admissions, invasive procedures and parental anxiety

    Common responses include regression, apathy fears, sleep disturbances especially in children <7

    Changes in the Pediatric Population with the focus of shorter stays and outpatient surgery a great percentage of children hospitalized have more serious and complex problems than in the past

    Hospitalization can be positive as well in that the child recovers from an illness while hospitalized
  61. **Stressors and Reactions of family to hospitalized child
    Parental Reactions-feeling helpless, questioning competency of staff, accepting the reality of hospitalization, needing to have information explained in simple language, dealing with fear, coping with uncertainly and seeking reassurance from caregivers

    Siblings- loneliness, fear and worry as well as anger, resentment, jealously and guilt, parents are often unaware of the feelings of this child while one is hospitalized Altered

    Family Role- Intensified attention toward the sick child siblings may feel jealous
  62. **Nursing Care
    Preparing children for hospitalization
    Admission assessment and physical assessment

    Preventing or minimizing separation family centered care

    Nurses must have appreciation of child’s separation behaviors

    Toddlers and preschoolers have limited understanding of time

    The young child’s ability to tolerate parental absence is limited

    Older children may find it helpful to have a clock

    Familiar surroundings increase child adjustment to separation

    Helping children maintain their usual contact also minimizes the effects of separation

    Promote Freedom of Movement

    Maintain Child’s Routine

    Encourage independence

    Promoting understanding

    Preventing or minimizing Fear of Bodily Injury

    Providing Developmentally Appropriate Activities

    Provide opportunities for play and expressive activities games, books, toys

    Creative expression, dramatic play

    Fostering Parent Child Relationships

    Provide for Educational Opportunities

    Promote self mastery
  63. **Support the Families
    Willingness to stay and listen to the parent verbal and nonverbal messages

    Support may also be provided through the clergy

    Support involves accepting cultural, socioeconomic and ethnic values

    Parents need help in accepting their own feelings toward the ill child

    Family Centered Care also addresses the siblings
  64. **Providing Information
    One of the most important things is to provide information about the disease, it’s treatment, the prognosis and home care

    The child’s emotional and physical reaction to illness and hospitalization

    The probable emotional reaction of family members to the illness

    Nurses must also prepare parents for reactions of siblings
  65. **Encouraging Parent Participation
    Preventing or minimizing separation is a key nursing goal with the child who is hospitalized, but maintaining parent-child contact is also beneficial for the family

    Foster environment that encourages parents to stay with their children and participate care whenever possible

    Parents should be included in care planning and understand that they are contributing to their child’s recovery, they are more inclined to remain with their child and have more emotional reserves to support themselves and their child in the hospital
  66. **Preparing for Discharge
    Involves education

    Usually best accomplished using interdisciplinary team

    Throughout hospitalization nurse must be aware of teaching that needs to be done prior to discharge

    All family members need to have written instructions regarding care at home

    Follow up appointments are also made
  67. **Care of Child and Family in Special Hospital Situations
    Ambulatory care ensures that children will not be separated from families

    Families report waiting is the most stressful

    A follow up phone call is made in 48 to 72 hours to check on the patient

    Isolation- increases all the stressors associated with hospitalization

    Younger children don’t understand isolation

    Preparation is very important

    Especially younger children must be shown the mask, gown and gloves

    When child’s condition improves play activities are provided
  68. **Emergency Admission
    Very traumatic

    Admission as result of injury give little time for preparation

    There is wide discrepancy between what constitutes a medical emergency

    Other factors for overuse of ER’s include uninsured individuals using this instead of primary providers
  69. **Intensive Care Units
    Admission to ICU is traumatic for both parents and child

    Nature and severity of the illness and the circumstances surrounding the admission

    Parents experience significantly more stress

    Families emotional needs are paramount when child admitted to the ICU

    Critical Care must be centered on the family

    Critically ill children becomes the parents primary focus

    Continued visits by ICU staff to assess child’s and parents adjustment and to act as liaison with nursing staff
  70. **Prenatal:
    **Middle childhood
    **Late childhood
    • **Prenatal:
    • -germinal: conception to 2 weeks-embryo: 2-8 weeks (2 months)
    • -fetal: 8-40 weeks

    • **Infancy (Birth to 12 months)
    • -neonatal: birth-19 days
    • -develops basic trust in the world

    • **Early childhood 1-6 year:
    • -toddler: 1-3 years & Preschool 3-6 yrs
    • -intense activity, discovery, personality development, acquire language

    • **Middle childhood: 6-11 yrs:
    • -school age, away from family and into peer relationships, social development and social skills

    • **Late childhood 11-19 years
    • -adolescence starts at 13
    • -rapid maturation, entry into adulthood, focus on individual