PEDS HESI HINTS 2021-Growth and Development
- Client safety is the hallmark of nursing. The fundamental components of nursing practice include nursing
... [Show More] process integrated w/ caring, communication, and spirituality, teaching, and learning as well as documentation of the integration of each of these elements
- Erikson (Psychosocial) – TM,AS,IG,II,IRC,II -TMASIGIIIRCII
o Trust vs mistrust (birth-1 year)
▪ Having parents hold their child while in the hospital is an excellent means of building the trust relationship
o Autonomy vs shame and doubt (1-3 year)
o Initiative vs guilt (3-6 year)
o Industry vs inferiority (6-12 year)
▪ Academic performance sense of industry = completing hw, staying on track w/ classmates
o Identity vs role confusion (12-18)
o Intimacy vs isolation (18+)
- Piaget (cognitive) - SPCF
o Sensorimotor period (birth-2 year)
o Preoperational thought (2-4 year)
o Concrete operation (7-11 year)
o Formal operation (11-15 year)
- Kohlberg (moral) NE,PO,IH&CR, GBGG &LO, SC & PP & UP)
o Infancy - Naiveté and egocentricism
o Toddler - Punish-obedience orientation
o Early childhood - Instrumental hedonism and concrete reciprocity
o Middle - childhood Good boy or good girl orientation, Law and order orientation
o Adolescence - Social contract orientation, Personal principle orientation, Universal principle orientation
- Denver developmental test
o Evaluates children from 1mo-6 years: gross motor skills, fine motor skills, language development, and personal/social development
- Infant (birth 1 year)
o Birth weight DOUBLES by 6 months, TRIPLES, by 12 months (if baby was born 9lbs, by 6 months, they would be 12lbs and by 1 y/o they would be 18lbs)
▪ Newborns can lose up to 10% of their weight w/o concern, but should regain
their birth weight by 2 weeks of age
o Newborn vaccine: Hep B birth-2 months (usually given prior to discharge)
o Birth length INCREASES by 50%/doubles by 12 months
o Posterior fontanel closes in 2-3 months, anterior fontanel closes in 12-18 months
o Heart rate: 110-160 (birth-1mo)
o Anticipatory guidance
▪ Separation anxiety (begins around 6 months to 30 months): if parents are not able to be w/ the infant (ex: hospitalization), baby may be inconsolable
▪ Aspiration is a common cause if injury/death at this age – often find small things
on the floor and put them in their mouths (older siblings often responsible for leaving around small objects)
o Nutrition
▪ Infants should be started on vegetables prior to fruits. The sweetness of fruits may inhibit infants from taking vegetables
▪ Full term infants have iron stores that last approx. 4-6 months
▪ Premature infants have iron stores form the mother that last approx. 2 months, so it is important to introduce an iron supplement by 2 months of age
o Hospitalization/nursing implications
▪ Emerging skills may disappear
▪ Plan & encourage to have parents as part of infant’s care
• Infants are more secure when in proximity to the parents – the parent’s lap = excellent place to assess the child
▪ Prep and teach family, but speak & console infant (esp. during pain/stress)
▪ Toys: mobiles, rattles, squeaking toys, picture books, balls, colored blocks, and activity boxes (ex: musical rattle infants have short attention span and enjoy auditory/visual stimulation
▪ The nurse should not deliver more than 1mL/injection to a 6mo old
▪ Medications should never be mixed in a large amount of food/formula b/c you can’t be sure child will take the entire feeding
▪ Formula decreases the absorption of iron
- Knowledge of normal growth and development Is used to evaluate interventions and therapy
o Ex: what behavior would indicate that thyroid hormone therapy for a 4 month old is effective? (what milestones are accomplished at 4 months?)
o Head control – milestone is met? indicates replacement therapy is adequate for
growth
- Toddler (1-3 years)
o Birth weight QUADRUPLES by 30 months, achieves 50% of adult height by 2 y/o
o Varicella vaccine
o Anticipatory guidance
▪ Engage in parallel play play alongside child, but rarely engage in activities w/ the other child
▪ Freud/Erickson toilet training is the essential event that must be mastered by
the toddler
▪ Very egocentric, do not consider needs of others (children)
o Hospitalization/Nursing implications
▪ Simple explanations right before procedures (1 y/o vs 3 y/o explanations differ)
▪ Enforced separation from parents (hospitalization) = greatest threat to toddler’s physiological/emotional integrity (teach parents to tell child they’ll be back!)
▪ Common stressors of the hospitalized toddler
• Interrupted routine, sleep pattern disturbances, fear of being hurt
▪ Very important to maintain a child’s home routine when parents are present and when not – increase child’s sense of security and decrease anxiety
▪ Provide security objects/favorite toys from home
▪ Respect & implement routine as much as possible
▪ REGRESSION (aka bedwetting)
▪ Toys: board and mallet, push-pull, toy phones, stuffed animals, storybooks w/pictures – playroom if able (mobility is important to development)
▪ Very basic explanations
▪ Toddlers learning to name body parts/concerned about their bodies
▪ Autonomy: provide guided choices when appropriate, allow to participate in actions of which they are capable
- Preschool (3-6 years)
o Gains 5lbs/year and grows 2.5 to 3 inches
o Posture: erect, more slender
o Vision: 22/20
o Respirations: 20-30bpm
o Runs, jumps, skips, hops, establishes handedness, and learns colors and shapes.
o 3 y/o: tricycle
o Falls: common injury
o 4 y/o: use scissors also has aggressiveness
o 5 y/o: ties shoelaces aggressiveness becomes independence)
o Learns sexual identity (curiosity, masturbation – common)
o Imaginary playmates and fears = common
o Literal thinkers (ex: child’s parents say Grandpa is in heaven, so she will think they are in heaven when they are at his funeral)
o Implications/hospitalization
▪ Emphasize understanding of child’s egocentricity
• Believe abuse/illness is their fault and should be reminded they are not bad people
▪ Explain they did not cause illness and pain/procedures are not punishment
▪ Answer child’s questions at child’s level (simple words they understand)
• What is/what is not going to be “fixed”
• Concrete/Simple explanations/basic pictures = helpful
• Understand time in relation to events (ex: nap time)
• Let child handle equipment/models of the equipment
▪ Therapeutic play/medical play helpful for child to act out their experiences
• Enjoy games, good way to elicit their assistance/cooperation during a procedure
▪ Fear of mutilation = common
• Bandaid – helpful in restoring body integrity
• Common response is to cry/protest during an immunization
▪ Toys: coloring books, puzzles, cutting and pasting, dolls, building blocks, clay and toys that allow the preschooler to workout hospitalization procedures
- Use facts and principles related to growth and development in planning teaching interventions
o Ex: what task could a 5 y/o w/ diabetes expect to accomplish by him or herself?
o Let the child choose injection site, gives them a sense of control
- Knowledge of normal growth and developmental milestones are important in the delivery and care of an infant. If there appears to be a discrepancy in the infant’s development, it’ll warrant HCP to further investigate possible cause of delay
- School-age (6-12 y/o)
o Normal for girls to grow taller/gain more weight at this time [Show Less]