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2. CHILD-BEARING STAGE 3. GROWN CHILD STAGE 4. OLDER FAMILY -ESTABLISH SATISFYING RELATIONSHIPS BUILT ON MULTIPLE TRUSTS AND BONDS -PARENTS ADOPT NEW ROLES -EMPTY NEST SYNDROME!!! -RETIREMENT OF ONE OR BOTH PARENTS 6 LEADING CAUSES OF CHILD DEATHS? 1. VEHICLE ACCIDENTS INFANT MORTALITY -NEONATAL PERIOD: <28 DAYS OF LIFE BIRTH WEIGHT: OTHER STATISTICS: -MORTALITY INCREASED IN
TODDLERHOOD 9 4 FAMILY PRACTICE PATTERNS? 1. AUTHORITARIAN OR DICTATORIAL 10 AUTHORITARIAN OR DICTATORIAL FAMILY PRACTICE PATTERN? -RULES MADE AND ENFORCED BY PARENTS -PARENTS TRY TO CONTROL THE CHILD'S BEHAVIORS AND ATTITUDES THROUGH UNQUESTIONED RULES AND EXPECTATIONS EXAMPLE: THE CHILD IS NEVER ALLOWED TO WATCH TELEVISION ON SCHOOL NIGHTS 11 PERMISSIVE OR "LAISSEZ-FAIRE" PARENTING STYLE? -PARENTS EXERT LITTLE OR NO CONTROL OVER THE CHILD'S BEHAVIORS, AND CONSULT THE CHILD WHEN MAKING DECISIONS. -PARENTS DON'T REGULATE OR SET LIMITS EXAMPLE: THE CHILD ASSISTS WITH DECIDING WHETHER OR NOT HE WILL WATCH TELEVISION 12 DEMOCRATIC OR AUTHORITATIVE PARENTING STYLE? -ALL MEMBERS HAVE EQUAL INPUT AND ARE RESPECTFUL -PARENTS DIRECT THE CHILD'S BEHAVIOR BY SETTING RULES AND EXPLAINING THE REASON FOR EACH RULE SETTING. -PARENTS NEGATIVELY REINFORCE DEVIATIONS FROM THE RULES EXAMPLES: -THE PRIVILEGE IS TAKEN AWAY BUT LATER REINSTATED BASED ON NEW GUIDELINES 13 UNINVOLVED OR PASSIVE PARENTING STYLE? -LITTLE OR NO COMMITMENT TO PARENTING -PARENTS ARE UNINVOLVED, INDIFFERENT, AND EMOTIONALLY REMOVED EXAMPLES: 14 POSITIVE PARENTAL INFLUENCES? -PARENTS HAVE GOOD MENTAL HEALTH
15 WAYS TO PROMOTE ACCEPTABLE BEHAVIOR? -VALIDATE THE CHILD'S FEELINGS, AND OFFER SYMPATHETIC EXPLANATIONS -PROVIDE ROLE MODELING AND REINFORCEMENT FOR ACCEPTABLE BEHAVIOR -SET CLEAR AND REALISTIC LIMITS AND EXPECTATIONS BASED ON THE CHILD'S DEVELOPMENTAL LEVEL -FOCUS ON THE BEHAVIOR WHEN IMPLEMENTING DISCIPLINE -MEDICAL HX OF PARENTS, SIBLINGS, AND GRANDPARENTS -FAMILY STRUCTURE FOR ROLES/POSITION WITHIN THE FAMILY, AS WELL AS OCCUPATION AND EDUCATION OF FAMILY MEMBERS -DEVELOPMENTAL TASKS A FAMILY WORKS ON AS THE CHILD GROWS -FAMILY CHARACTERISTICS: CULTURAL, RELIGIOUS, AND ECONOMIC INFLUENCES ON BEHAVIOR, ATTITUDES, AND ACTIONS -FAMILY STRESSORS, SUCH AS EXPECTED (BIRTH OF A CHILD) AND UNEXPECTED (ILLNESS OF A CHILD, DIVORCE, DISABILITY OR DEATH OF A FAMILY MEMBER) EVENTS THAT CAUSE STRESS -AVAILABILITY OF AND FAMILY INTERACTIONS WITH COMMUNITY RESOURCES -FAMILY SUPPORT SYSTEMS, SUCH AS AVAILABILITY OF EXTENDED FAMILY, WORK AND PEER RELATIONSHIPS, AS WELL AS SOCIAL SYSTEMS AND COMMUNITY RESOURCES TO ASSIST THE FAMILY IN MEETING NEEDS OR ADAPTING TO A STRESSOR 17 Leading causes of death, disease, & disability (cardiovascular, cancer, lung, depression, violence, substance abuse, injuries, nutritional deficiency, & HIV/AIDS) can be reduced by preventing 6 category of behavior: Tobacco use, behaviors that result in injury or violence, alcohol or substance use, dietary & hygienic practices that cause disease, sedentary lifestyle, sexual behaviors that causes pregnancy & disease 19 AFFINAL FAMILY DEFINITION? 21 "HOUSEHOLD" FAMILY DEFINITION? ACCOMMODATES OTHER VARIETIES OF FAMILY STYLES family is system that continually interacts with its members and environment – nurse can intervene to help family prepare for and cope with change crisis interventions are used by nurses to help family cope with challenging event nurses provide anticipatory guidance to prepare family members for transition to next developmental stage 25 HEALTHY PEOPLE 2020 LEADING HEALTH INDICATORS AND GOALS? GOALS LEADING HEALTH INDICATORS is learned beliefs, values, and practices that are shared within the group is division of humans possessing traits that are transmissible through descent is affiliation of a set of people who share unique cultural, social, or linguistic heritage is the process by which society imparts its competencies, values, and expectations to children patterns of behavior for people in variety of social positions. Role prohibits some behaviors and allows others. Provides significant influence on development of child’s self-concept 31 Parent-Professional collaboration: Encouraging activities to develop self-confidence and self-esteem BIRTH TO 4 WEEKS (28 DAYS) 4 WEEKS (28 DAYS) TO 1 YEAR 39 NEONATAL REFLEXES AND WHEN THEY DISAPPEAR? MORO= 3-4 MONTHS – increase in physical size & weight of whole or any of its parts – gradual change & expansion; advancement from lower to more advanced stage of complexity 42 DIRECTIONAL PATTERN OF GROWTH AND DEVELOPMENT? Cephalocaudal: (head to tail) lower extremities Differentiation : simple operations to complex activities. Global patterns of behavior to specific refined patterns 43 SEQUENTIAL PATTERN OF GROWTH AND DEVELOPMENT? definite, predictable sequence with each child passing thru each stage has a fixed, precise order, it does not progress at the same rate or pace. There are periods of acceleration & decelerated growth in total body growth & in subsystems. Pass thru the predictable stage at different rates. Range of time rather than certain point. Proceeds in orderly sequence ht: sm-lg. motor: sit-creep-stand-walk-run -limited times during the process of growth when reacts with environment in a specific manner. (critical, sensitive, vulnerable and optimal times) Depends whether the quality of interactions will be beneficial or harmful. -IF THEY MISS ANY SENSITIVE PERIOD IN DEVELOPMENT, THEY WON'T BE AS ADVANCED IF THEY TRY TO MAKE IT UP SENSITIVE PERIODS: Each child is unique – higher in children -Best indicators of biological age 49 IMPORTANT HT AND WT STATISTICS? NEED TO KNOW!!!! -Ht at 2
is approximately 50% of eventual adult ht 51 GROWTH DIMENSION STANDARDS? Height or length Age, gender specific, and nutritional status 53 FACTORS THAT INFLUENCE GROWTH AND DEVELOPMENT? Hereditary traits Manner of thinking, behaving, or reacting that is characteristic of individual TYPES: 55 Easy child TEMPERAMENT: -even tempered, regular, predictable habits -easygoing children are even tempered, are regular and predictable in their habits, and have a + approach to new stimuli. They are open and adaptable to change and display a mild-to-moderately intense mood that is typically positive. Approximately 40% of children fall into this category. 56 Difficult child TEMPERAMENT: -highly active, irritable, and irregular habits -difficult children are highly active, irritable, and irregular in their habits. Negative withdrawal responses are typical, and they require a more structured environment. These children adapt slowly to new routines, people, and situations. Mood expressions are usually intense and primarily negative. They exhibit frequent periods of crying, and frustration often produces violent tantrums. This group represents about 10% of children 57 Slow-to-warm-up child TEMPERAMENT: -react negatively and with mild intensity to new stimuli; unless pressured, adapt slowly with repeated contact -these children typically react negatively and with mild intensity to new stimuli and, unless pressured, adapt slowly with repeated contact. They respond with only mild but passive resistance to novelty or changes in routine. They are inactive and moody but show only moderate irregularity in functions. 15% of children demonstrate this temperament pattern. -May denote acute illness, chronic disease, or disability 59 What has had the greatest impact on reducing infant mortality in the United States? -Access to high-quality prenatal care -Access to and the use of high-quality prenatal care is a promising preventive strategy to decrease early delivery and infant mortality. The improvements in perinatal care, in particular respiratory care and care of the mother-baby dyad before delivery, have had the greatest impact. There has been a decrease in some congenital anomalies such as spina bifida, but this is not the greatest impact. Better maternal nutrition has had a positive influence but not the greatest overall impact. Changes in funding have not had the greatest impact. 60 The nurse teaching parents of an adolescent about nutrition will include what important information? -Resources to assist lower income families about obtaining enough protein. -Lower income families may need resources and information about how to obtain assistance in getting expensive foods such as meats to get enough protein intake. During adolescence, parental influence diminishes and the adolescent makes food choices related to peer acceptability and sociability. Occasionally these choices are detrimental to adolescents with chronic illnesses, such as diabetes, obesity, chronic lung disease, hypertension, cardiovascular risk factors, and renal disease. Families that struggle with lower incomes, homelessness, and migrant status generally lack the resources to provide their children with adequate food intake; nutritious foods, such as fresh fruits and vegetables; and appropriate protein intake. The result is nutritional deficiencies with subsequent growth and developmental delays, depression, and behavior problems. Behavior problems can indeed be related to nutritional deficiencies. 61 The role of the pediatric nurse is influenced by trends in health care. The greatest trend in health care is: shift of focus to prevention of illness and maintenance of health. 62 Evidence-based practice, a current health care trend, is best described as: - questioning why something is effective and whether there is a better approach. 63 The signs and symptoms in a nursing diagnosis describe: - a cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems. -This is the third part of the nursing diagnosis, the signs and symptoms. 64 -projected changes in an individual’s health status, clinical conditions, or behavior? These are the outcomes or goals that are established. 65 -an individual’s response to health pattern deficits in the child, family, or community? This is the definition of the problem statement, the first component of the nursing diagnosis. 66 - physiologic, situational, and maturational factors that cause the problem or influence its development? This is the definition of etiology, the second component of the nursing diagnosis. 67 When teaching an adolescent mother about risk factors for neonatal death, the most important factor is: - low birth weight. -LBW, which is closely related to early gestational age, is considered the leading cause of neonatal death in the United States. Injuries are the leading cause of death in children over age 1 year, with the majority being motor vehicle accident (MVA) injuries. Injuries to the mother and chronic illness are not the major causes of neonatal death. 68 Nurses play an important role in current issues and trends in health care. Which is a current trend in pediatric nursing and health care today? -Health promotion resources enable children to achieve their full potential. -Health promotion provides opportunities to reduce differences in current health status among members of different groups and provides a better chance to achieve the fullest health potential. The patient and family is the unit of care for the health care provider. Discharge planning begins when the patient is admitted. The focus of pediatric health care is trending away from acute hospital settings. 69 What is the most appropriate teaching point to include in a health promotion teaching plan for parents of children age 5 to 14? -Storing firearms in locked cabinets. -Improper use of firearms is the fourth leading cause of death from injury in children 5 to 14. Mechanical suffocation is the leading cause of death from injury in infants. Homicide is the second leading cause of death in 15 to 19 year olds. Poisoning causes a considerable number of injuries in children under 4 years of age. 70 Place the following steps of the nursing process in the proper order of completion when the nurse is caring for a child with pneumonia. (Place the answer options in the correct order. Separate each answer by a comma.) (Select all that apply). Determine whether antibiotic therapy has been effective by reviewing white blood cell count. Correct The correct steps in the nursing process are: Assessment: listening to breath sounds 71 Which health promotion teaching points should a nurse include in a dental teaching plan to help prevent dental caries? (Select all that apply.) -Drink fluoridated water. -Dental caries is the single most common chronic disease of childhood. Nearly one in five children between the ages of 2 and 4 years has visible cavities. The most common form of early dental disease is early childhood caries, which may begin before the first birthday and progress to pain and infection within the first 2 years of life. -Preschoolers of low-income families are twice as likely to develop tooth decay and only half as likely to visit the dentist as other children. -Early childhood caries is a preventable disease, and nurses play an essential role in educating children and parents about practicing dental hygiene beginning with the first tooth eruption; drinking fluoridated water, including bottled water; and instituting early dental preventive care. 72 Children are taught the values of their culture through observation and feedback on their own behavior. A nurse teaching a class on cultural awareness-competence should be aware of which factor(s) that may be culturally determined? (Select all that apply.) -Social roles -Social roles are influenced by culture. -Cultural development may be limited by geography. The geographic boundaries are not culturally determined. 73 A camp nurse is assessing a group of children attending summer camp. Based on the nurse’s knowledge of special parenting situations, which group of children is at risk for a sense of belonging? - Children recently placed in foster care -Children placed in foster care are at greater risk to have problems perceiving a sense of belonging. 74 What is appropriate advice for parents who are preparing to tell their children about their decision to divorce? -Give reassurance that the divorce is not the children’s fault. -Parents can cry in front of children; it may give the children permission to do the same. 75 The most overwhelming adverse influence on health is: race. -socioeconomic status. -Although children of different racial groups have differing health issues, socioeconomic status is a key predictor. Customs do not usually have an adverse effect on health. A higher percentage of lower-class individuals have some health problem at any one time than other individuals in different classes. There is a high correlation between poverty and poor nutrition. On a population basis, genetic constitution is not an overwhelming adverse influence. 76 Which statement is true concerning folk remedies? They may be used to reinforce the treatment plan. -They may be used to reinforce the treatment plan. -Whenever they are compatible, folk remedies should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the remedy, they may not be incompatible. These circumstances vary with the remedy. These circumstances vary with the remedy. 77 The nurse is planning care for a patient with cultural background different from that of the nurse. An appropriate goal is to: strive to keep cultural background from influencing health needs. -adapt as necessary cultural practices to health needs. -The cultural background is part of the individual; it would be very difficult to
eliminate its influence. 78 The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy in the toddler? Helping the toddler complete tasks -Encourage the toddler to do things for self when capable of doing them -To successfully achieve autonomy, the toddler needs to have a
sense of accomplishment. This does not occur if parents complete tasks for the toddler. -Autonomy develops when children complete tasks of which they are capable. KNOW!!! 79 Before transporting a 16-year-old American Indian female for a magnetic resonance imaging (MRI) scan, the nurse notices the girl is wearing a decorated amulet necklace. The nurse’s next BEST action is to: remove the necklace and place it at the nurse’s station. - ask the patient if there is a special reason for wearing the necklace. -The nurse should first ask the patient the purpose of wearing the necklace. The amulet may be worn as a religious ritual or simply as an accessory. After assessing why the necklace is worn, the nurse could then explain the reason for having to remove the necklace for the procedure. The first step though is to assess. Placing tape around the neck is not an appropriate action and could be unsafe. The necklace should be left with family members if possible or in a locked cabinet, rather than at the nurse’s station. 80 Parents of a 10-year-old child are concerned that their child has recently been showing signs of loneliness and abandonment. What should the nurse consider when discussing this issue with the parents? Changing self-esteem is difficult after about age 5. - Transitory periods of loneliness and abandonment are expected developmentally. -Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one’s worthiness. Self-esteem changes with development. Transient changes are expected and with positive encouragement and support are only temporary. Self-esteem is based on several components: competence, sense of control, moral worth, and worthiness of love and acceptance. 81 While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents’ religious beliefs/practices. The nurse should recognize that this is: normal in spiritual development. -normal in spiritual development. -This describes stage 4 in spiritual development. Adolescents attempt to determine which of their parental standards and beliefs to incorporate into their own. 82 Cultural practices possibly considered abusive by the dominant culture are: • Coining—A Vietnamese practice that may produce weltlike lesions on
the child’s back when the edge of a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of disease 83 The practice of cultural humility is continual and an important concept in the nursing process. Nurses can facilitate this process by: (Select all that apply.) integrating cultural knowledge. -integrating cultural knowledge.
-Integrating cultural knowledge is essential to providing care to families and the community. Recognizing cultural difference is a component of cultural awareness, humility, and competence. Acting culturally appropriate is essential in understanding and being able to deal effectively with families in a multicultural community. Nurses must be aware of their own beliefs and practices before they can begin to understand the varied and numerous cultural influences on the life of children and family. It is essential that nurses make an effort to adapt health care practices to the family’s health needs rather the attempting to change longstanding beliefs. 84 The nurse is talking to a group of parents about different types of play in which children engage. Which statement made by a parent would indicate a correct understanding of the teaching? “Parallel-play children borrow and lend play materials and sometimes attempt to control who plays in the group.” - “Cooperative play is organized, and children play in a group with other children.” -Play in which children borrow and lend play materials and attempt to control who plays in the group is known as associative play. -Parallel play occurs when children play independently but among other children. -Onlooker play is described as play in which children watch but make no attempt to enter into play with other children. -Cooperative play is play that is organized; children play in a group with other children and plan activities for purposes of accomplishing an end. 85 Which best describes Piaget’s cognitive stage of formal operations? Deductive and abstract reasoning -Deductive and abstract reasoning -Piaget’s cognitive stage of formal operations occurs between the ages of 11 and 15; deductive and abstract reasoning are developed. -Inductive reasoning and beginning logic begin in the concrete operations stage between the ages of 7 and 11. -Transductive reasoning and egocentrism occur in the preoperational stage at age 2 to 7. -Cause-and-effect and object permanence occur during the sensorimotor stage from birth to 2 years. 86 Parents are often confused by the terms growth and development and use the terms interchangeably. Based on the nurse’s knowledge of growth and development, the most appropriate explanation of development is: a child grows taller all through early childhood. - a child learns to throw a ball overhand. Correct -Development is the mental and cognitive attainment of skills. Growth is the increase in physical size—both height and weight. 87 A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child’s development is on target? The child has not gained weight for 3 months. Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones. Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child’s development may not be on target. In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child’s development may not be on target. A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet. -The child can throw a large ball but not a small ball. -Development is continuous and proceeds from gross to refined, so children whose development is on target can usually throw large objects before small ones. -Not gaining weight for 3 months is an abnormal assessment finding; it would indicate that the child’s development may not be on target. -In children, the legs are normally the most rapidly growing part of the body; if this is not the case, the child’s development may not be on target. -A child whose development is on target can sit steadily before pulling herself or himself up to her or his feet. 88 Based on Piaget’s theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? If an object is
hidden, that does not mean that it is gone. - If an object is hidden, that does not mean that it is gone. -Part of learning permanence is learning that although an object is no longer visible, it still exists. At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years. 89 A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson’s theories. Based on the nurse’s knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to: feed lunch. - allow the toddler to start making choices about what to wear. -A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler is developing autonomy and focusing on doing things for himself or herself and therefore would not want the mother to feed him or her. The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage. A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment. 90 A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group? The amount of medicine is less. -The amount of medicine is less. -A preschool child does not have the ability to understand the concept of conservation. This concept is not developed until school age. -Understanding conservation occurs between 7 to 10 years of age, when a child begins to realize that physical factors, such as volume, weight, and number, remain the same even though outward appearances are changed. Children are able to deal with a number of different aspects of a situation simultaneously. This is not an expected response by a child. A preschool child will not typically believe the glass changed shape to accommodate the medicine but rather that the amount of medicine is less in the short, wide glass. 91 A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory? Erikson - Kohlberg -Kohlberg developed the theory of moral development sequence for children. It includes how children acquire moral reasoning and is based on cognitive developmental theory. -Erikson developed the theory of psychosocial development. -Fowler developed the theory of spiritual development. -Freud developed the theory of psychosexual development. 92 During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as: concrete operations. -concrete operations. -Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options. -Preoperational thinking is concrete and tangible. During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration. Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience. -School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school. -Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years. 93 Which statement helps explain the growth and development of children? Development proceeds at a predictable rate. -The sequence of developmental milestones is predictable. -There is a fixed, precise order to development. There are periods of both accelerated and decelerated growth and development. Each child develops at his or her own rate. Physical growth and development proceed at differing rates. 94 During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse’s knowledge of developmental levels, the most appropriate toys to suggest are: (Select all that apply.) push-pull toys. -push-pull toys. -Both gross and fine motor skills are becoming more developed and children at this age enjoy toys that can help refine these skills. Children at this age enjoy more colorful toys. Children at this age are less interested in placing toys in the mouth and more interested in toys that can be manipulated. 95 The nurse is developing a teaching plan about preventing fetal exposure to teratogens. The nurse should include which teratogenic agents or conditions? (Select all that apply.) acetaminophen (Tylenol) - isotretinoin (Accutane) -Teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors. -Types of teratogens include drugs (phenytoin [Dilantin], warfarin [Coumadin], isotretinoin [Accutane]); chemicals (ethyl alcohol, cocaine, lead); infectious agents (rubella, cytomegalovirus); physical agents (maternal ionizing radiation, hyperthermia); and metabolic agents (maternal PKU). Many of these teratogenic exposures and the resulting effects are completely preventable, such as ingestion of alcohol resulting in fetal alcohol syndrome or fetal alcohol effects, which causes severe birth defects, including cognitive impairment. The incidence of fetal alcohol syndrome is estimated at 5.2 per 10,000 live births (American Academy of Pediatrics, 2000). 96 The nurse expects which characteristic of fine motor skills in a 5-month-old infant? Strong grasp reflex - Able to grasp object voluntarily a=This is
characteristic of a 1-month-old infant. b=This is characteristic of an 11-month-old infant. 97 The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. The nurse should recognize that: this assessment is normal. - developmental/neurologic evaluation is needed. -A 6-month-old infant should have social interaction beyond smiling and cooing. The child requires evaluation. The head lag should be almost gone by 4 months of age. This child requires evaluation. The child requires evaluation before interventions can be determined. 98 The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of: trust. -trust. -The task of infancy is the development of trust. -Industry vs. inferiority is the developmental task of school-age children. 99 A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse’s reply should be based on knowledge that: the infant is most likely spoiled. -this is a normal reaction for this age. -These are developmentally appropriate. The infant is experiencing stranger anxiety, which is expected for this age child. These are developmentally appropriate. No data have been shown to support this. 100 At what age would the nurse advise parents to expect their infant to be able to say “mama” and “dada” with meaning? 4 months -10 months -Consonants are added to infant vocalizations. Babbling resembles one-syllable sounds. At this age infants say sounds with meaning. This is late for the development of sounds with meaning. 101 The MOST appropriate recommendation for relief of teething pain is to instruct the parents to: rub gums with aspirin to relieve inflammation. -give child a frozen teething ring to relieve inflammation. -Gums should not be rubbed with aspirin. It can be dangerous if the child aspirates aspirin. Hydrogen peroxide would not be effective. Cold reduces inflammation and should be used for relief of teething irritation. Cold, not warmth, reduces inflammation. 102 The mother of a 3-month-old breastfed infant asks about giving her baby water since it is summer and very warm. The nurse should recommend that: fluids in addition to breast milk are not needed. =fluids in addition to breast milk are not needed. -The child will nurse according to needs. Additional fluids are not necessary for the breastfed baby. Supplemental water should not be given. It may cause water intoxication. Supplemental water should not be given. It may cause water intoxication. Clear juices do not provide sufficient caloric or nutrient intake and may interfere with breastfeeding. 103 The parent of a 12-month-old infant says to the nurse, “He pushes the teaspoon right out of my hand when I feed him. I can’t let him feed himself; he makes too much of a mess.” The nurse’s BEST response is: “It’s important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess.” -“Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable.” -The child is developmentally ready for self-feeding. Ignoring the behavior and not allowing the child to self-feed is not fostering the child’s development. The child is developmentally ready for self-feeding. The parent should not force the use of the spoon but should substitute finger foods. This response minimizes the parent’s concerns about the mess created by self-feeding. At 12 months the child should be self-feeding. Since children this age eat primarily finger foods, it is useful to offer the parent suggestions for keeping the mess to a minimum. 104 The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem? Putting her in parents’ bed to cuddle -Beginning to put her to bed while still awake -The nurse needs to discuss the issue of co-sleeping with parents. Having the infant in bed with them may still interfere with their sleep. Parents need to develop bedtime rituals that involve putting the child in bed when awake. If the child is put in bed awake, she will be able to return to sleep more easily if she awakens at night. Providing formula at night contributes to bottle-mouth caries. 105 A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention? A= “Never shake baby
powder directly on your infant because it can be aspirated into his lungs.” -“When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall.” A=This is appropriate guidance for a first-month appointment. B=This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. C=Rolling over from abdomen to back occurs between 4 and 7 months. This is the appropriate anticipatory guidance for this age. D= This information should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. 106 The nurse in the pediatric clinic identifies which infants at risk for developing vitamin D–deficient rickets? Lacto-ovo vegetarians -Those using yogurt as primary source of milk -Individuals who follow this diet include milk and its products in their diet. Breast milk has sufficient vitamin D if the mother is not deficient in this vitamin. Yogurt may not be supplemented with vitamin D. Lack of sunlight contributes to vitamin D–deficient rickets. 107 A 3-month-old bottle-fed infant is allergic to cow’s milk. The nurse’s BEST option for a substitute is: goat’s milk. -casein hydrolysate milk formula. -The milk protein in goat’s milk cross-reacts with cow’s milk protein. This is avoided because of the cross-reaction with soy. The cow’s milk protein is also found in skim milk. The milk protein is broken down in these formulas. 108 The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse’s initial action is to: advise the mother to follow a milk-free diet for 3 to 5 days. -take a thorough, detailed history of usual daily events. -The initial step in managing colic is to take a thorough, detailed history of the usual daily events including: diet, time of day when child cries, presence of family members, type of cry, etc. Before suggesting formula changes or medications to relieve symptoms, a detailed history is needed. It is important that the nurse convey an empathetic and compassionate attitude and reassure the parents that they are not doing anything wrong. 109 Which strategy might be recommended for an infant with failure-to-thrive to increase caloric intake? Using developmental stimulation by a specialist during feedings -Being persistent through 10 to 15 minutes of food refusal -Feeding times should have a nonstimulating environment so the focus is on the meal. Solids should be introduced slowly to decrease dependence on the bottle. Calm perseverance is important. Parents often fail to persist through the child’s refusals. Daily schedule should be structured to provide consistency for the child. 110 The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was “just fine” when they put him in his crib already asleep. The nurse should suspect his death was caused by: suffocation. -sudden infant death syndrome (SIDS). -Although the child was found under the blanket, the bloody fluid is consistent with SIDS, not suffocation. No other injuries are reported. No previous acute life-threatening events had been reported. The death is consistent with the characteristics of SIDS. 111 A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. There are no other liquids given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? Vitamin B - Vitamin D -The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 200 IU of vitamin D daily by age 2 months to decrease vitamin D deficiency. Vitamin B is not needed. Vitamin C is not needed. Vitamin K is not needed. 112 A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. The nurse is aware that children in this country are at increased risk for: rickets. -kwashiorkor. -Kwashiorkor is defined as primarily a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet. 113 A nurse is caring for a 2-month-old exclusively breastfed infant with an admitting diagnosis of colic. Based on the nurse’s knowledge of breastfed infants, what type of stool is expected? Dark brown and small hard pebbles -Semiformed, seedy, yellow -Colic does not change the appearance, texture, or color of stools. The color, consistency, and texture of the stools would be normal for the type of feeding. In a breastfeeding infant, that would be semiformed, seedy, and yellow. Dark brown, small hard pebbles are not a typical bowel movement of an exclusively breastfed infant. Loose stool with green mucus streaks is not a typical bowel movement of an exclusively breastfed infant. Formed stool with white mucus is not a typical bowel movement of an exclusively breastfed infant. 114 The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8-week-old make which statement? (Select all that apply.) “I only smoke in the kitchen.” -“I only smoke in the
kitchen.” -Maternal smoking increases the risk of SIDS. Smoking anywhere in the home with an infant present is not recommended. The “Back to Sleep” Campaign is given credit for reducing the rate of SIDS in the United States. Co-sleeping increases the risk of SIDS. 115 When preparing to administer Hepatitis B vaccine to a newborn, the nurse should: (Select all that apply.) initiate an immunization record. -initiate an immunization record. -An immunization record is important for the nurse to initiate and give to the mother so that a continuous record of immunizations is maintained. Hepatitis B vaccine is the primary prevention for the disease. If the mother is positive for the hepatitis B virus, the newborn will need to receive the hepatitis B immunoglobulin (HBIG) in addition to the hepatitis B vaccine. The dose of hepatitis B vaccine is 0.5 mL, to be given with a 25-gauge, 5/8 inch needle, intramuscularly (IM) in the newborn. Signed informed consent must be obtained from the mother before administration of the vaccine. The only safe intramuscular injection site for the newborn is the vastus lateralis muscle. 116 Infants most at risk for sudden infant death syndrome (SIDS) are those: (Select all that apply.) who sleep supine -who sleep prone -Infants at increased risk for SIDS are low birth weight, have low Apgar scores, sleep prone, cosleep, were premature, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIDS. A cousin dying of SIDS does not present an increased risk for the infant. 117 The nurse is providing education to a parent of a 10-month-old infant receiving iron supplements. What will be included in the teaching? (Select all that apply.) Administer iron with meals. Administration of Iron Supplements includes: -Place iron toward the back side of the mouth with a dropper. -Administration of Iron Supplements includes: Ideally iron supplements should be
administered between meals for greater absorption.
118 The primary goals in the nutritional management of children with failure to thrive (FTT) are: (Select all that apply.) allow for catch-up growth. -allow
for catch-up growth. -The goal is to provide sufficient calories to support “catch-up” growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with
high-calorie foods and drinks in addition to treating any coexisting medical problems. 119 SOCIAL-AFFECTIVE PLAY? -PLAY BEGINS WITH SOCIAL-AFFECTIVE PLAY, WHEREIN INFANTS TAKE PLEASURE IN RELATIONSHIPS WITH PEOPLE. -AS ADULTS TALK, TOUCH, NUZZLE, AND IN VARIOUS WAYS ELICIT RESPONSES FROM AN INFANT, THE INFANT SOON LEARNS TO PROVOKE PARENTAL EMOTIONS AND RESPONSES WITH SUCH BEHAVIORS AS SMILING, COOING, OR INITIATING GAMES AND ACTIVITIES. -A NONSOCIAL STIMULATING EXPERIENCE THAT ORIGINATES FROM WITHOUT. -OBJECTS IN THE ENVIRONMENT (LIGHT AND COLOR, TASTES AND ODORS, TEXTURES AND CONSISTENCIES) ATTRACT CHILDREN'S ATTENTION, STIMULATE THEIR SENSES AND GIVE PLEASURE. -PLEASURABLE EXPERIENCES ARE DERIVED FROM HANDLING RAW MATERIALS (WATER, SAND, FOOD), BODY MOTION (SWINGING, BOUNCING, ROCKING), AND OTHER USES OF SENSES AND ABILITIES (SMELLING, HUMMING). -AFTER INFANTS HAVE DEVELOPED THE ABILITY TO GRASP AND MANIPULATE, THEY PERSISTENTLY DEMONSTRATE AND EXERCISE THEIR NEWLY ACQUIRED ABILITIES THROUGH SKILL PLAY, REPEATING AN ACTION OVER AND OVER AGAIN. -CHILDREN ARE NOT PLAYFUL BUT FOCUSING THEIR ATTENTION MOMENTARILY ON ANYTHING THAT STRIKES THEIR INTEREST. -THEY DAYDREAM, FIDDLE WITH CLOTHES OR OTHER OBJECTS, OR WALK AIMLESSLY. -THIS ROLE DIFFERS FROM THAT OF ONLOOKERS, WHO ACTIVELY OBSERVE THE ACTIVITY OF OTHERS 123 DRAMATIC OR PRETEND PLAY? -ONE OF THE VITAL ELEMENTS IN CHILDREN'S PROCESS OF IDENTIFICATION IS DRAMATIC PLAY, ALSO KNOWN AS SYMBOLIC OR PRETEND PLAY. -IT BEGINS IN LATE INFANCY (11-13 MONTHS) AND IS THE PREDOMINANT FORM OF PLAY IN PRESCHOOL CHILDREN. -BY ACTING OUT EVENTS OF DAILY LIFE, THEY LEARN AND PRACTICE THE ROLES AND IDENTITIES MODELED BY THE MEMBERS OF THEIR FAMILY AND SOCIETY. -CHILDREN IN ALL CULTURES ENGAGE IN GAMES ALONE AND WITH OTHERS. -SOLITARY ACTIVITY INVOLVING GAMES BEGINS AS VERY SMALL CHILDREN PARTICIPATE IN REPETITIVE ACTIVITIES AND PROGRESS TO MORE COMPLICATED GAMES THAT CHALLENGE THEIR INDEPENDENT SKILLS SUCH AS PUZZLES, SOLITAIRE, AND COMPUTER OR VIDEO GAMES. -VERY YOUNG CHILDREN PARTICIPATE IN PAT-A-CAKE AND PEEK-A-BOO. -PRESCHOOL CHILDREN LEARN AND ENJOY FORMAL GAMES, BEGINNING WITH RITUALISTIC, SELF-SUSTAINING GAMES SUCH AS RING-AROUND-A-ROSY AND LONDON BRIDGE. -PRESCHOOL CHILDREN HATE TO LOSE AND TRY TO CHEAT, WANT TO CHANGE THEIR MOVES. -SCHOOL-AGE CHILDREN AND ADOLESCENTS ENJOY COMPETITIVE GAMES, INCLUDING CARDS, CHECKERS, AND CHESS, AND PHYSICALLY ACTIVE GAMES SUCH AS BASEBALL. -CHILDREN JUST WATCH WHAT OTHER CHILDREN ARE DOING BUT MAKE NO ATTEMPT TO ENTER INTO THE PLAY ACTIVITY. -EXAMPLE: WATCHING AN OLDER SIBLING BOUNCE A BALL IS A COMMON EXAMPLE OF ONLOOKER ROLE -CHILDREN PLAY ALONE, FOCUS ON OWN ACTIVITY. -THEY PLAY ALONE WITH DIFFERENT TOYS THAN WHAT OTHER CHILDREN ARE PLAYING WITH. -THEY ENJOY THE PRESENCE OF OTHER CHILDREN BUT MAKE NO EFFORT TO GET CLOSE TO OR SPEAK TO THEM. -CHILDREN PLAY BESIDE SOMEONE, BUT NOT WITH THAT SOMEONE. -THEY PLAY WITH TOYS SIMILAR TO THOSE THAT THE CHILDREN AROUND THEM ARE USING BUT AS EACH CHILD SEES FIT, NEITHER INFLUENCING NOR BEING INFLUENCED BY THE OTHER CHILDREN. -THERE IS NO GROUP ASSOCIATION. -THIS TYPE OF PLAY IS NORMALLY OBSERVED IN TODDLERS -INDIVIDUALS WHO ARE INVOLVED IN A CREATIVE CRAFT WITH EACH PERSON SEPARATELY WORKING ON AN INDIVIDUAL PROJECT ARE ENGAGED IN PARALLEL PLAY. -CHILDREN PLAY TOGETHER WITH SIMILAR OR IDENTICAL TOYS OR ACTIVITIES. -THERE IS NO ORGANIZATION IN THEIR PLAY, DIVISION OF LABOR, LEADERSHIP ASSIGNMENT, OR MUTUAL GOAL. -CHILDREN BORROW AND LEND PLAY MATERIALS WITH OTHER CHILDREN, FOLLOW EACH OTHER WITH WAGONS AND TRICYCLES, AND SOMETIMES ATTEMPT TO CONTROL WHO MAY OR MAY NOT PLAY IN THE GROUP. -THERE IS NO GROUP GOAL. -THERE IS A GREAT DEAL OF BEHAVIORAL CONTAGION; WHEN ONE CHILD INITIATES AN ACTIVITY, THE ENTIRE GROUP FOLLOWS THE EXAMPLE. -CHILDREN PLAY IN A GROUP, OBTAIN A GOAL, FORM A GAME, THEY HAVE LEADERS AND FOLLOWERS. -PLAY IS ORGANIZED -THE LEADER-FOLLOWER RELATIONSHIP IS DEFINITELY ESTABLISHED, AND THE ACTIVITY IS CONTROLLED BY ONE OR TWO MEMBERS WHO ASSIGN ROLES AND DIRECT THE ACTIVITY OF THE OTHERS. -SENSORIMOTOR STAGE= BIRTH TO 2YEARS OF AGE -SENSORIMOTOR STAGE TRANSITIONS TO THE PREOPERATIONAL STAGE AROUND THE AGE OF 19-24 MONTHS LANGUAGE DEVELOPMENT: PSYCHOSOCIAL DEVELOPMENT 132 PIAGET= SEPARATION TASK? INFANTS LEARN TO SEPARATE THEMSELVES FROM OTHER OBJECTS IN THE ENVIRONMENT 133 PIAGET=OBJECT PERMANENCE? THE PROCESS BY WHICH INFANTS KNOW THAT AN OBJECT STILL EXISTS WHEN IT IS OUT OF VIEW. -OCCURS APPROXIMATELY 9 MONTHS OF AGE 134 PIAGET=MENTAL REPRESENTATION? THE RECOGNITION OF SYMBOLS 135 SOCIAL DEVELOPMENT OF INFANT? -INITIALLY INFLUENCED BY INFANTS' REFLEXIVE BEHAVIORS AND INCLUDES ATTACHMENT, SEPARATION, RECOGNITION/ANXIETY, AND STRANGER FEAR -ATTACHMENT IS OBSERVED WHEN INFANTS BEGIN TO BOND WITH THEIR PARENTS. USUALLY SEEN IN 1ST MONTH, BUT IT ACTUALLY BEGINS BEFORE BIRTH. -ATTACHMENT IS ENHANCED WHEN INFANTS AND PARENTS ARE IN GOOD HEALTH, HAVE POSITIVE FEEDING EXPERIENCES, AND RECEIVE ADEQUATE REST -SEPARATION-INDIVIDUATION OCCURS DURING THE 1ST YEAR OF LIFE AS INFANTS FIRST DISTINGUISH THEMSELVES AND THEIR PRIMARY CAREGIVER AS SEPARATE INDIVIDUALS, AND THEN DEVELOP OBJECT PERMANENCE. -SEPARATION ANXIETY BEGINS AROUND 4-8 MONTHS. INFANTS WILL PROTEST WHEN SEPARATED FROM PARENTS, WHICH CAN CAUSE CONSIDERABLE ANXIETY FOR PARENTS -STRANGER FEAR BECOMES EVIDENT BETWEEN 6-8 MONTHS OF AGE, WHEN INFANTS ARE LESS LIKELY TO ACCEPT STRANGERS. -REACTIVE ATTACHMENT DISORDER RESULTS FROM MALADAPTIVE OR ABSENT ATTACHMENT BETWEEN THE INFANT AND PRIMARY CAREGIVER, AND CONTINUES THROUGH CHILDHOOD AND ADULTHOOD. 136 BODY-IMAGE CHANGES OF INFANT? -INFANTS DISCOVER
THAT MOUTHS ARE PLEASURE PRODUCERS 137 AGE-APPROPRIATE ACTIVITIES? -INFANTS HAVE SHORT ATTENTION SPANS AND WILL NOT INTERACT WITH OTHER CHILDREN DURING PLAY=SOLITARY PLAY APPROPRIATE INFANT TOYS: 138 INDICATORS FOR INTRODUCING SOLID FOODS TO INFANTS? -INTEREST IN SOLID FOODS, VOLUNTARY CONTROL OF THE HEAD AND TRUNK, AND DISAPPEARANCE OF THE EXTRUSION REFLEX=TONGUE MOVEMENT -NEW FOODS SHOULD BE INTRODUCED ONE AT A TIME, OVER A 4-7 DAY PERIOD, TO OBSERVE FOR SIGNS OF ALLERGY OR INTOLERANCE, WHICH MAY INCLUDE FUSSINESS, RASH, VOMITING, DIARRHEA, AND CONSTIPATION. -IRON-FORTIFIED CEREALS ARE THE FIRST SOLID FOOD INTRODUCED DUE TO THE HIGH IRON CONTENT. -VEGETABLES OR FRUITS ARE STARTED FIRST BETWEEN 6-8 MONTHS OF AGE. AFTER BOTH HAVE BEEN INTRODUCED, MEATS MAY BE ADDED. -CITRUS FRUITS, MEATS, AND EGGS ARE NOT STARTED UNTIL AFTER 6 MONTHS OF AGE -BREAST MILK/FORMULA SHOULD BE DECREASED AS INTAKE OF SOLID FOODS INCREASES, BUT SHOULD REMAIN THE PRIMARY SOURCE OF NUTRITION THROUGH THE 1ST YEAR. -TABLE FOODS THAT ARE COOKED, CHOPPED, AND UNSEASONED ARE APPROPRIATE BY 9 MONTHS OF AGE. -APPROPRIATE FINGER FOODS INCLUDE: RIPE BANANAS, TOAST STRIPS, GRAHAM CRACKERS, CHEESE CUBES; NOODLES, AND PEELED CHUNKS OF APPLES, PEARS, OR PEACHES. -CAN BE ACCOMPLISHED WHEN INFANTS SHOW SIGNS OF READINESS, AND ARE ABLE TO DRINK FROM A CUP (SOMETIME IN THE 2ND 6 MONTHS) -BEDTIME FEEDINGS ARE THE LAST TO BE STOPPED -ANTERIOR FONTANELS CLOSE BY 18 MONTHS OF AGE 141 ERIKSON AND PIAGET DEVELOPMENT IN TODDLERS? -SENSORIMOTOR STAGE (PIAGET) TRANSITIONS TO THE PREOPERATIONAL STAGE AROUND THE AGE OF 19-24 MONTHS. -CONCEPT OF OBJECT PERMANENCE BECOMES FULLY DEVELOPED LANGUAGE ERIKSON=AUTONOMY VS
SHAME AND DOUBT MORAL DEVELOPMENT: SELF-CONCEPT DEVELOPMENT: BODY-IMAGE CHANGES: AGE-APPROPRIATE ACTIVITIES: APPROPRIATE ACTIVITIES FOR TODDLERS: 142 PRESCHOOLERS DEVELOPMENT (3-6 YEARS)? PIAGET:
-PRESCHOOLER MOVES FROM TOTALLY EGOCENTRIC THOUGHTS TO SOCIAL AWARENESS AND THE ABILITY TO UNDERSTAND THE VIEWPOINTS OF OTHERS -PRESCHOOLERS MAKE JUDGMENTS BASED ON VISUAL APPEARANCES. THIS INCLUDES MAGICAL THINKING, ANIMISM, AND CENTRATION ERIKSON: -A DISEASE CAUSED BY INVASION AND MULTIPLICATION OF MICROORGANISMS A DISEASE CAUSED BY AN INFECTIOUS AGENT THAT IS TRANSMITTED TO A PERSON BY DIRECT OR INDIRECT CONTACT, VEHICLE OR VECTOR, OR AIRBORNE ROUTE. 145 6 LINKS OF CHAIN OF INFECTION? 1. CAUSATIVE AGENT=VIRUS, BACTERIA, FUNGUS 146 WHAT 3 LINKS MUST BE PRESENT FOR AN ILLNESS TO OCCUR? 1.
PATHOGEN 147 Chain of infection DEFINITION? -The process by which pathogens are transmitted from the environment to a host, invade the host, and cause infection 148 Safe Injection Practices include: -Use of a new needle and syringe every time a medication vial or IV bag is accessed —transmitted by contact with an infected person 150 Indirect TRANSMISSION? —transmitted by contact with objects that have been contaminated by an infected person (fomites) 151 AIRBORNE INFECTIOUS ORGANISMS? -TB 152 DROPLET INFECTIOUS ORGANISMS? -INFLUENZA 153 CONTACT INFECTIOUS ORGANISMS? -NOROVIRUS 154 EXPANDED PRECAUTIONS (PROTECTIVE ISOLATION)? -Used for patients who are not communicable but have high susceptibility to infection, such as a
neutropenic patient or bone marrow transplant recipient --NOTE: If a disease has more than one mode of transmission, then more than one precaution technique is used 155 REASONS FOR VULNERABILITY OF CHILDREN TO COMMUNICABLE DISEASES? -IMMATURE IMMUNE SYSTEM KNOW!!!!!=FECAL-ORAL AND RESPIRATORY ROUTES MOST COMMON EXAMPLES OF THESE ROUTES: 1. KILLED VIRUS -inactivated poliovirus -tetnus toxoid -MEASLES 160 Recombinant VACCINE form? -HBV 161 Conjugated VACCINE FORM? -hiB (H. INFLUENZAE TYPE b) -JOINED WITH ANOTHER SUBSTANCE TO INCREASE THE IMMUNE RESPONSE 162 TYPES OF IMMUNIZATION? -ACTIVE IMMUNITY -antibody production is stimulated (antigen given in vaccine form) -antibodies produced in another and given (does not have lasting effects-must develop active immunity)
165 Transplacental immunity? -passive immunity transferred from mother (decreases or disappears as child develops ability to make antibodies Interferes with ADLs for more than 3 months in a year 167 Congenital disability: 169 Developmental disability: Any mental or physical disability present before age 22 Functional limitation that interferes with a person’s ability (walk, lift, hear, or learn) Condition or barrier imposed by society, environment, or own self Loss or abnormality of structure or function Birth to 21years old with chronic disability that requires routine use of a medical device to compensate for loss of life-sustaining body function. Requires daily care 174 Children with special health care needs are defined as: SCOPE: those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition requiring health & related services of a type or amount beyond what are required for healthy children. -Commonly: Respiratory tract & impairments of speech, special senses, & intelligence. I=INTRODUCTION S=SITUATION B=BACKGROUND A=ASSESSMENT R=RECOMMENDATION R=READBACK 176 ASSISTING FAMILY MEMBERS IN MANAGING FEELINGS OF DISABLED CHILD? Family responses vary dependent on characteristics of the ill individual, presence of additional stressors, coping skills, resources available, values & beliefs, duration & characteristics of the illness -Individual: age, gender, personality type, developmental level -Resources: financial, time, knowledge, social & emotional support & services 177 PITFALLS OF COMMUNICATION? Giving advice, talking about yourself, telling pt is wrong, entering into hallucinations and delusions of patient, false reassurance, cliché, giving approval, asking WHY, changing subject, defending doctors and other health team members -Non-therapeutic: talking too rapidly, giving one’s own opinion (words such as nice, bad, right, wrong, should and ought), incongruence 178 The Typologies of Chronic Illness Across the Life Cycle? -Newly married couples 179 Newly married couples: May romanticize the illness during courtship, but are soon faced with the challenges of chronic illness and the impact on employment, relationships, finances, sexuality and reproduction, and life expectancy. 180 Families of adolescents: The impact of chronic illness on an adolescent and the family is similar to other stages with the added impact on both individual and family developmental tasks. 181 Families with young children: Chronic illness significantly impacts parenting strategies, equality between children (sharing of resources, family tasks, time, etc.), and family routines and rituals. For example, a child with severe asthma may not have as many chores as his siblings, and the rush to the emergency room during life-threatening events may become a family “routine”, with each family member knowing their role. 182 Families launching children: When launching of children is delayed or prevented due to a chronic illness, families tend to turn inward, further delaying other developmental milestones, including employment, marriage, child bearing, and other adult roles. 183 Families in Later Life: This stage is characterized by family members focusing on maintaining health or adapting to chronic illness. REFERS TO THE EFFORTS THAT FAMILY MEMBERS MAKE TO CREATE A NORMAL FAMILY LIFE, THEIR PERCEPTIONS OF THE CONSEQUENCES OF THESE EFFORTS, AND THE MEANINGS THEY ATTRIBUTE TO THEIR MANAGEMENT EFFORTS. -FOR CHRONICALLY ILL CHILDREN; FOR FAMILIES: 185 HOME CARE GOALS OF THE ILL CHILD? -NORMALIZE THE LIFE OF THE CHILD, INCLUDING THOSE WITH TECHNOLOGICALLY COMPLEX CARE, IN A FAMILY AND COMMUNITY CONTEXT AND SETTING -MINIMIZE THE DISRUPTIVE IMPACT OF THE CHILD'S CONDITION ON THE FAMILY -FOSTER THE CHILD'S MAXIMUM GROWTH AND DEVELOPMENT. 186 4 TYPES OF PARENTAL REACTIONS TO THE PERIOD OF ADJUSTMENT OF AN ILL CHILD? 1.
OVERPROTECTION 187 OVERPROTECTION REACTION OF PARENTS WITH ILL CHILD? -PARENTS FEAR LETTING THE CHILD ACHIEVE ANY NEW SKILL, AVOID ALL DISCIPLINE, AND CATER TO EVERY DESIRE TO PREVENT FRUSTRATION. 188 REJECTION REACTION OF PARENTS WITH ILL CHILD? PARENTS DETACH THEMSELVES EMOTIONALLY FROM THE CHILD BUT USUALLY PROVIDE ADEQUATE PHYSICAL CARE OR CONSTANTLY NAG AND SCOLD THE CHILD. 189 DENIAL REACTION OF PARENTS WITH ILL CHILD? -PARENTS ACT AS IF THE DISORDER DOES NOT EXIST OR ATTEMPT TO HAVE THE CHILD OVERCOMPENSATE FOR IT. 190 GRADUAL ACCEPTANCE REACTION OF PARENTS WITH ILL CHILD? -PARENTS PLACE NECESSARY AND REALISTIC RESTRICTIONS ON THE CHILD, ENCOURAGE SELF-CARE ACTIVITIES, AND PROMOTE REASONABLE PHYSICAL AND SOCIAL ABILITIES. Sensorimotor development Intellectual
development Creativity Self-awareness: Therapeutic value 192 5 PRINCIPLES OF FAMILY CENTERED CARE? The five main principles include: -openly sharing information about alternative treatments, ethical concerns, and uncertainties about health care treatments; -forming partnerships between families and health professionals to decide what is important for families; -respecting the racial, ethnic, cultural, and socioeconomic diversity of families and their ways of coping; -supporting and strengthening families’ abilities to grow and develop 193 ELEMENTS OF FAMILY CENTERED CARE? 1. The Family is at the Center 2. Family-Professional Collaboration 3. Family-Professional Communication 4. Cultural Diversity of Families 5. Coping Differences and Support 6. Family-Centered Peer Support 7. Specialized Service and
Support Systems 8. Holistic Perspective of Family-Centered Care 194 WHAT RISK FACTORS SHOULD NURSES ASSESS FOR IN CHILDREN? Unintentional injuries Unintentional injuries: The highest risk across childhood is unintentional injuries, with motor vehicle accidents (MVA) accidents impacting 34.7 children per 100,000 ages 15 to 24 died in MVA I 2001. Thirty-two percent of deaths of youth ages 14 to17 were due to MVA. 195 STRESSORS OF HOSPITALIZATION? SEPARATION ANXIETY PHASES: 196 PROTEST PHASE OF SEPARATION ANXIETY? -Cry and scream, cling to parent Observed during later infancy: Cries, Screams, Searches for parent with eyes, Clings, Avoids & rejects contact with strangers 197 DESPAIR PHASE OF SEPARATION ANXIETY? -Crying stops; evidence of depression Despair: Inactive; Withdraws from others; Depressed, sad; Uninterested in environment; Uncommunicative; Regressesive behavior; ---may last variable length of time. Child may deteriorate from refusal to eat or drink. 198 DETACHMENT PHASE OF SEPARATION ANXIETY? -Denial; resignation but not contentment Detachment: Shows > interest in environment; Interacts with strangers or familiar caregivers; Forms new but superficial relationships; Appears happy ---- detachment usually occurs after prolonged separation from parent; rarely seen
in hospitalized children 199 FAMILY INTERACTION MODEL? The family interaction model is a good model to use to assist nurses in helping family members understand developmental and family career changes, and how these changes impact their ability to adapt to an illness of a family member. The assumptions of this model include: The concepts included include: 200 FAMILY CAREER CONCEPT IN FAMILY INTERACTION MODEL? Family career is the interaction between development and transitions experienced by a family over time, represented by family stages and family transitions. This concept incorporates stages, tasks and transitions, combining the expected developmental stages and the diverse experiences of American families, such as divorce, blended families, adoption, and death. This concept reminds us that families are constantly changing and diverse. 201 IDENTIFICATION OF FAMILY STAGES IN FAMILY INTERACTION MODEL Identification of family stages help families and nurses predict needs. For example, if a family is in the stage of raising school-age children, they will need knowledge of school-age development, such as knowing children are beginning to develop judgments about themselves and others, and they are identifying their strengths and weaknesses. This is the age children identify what they are “good” at and thrive on non-monetary achievements. They are also beginning to understand morals and ethics in a concrete manner (right or wrong), and have trouble understanding the “gray” areas. Parents of school-aged children are faced with working with community schools and agencies to assure they expose their children in a positive manner to these outside resources. They are also faced with encouraging independence in hygiene, increasing responsibility, and increased negotiation with all activities. Anticipating these tasks can help nurses provide the support needed for successful family coping. 202 TASKS CONCEPT IN FAMILY INTERACTION MODEL? Tasks: Across all stages are specific tasks. Overall tasks to survival continue regardless of the stage, and include 1) securing shelter, food and clothing, 2) developing emotionally healthy individuals, 3) assuring each individual can function in a social world, 3) assuring the family is able to contribute to the next generation and 5) assuring the family is able to promote the health of individuals within the family. The nurse’s role is to assist families in being successful with these tasks so the health of the family is maintained. 203 FAMILY TRANSITIONS CONCEPT IN FAMILY INTERACTION MODEL? Family transitions: Family transitions are events that signal a reorganization of family roles and tasks. They may be developmental or situational. Transitions are what impact health. Developmental transitions are more predictable and called normative. Situational transitions, in contrast, are not predictable and vary from family to family. They include changes such as moves, financial changes, divorce, marriage, unexpected births and deaths, etc. These are referred to as non-normative changes. When thinking about the non-normative changes, it is helpful to recall systems theory, as an unexpected change in one family member impacts all family members. Likewise, a change in the whole family, such as a move, impacts each individual member. It is at times of greatest transition that a family is at greatest risk for health problems. 204 INDIVIDUAL DEVELOPMENT CONCEPT IN FAMILY INTERACTION MODEL? Individual development: the expected changes in each member associated with growth and development. The three dimensions of individual development include: social-emotional, cognitive, and physical. [Review Table 11-1 at this point to review the different areas of individual development, including ages, social-emotional stages by Erickson, significant relationships, stage-sensitive family developmental tasks (Duvall & Miller), human needs (Maslow), Values orientation (Kohlberg), Cognitive stage of Development (Bukatko and Daehler, Piaget and Inhelder), Developmental landmarks or milestones, physical maturation, developmental steps, and common developmental problems. 205 PATTERNS OF HEALTH, DISEASE, AND ILLNESS CONCEPT IN FAMILY INTERACTION MODEL? Patterns of health,
disease and illness: expected behaviors in these health situations: Healthy behaviors are those behaviors that promote optimal physical and social-emotional well-being. Disease is pathology or what has gone wrong within the body, mind, or spirit. Disease is often culturally defined, and families often rely on health professionals to define what is a disease. A disease may be physical, emotional, spiritual, familial or social. For example, sickle-cell anemia is a physical disease, whereas child
abuse is a family and social disease. Diseases are often further classified into acute, chronic, life-threatening or end-of-life. Illness represents the family activities associated with managing the disease. The illness patterns are shaped by family interactions. After an acute illness, families typically return to their pre-illness state. However, after the diagnosis of a chronic illness, the family has to adapt long-term, and has to develop new patterns. Disease is pathology or what has gone wrong within the body, mind, or spirit. Disease is often culturally defined, and families often rely on health professionals to define what is a disease. A disease may be physical, emotional, spiritual, familial or social. For example, sickle-cell anemia is a physical disease, whereas child abuse is a family and social disease. Diseases are often further classified into acute, chronic, life-threatening or end-of-life. Illness represents the family activities associated with managing the disease. The illness patterns are shaped by family interactions. After an acute illness, families typically return to their pre-illness state. However, after the diagnosis of a chronic illness, the family has to adapt long-term, and has to develop new patterns. 208 LOSS OF CONTROL: INFANT NEEDS? Trust 209 LOSS OF CONTROL: TODDLER NEEDS? Autonomy 210 LOSS OF CONTROL: PRESCHOOLER NEEDS? Egocentric and
magical thinking typical of age 211 LOSS OF CONTROL: SCHOOL AGE NEEDS? Striving for independence and productivity 212 LOSS OF CONTROL: ADOLESCENT NEEDS? Struggle for independence and liberation 213 YOUNG INFANTS RESPONSE TO PAIN? Generalized response of rigidity, thrashing -Loud crying, screaming 214 OLDER INFANTS RESPONSE TO PAIN? Withdrawal from painful stimuli 215 SCHOOL AGE CHILD'S RESPONSE TO PAIN? Stalling behavior (“wait a minute”) 216 ADOLESCENT RESPONSE TO PAIN? Less vocal protest, less motor activity 217 EFFECTS OF HOSPITALIZATION ON THE CHILD? -Effects may be seen before admission, during hospitalization or after discharge -Child’s concept of illness is more important than intellectual maturity in predicting anxiety=KNOW!!! 218 INDIVIDUAL RISK FACTORS THAT INCREASE VULNERABILITY TO STRESSES OF HOSPITALIZATION? “Difficult”
temperament 219 CHANGES IN THE PEDIATRIC POPULATION? More serious and complex problems 220 BENEFICIAL EFFECTS OF HOSPITALIZATION? Recovery from illness 221 PARENTAL RESPONSES TO CHILD HOSPITALIZATION? -Disbelief, anger, guilt -Fear, anxiety -Frustration
-Depression 222 SIBLINGS REACTION TO ILL-CHILD HOSPITALIZATION? Loneliness, fear, worry 223 ALTERED FAMILY ROLES DUE TO ILL-CHILD HOSPITALIZATION? -Anger and jealousy between siblings and ill child 224 INTERVENTIONS TO PREVENT OR MINIMIZE SEPARATION? -Primary nursing goal 225 INTERVENTIONS TO NORMALIZE THE HOSPITAL EXPERIENCE? -Maintain child’s routine, if possible 226 PAIN FACTS AND FALLACIES? FACT: children are undertreated for pain 227 PRINCIPLES OF PAIN ASSESSMENT IN CHILDREN: QUESTT? Question the child 228 NONPHARMACOLOGIC INTERVENTIONS FOR PAIN? -Based on age 229 ANESTHETICS; TOPICAL AND LOCALS? -Major advancement for
atraumatic care 230 ANALGESICS USED FOR PAIN IN CHILDREN? -Opioids 231 DOSAGE OF ANALGESIA USED FOR CHILDREN? -Based on body weight up to 50 kg
232 CONCEPTS OF HOME CARE FOR ILL CHILD? -Care provided in family’s residence for children with complex health care needs -Home-based health care recognizes the family’s valuable contribution to the child’s overall health -Different from hospice care (care for the dying patient) -Parental desire and ability Central concepts of home care model: Promotion of optimal development: 233 ROLE OF THE NURSE PROVIDING HOME CARE FOR ILL CHILD? -Assess needs 234 PARENT-PROFESSIONAL COLLABORATION WITH HOME CARE? Parent-Professional collaboration: -Encouraging activities to develop self-confidence and self-esteem -Displaying increased awareness of and respect for family caregivers -Recognizing that families vary in defining their role -Demonstrating an ability to understand the families’ approach to caregiving -Sharing perspectives, not just tasks and functions -Supporting family members in their primary, irreplaceable role as caregivers -Exchanging expertise in providing care to the child -Assisting families in recognizing their contributions as worthwhile -Identifying strengths and resources of child and family -Negotiating options, priorities, and preferences -Assisting with coping by allowing families to find meaning in caring for the patient at home Which schoolWhich school-age client does the nurse anticipate will experience sibling rivalry as a source of stress? A 6-year-old school-age client is most likely to experience sibling rivalry as a source of stress.
At which stage of development should the nurse anticipate that pediatric clients will begin to show differences in play activities that are related to gender?During the late school-age years, the nurse should anticipate that pediatric clients will begin to show differences in play activities that are related to gender. There will be very few differences in play activities related to gender during the preschool stage of development.
Which stage of Kohlberg's theory of moral development would the nurse anticipate in a client who exhibits absolute obedience to authority and rules?In level I, preconventional reasoning, stage 1, the nurse anticipates absolute obedience to authority and rules. In level I, stage 2, the nurse anticipates that the child will realize there is more than one right view.
Which stage of psychosocial development would the nurse expect in a 4 year old child?A nurse is assessing a 4-year-old child. In what stage of Erikson's psychosocial development does the nurse expect the child to be in the process of achieving? The development of initiative is part of Erikson's early childhood or preschool stage, which includes children 3 to 6 years of age.
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