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a ANNA LIZA ALFONSO experience

Pediatric Nursing
A lecture

Pediatric Nursing

United Nations Declaration of the Rights of the Child


1. To be free from discrimination. 2. To develop physically and mentally in freedom and dignity. 3. To have a name and nationality. 4. To have adequate, housing, recreation, and medical services. 5. To receive special treatment if handicapped.

United Nations Declaration of the Rights of the Child


6. To receive love, understanding, and material security. 7. To receive an education and develop his or her abilities. 8. To be the first to receive protection in disaster. 9. To be protected from neglect, cruelty, and exploitation. 10. To be brought up in a spirit of friendship among people.

GENERAL PRINCIPLES
Definition of Terms A. Growth:
increase in size of a structure. Human

growth is orderly and predictable, but not even; it follows a cyclical pattern.

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GENERAL PRINCIPLES
B. Development:
maturation of physiologic and

psychosocial systems to more complex state.

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Developmental task
A growth responsibility that arises

at a certain time in the course of development

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GENERAL PRINCIPLES
C. Cephalocaudal:
head-to-toe progression of growth and

development Development proceeds from head down to the toes Infants achieve control of the head before the trunk
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GENERAL PRINCIPLES
D. Proximodistal:
Trunk-to-periphery (fingers and toes)

progression of growth and development Development proceeds from the midline of the body to the extremities

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Growth Pattern

General Principles
Growth and development are continuous

processes from conception until death. Growth and development proceed in an orderly sequence. Different children pass through the predictable stage at different rates. All body systems DO NOT develop at the same rate Development is cephalocaudal
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General Principles
Development proceeds from proximal to

distal body parts. Development proceeds from gross to refined skills. There is an optimum time for initiation of experiences or learning. Neonatal reflexes must be lost before development can proceed. A great deal of skill and behavior is learned by practice.
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Rates of Development
Fetal period and infancy: the head and neurologic tissue grow faster than

other tissues. Infancy and adolescence: fast growth periods T0ddler through school-age: slow growth periods Toddler and preschool periods: the trunk grows more rapidly than other tissue. The limbs grow most during schoolage period. The trunk grows faster than other tissue during adolescence.
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Stages of Growth and Development

Pre-natal period Neonate- birth to TWENTY-EIGHT days Infancy- One month to 12 months Toddler- 1 year to 3 years Pre-school- 3 years to 6 years School-aged- 6 years to 12 years Adolescence- 12 years to 18 years

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Factors influencing G & D


Genetic influences
Gender Health

Intelligence
Temperament

Categories: easy child Slow to warm child Difficult child


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Environmental influences
socio-economic level
Parent-child relationship

Ordinal position in the family


Health

nutrition
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The Personality Development


1. Psychosexual theory2. 3. 4. 5.

Psychoanalytical theory Psychosocial theory Cognitive theory Moral development theory Interpersonal Theory

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Psychosexual/Psychoanalytical
Five Stages of Psychosexual Development

Oral Anal Phallic or Oedipal Latency Genital

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Freuds Stages of Childhood Psychosexual/Psychoanalytical


Oral stage (Infant)

Child explores the world by using especially tongue

mouth,

Anal stage (Toddler)

Child learns to control urination and defecation

Phallic stage (Preschooler)


Learns sexual identity through awareness of genital

area

Latent stage (School-age Child)


Personality development appears to be nonactive or

dormant

Genital stage (Adolescent)


Adolescent develops sexual maturity and learns to

establish satisfactory relationships with the opposite sex

Psychosexual/Psychoanalytical

Freud proposes that the underlying motivation to human development is an energy form or life instinct called LIBIDO. Unconscious mind is the mental life of a person of which the person is unaware. Proposed concepts like: ID, EGO, SUPER EGO

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ID

developed during infancy "I know what I want and I want it now! Pleasure principle

EGO

developed during toddler period "I can wait for what I want!" Reality principle balances the id and superego

SUPEREGO developed during preschool period "I should not want that! Conscience- Morality principle
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Psychosexual/Psychoanalytical
Phase Age Focus

Oral
Anal Phallic

0- 1 yr
1 - 3 yrs 3- 5 yrs

Site of gratification: Mouth


Site of gratification: Anus Site of gratification: Genitals

Latency
Genital

6- 12 yrs
12 & above

Site of gratification: (School Activities)


Site of gratification: Genitals

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Psychosexual/Psychoanalytical
Phase Oral Anal Phallic Latency Genital Age 0-1 year 1- 3 years 3- 5 years 6- 12 years 12 - above Focus Major task: Weaning Major task: Toilet training Major task: Oedipal & Electra complex Major task : School/Academics Major task: Sexual intimacy

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Psychosexual model (Freud)


1. ORAL 0-12 months Pleasure and gratification through mouth Behaviors: dependency, eating, crying, biting Distinguishes between self and mother Develops body image, aggressive drives

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Psychosexual Model (Freud)


2. ANAL 1 year - 3 years Pleasure through elimination or retention of feces Behaviors: control of holding on or letting go Develops concept of power, punishment, ambivalence, concern with cleanliness or being dirty

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Psychosexual Model (Freud) 3. PHALLIC/OEDIPAL

3 - 6 years Pleasure through genitals Behaviors: touching of genitals, erotic attachment to parent of opposite sex Develops fear of punishment by parent of same sex, guilt, sexual identity

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Psychosexual Model (Freud)


4. LATENCY

6 - 12 years Energy used to gain new skills in social relationships and knowledge Behaviors: sense of industry and mastery Learns control over aggressive, destructive impulses Acquires friends

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Psychosexual Model (Freud)

5. GENITAL 12 - 20 years Sexual pleasure through genitals Behaviors: becomes independent of parents, responsible for self Develops sexual identity, ability to love and work

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Eriksons Psychosocial Theories


Trust versus mistrust
Autonomy versus shame and doubt Initiative versus guilt

Industry versus inferiority


Identity versus role confusion Intimacy versus isolation

Generativity versus stagnation


Ego integrity versus despair
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Eriksons Psychosocial Theory


Age 0- 1 yr 1- 3 yrs 3- 5 yrs
Task Achievements

Trust vs Mistrust
Autonomy vs S/D Initiative vs Guilt

Optimism
Self-Control

6- 12 yrs
12- 18

Direction and purpose Industry vs inferiority Competence and method Identity vs Role Devotion and Confusion fidelity
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Psychosocial Model (Erikson)


1. Trust vs mistrust

0 - 18 months Learn to trust others and self vs withdrawal, estrangement

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Psychosocial Model (Erikson)


2. Autonomy vs shame and doubt

18 months - 3 years Learn self-control and the degree to which one has control over the environment vs compulsive compliance or defiance

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Psychosocial Model (Erikson)


3. Initiative vs guilt

3 - 5 years Learn to influence environment, evaluate own behavior vs fear of doing wrong, lack of selfconfidence, overrestricting actions

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Psychosocial Model (Erikson)


4. Industry vs inferiority

6 - 12 years Creative; develop sense of competency vs sense of inadequacy

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Psychosocial Model (Erikson)


5. Identity vs role confusion

12 - 20 years Develop sense of self; preparation, planning for adult roles vs doubts relating to sexual identity, occupational career

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Psychosocial Model (Erikson)


6. Intimacy vs isolation

18 - 25 years Develop intimate relationship with another; commitment to career vs avoidance of choices in relationships, work, or life-style

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Psychosocial Model (Erikson)


7. Generativity vs stagnation

21 - 45 years Productive; use of energies to guide next generation vs lack of interests, concern with own needs

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Psychosocial Model (Erikson)


8. Integrity vs despair
45 years to end of life Relationships extended, belief that own life has been

worthwhile vs lack of meaning of ones life, fear of death

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3 fundamental cognitive processes


1. assimilation- people acquire knowledge and skills 2. accomodation-process of change/adjustment to acquired skills 3. adaptation-or coping behavior, the ability to handle demands of environment
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Piaget
Sensori-motor (birth to 2 )
Pre-operational (2-7)
Preoperational preconceptual (2-4)

Preoperational intuitive (4-7)

Concrete operational (7-12) Formal operational (12 to adulthood)

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Cognitive Theory (Piaget)


0 - 2 years: sensorimotor reflexes, repetition of acts 2 - 4 years: preoperational/preconceptual -no cause and effect reasoning; egocentrism; use of symbols; magical thinking 4 - 7 years: intuitive/preoperational beginning of causation

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Cognitive Theory (Piaget)


7 12 years: concrete operations

- uses memory to learn - aware of reversibility


12 - 15 years: formal operations

-reality, abstract thought -can deal with the past, present and future
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Interpersonal theory (Sullivan)


This concept focuses on interaction

between an individual and his environment


Personality is shaped through

interaction with significant others


We internalize approval or disapproval

from our parents


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Interpersonal theory
Personality has three SELF-SYSTEM

Good Me develops in response to behaviors receiving approval by parents/SO


Bad Me develops in response to behaviors receiving disapproval by parents/SO Not Me develops in response to behaviors generating extreme anxiety in parents/SO and this is denied as part of oneself

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Interpersonal Model (Sullivan)


1. Infancy 0 - 18 months Others (Caregivers) will satisfy needs 2. Childhood 18 months - 6 years Learn to delay need gratification 3. Juvenile 6 - 9 years Learn to relate to peers
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Interpersonal Model (Sullivan)


4. Preadolescence 912 years Learn to relate to friends of same sex 5. Early adolescence 1214 years Learn independence and how to relate to opposite sex 6. Late adolescence 1421 years Develop intimate relationship with person of opposite sex
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KOHLBERGS Stages of MORAL Development

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Moral Theory
Pre-Conventional Stage 1 Stage 2 Conventional Stage 3 Stage 4 POST Conventional Stage 5 Stage 6
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PRECONVENTIONAL LEVEL
Stage 1 Age Group: 2-3 years Description of morality: Punishment or obedience (heteronomous morality) A child does the right things because a parent tells him or her to avoid punishment Child is UNABLE to understand others viewpoint
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PRECONVENTIONAL LEVEL
Stage 2

Age Group : 4-7 years


Description of morality:
Individualism- Hedonism Child carries out actions to satisfy own needs

rather than societys. The child does something for another if that person does something for him in return- an eye for an eye
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CONVENTIONAL LEVEL (level 2)


Stage 3 Age Group : 7-10 years Description of morality:
Orientation to interpersonal relations of

mutuality- CONFORMITY A child follows rules because of a need to be a good person in own eyes and in the eyes of others Good boy or Good girl
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CONVENTIONAL LEVEL (level 2)


Stage 4 Age Group : 10-12 years Description of morality:
Maintenance of social order, fixed rules and

authority Child FOLLOWS RULES of authority figures as well as parents to keep the system working LAW and ORDER
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POSTCONVENTIONAL LEVEL (level 3)


Stage 5
Age Group : 12 and above Description:

social contract, utilitarian law making

perspective child FOLLOWS STANDARDS OF SOCIETY for the good of all people

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POSTCONVENTIONAL LEVEL (level 3)


Stage 6
Age :older than 12 Descriptions:

universal ethical principle

orientation Respect and dignity of humanity


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Spiritual Development- Fowler


Stage Undifferentiated Intuitive-Projective Mythic-literal Synthetic-Conventional Individuating-reflective Age Group 0-3 years 4-6 years 7-12 years Adolescent Adult- after 18 Description No concept Imaginations Stories and Myths Expectations Ones system Various viewpoints

Paradoxical-consolidating Adult- after 30 UNIVERSALIZING

MAYBE never Love and justice

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Havighurst Devt Task


Babyhood/early childhood
Learning to take solid foods Learning to walk, talk, read Learning to control defecation Learning sexual differences Learning right/wrong-beginning

consciousness

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Late childhood
Physical skills (ordinary games)
Wholesome attitude Study/play along with age mates Sexual identity Fundamental skills Conscious and personal independence

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Adolescence
Matured roles of both sexes
Masculine/feminine roles Accepting owns body Socially responsible behavior Independence from parents Prepare for economic career, marriage, family

life,ideology

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Early adult
Start occupation
Select a mate Live with marriage partner

Start family
Rearing children Manage home

Civic responsibility
Finding congenial group
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Middle adult
Adult and civic responsibility
Adjustment to changes of middle ages and aging

parents Assist teen-agers to become responsible adults Reaching and maintain a satisfactory career

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Old Age
Adjusting to decreasing physical

strength,retirement,less income and death of spouse Adapting to social roles, physical arrangements and affiliation to members of same age

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Gross Motor Development


Newborn: barely able to lift head
6 months: easily lifts head, chest and upper abdomen

and can bear weight on arms

Head Control

Newborn

Age 6 months

Sitting Up

Age 2 months

Age 8 months

Sitting up
2months old: needs assistance
6 months old: can sit alone in the

tripod position 8 months old: can sit without support and engage in play

Ambulation

13 month old

Nine to 12-months

Ambulation
9 month old: crawl
1 year: stand independently from a crawl position 13 month old: walk and toddle quickly 15 month old: can run

Fine Motor - Infant


Newborn has very little control.

Objects will be involuntarily grasped and dropped without notice. 6 month old: palmar grasp uses entire hand to pick up an object 9 month old: pincer grasp can grasp small objects using thumb and forefinger

Speech Milestones
1-2 months: coos 2-6 months: laughs and squeals 8-9 months babbles: mama/dada as

sounds 10-12 months: mama/dada specific 18-20 months: 20 to 30 words 50% understood by strangers 22-24 months: two word sentences, >50 words, 75% understood by strangers 30-36 months: almost all speech understood by strangers

Hearing
BAER hearing test done at birth Ability to hear correlates with ability enunciate

words properly Always ask about history of otitis media ear infection, placement of PET tubes in ear Early referral to MD to assess for possible fluid in ears (effusion) Repeat hearing screening test Speech therapist as needed

Fine Motor Development

6-month-old
12-month-old

Red Flags in infant development


Unable to sit alone by age 9 months Unable to transfer objects from hand to

hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years.

Fine Motor - toddler


1 year old: transfer objects from hand to hand
2 year old: can hold a crayon and color vertical strokes Turn the page of a book Build a tower of six blocks

Toddler ( 1-3)

T
O D D L E R

ANTRUMS = LACK OF VOCABULARY WORDS OILET TRAINING

N IS THE FAVORITE WORD: Negativism 1. offer choices 2. limit question o not offer 3 large meals rink well from the cup
et the baby talk

at: do not let play with food isk: Aspiration & poisoning
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TANTRUMS
LACK OF VOCABULARY WORDS
300 WORDS

2 WORD SENTENCES MNGT: 1. I gnore 2. T ime 1 min/ age

I nstitute warning M ove to corner E xpalin well


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Toilet training
Signs of readiness:
Pulls/tugs soild diaper Please parent

Pants able to remove


Potty chair 5-10 min w/o fussing Patience

Pwede ng SIT, SQUAT & WALK

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Toilet training
Timing of good control
2 3 Day time bladder control 3 4 Night time bladder control

* 3 good bowel control

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Separation anxiety
> 18 mos Steps: Protest - cry 2. Despair widrawn 3. Denial repression of feeling
1.

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Play
ParAllel P arallel play; PUSH & PULL A ttention span short R emovable/ replaceable

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Safety:
Car: Lock all doors
Upright forward facing

position in convertible restraint > 20 lbs - < 40 lbs


Forward facing booster seat > 40 lbs - , 60 lbs < 49 tall

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Language:
1 y/o = 50 words 2 y/o = 300 words

3 y/o = 900 words


4 y/o = 1500 words 5 y/o = 2100 words

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Fine Motor Older Toddler


3 year old: copy a circle

and a cross build using small blocks 4 year old: use scissors, color within the borders 5 year old: write some letters and draw a person with body parts

Toddler

Adele Piliterri, Child Health Nursing, Lippincott

Toddler

Safety becomes a problem as the toddler becomes more mobile.


Pilliterri, Lippincott

Toddlers

Issues in parenting - toddlers


Stranger anxiety should dissipate by age 2 to 3

years Temper tantrums: occur weekly in 50 to 80% of children peak incidence 18 months most disappear by age 3 Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely Thumb sucking Toilet Training

Pre-School

Fine motor and cognitive abilities


Buttoning clothing
Holding a crayon / pencil Building with small blocks

Using scissors
Playing a board game Have child draw picture of himself
Pre-school tasks

Red flags: preschool


Inability to perform self-care tasks, hand

washing simple dressing, daytime toileting Lack of socialization Unable to play with other children Able to follow directions during exam Performance evaluation of pre-school teacher for kindergarten readiness

Pool Safety

School-Age

School Years: fine motor


Writing skills improve Fine motor is refined Fine motor with more focus
Building: models legos Sewing Musical instrument Painting Typing skills Technology: computers

School performance
Ask about favorite subject
How they are doing in school Do they like school By parent report: any learning

difficulties, attention problems, homework Parental expectations

Red flags: school age


School failure
Lack of friends Social isolation Aggressive behavior: fights, fire setting,

animal abuse

School Age: gross motor


8 to 10 years: team sports Age ten: match sport to

the physical and emotional development

School Age

School Age: cognitive


Greater ability to concentrate

and participate in selfinitiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.

13 to 18 Year Old

Adolescents

Adolescent
As teenagers gain independence they begin to

challenge values Critical of adult authority Relies on peer relationship Mood swings especially in early adolescents

Adolescent behavioral problems


Anorexia Attention deficit Anger issues

Suicide

Adolescent Teaching
Relationships
Sexuality STDs / AIDS Substance use and abuse Gang activity Driving Access to weapons

Adolescents

Death Concepts (Kozier)


AGE Infancy to 3 years old 3 years to 4 years 5 to 9 years 9-12 years Beliefs NO clear concept of Death It is Reversible, temporary sleep Understands DEATH is FINAL but can be AVOIDED Death is INEVITABLE, everyone will die someday Understands own mortality Fears a lingering Death Attitude is influenced by religion Experiences peak of death anxiety Death as multiple meanings
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12-18 years 18-45 45-65 years 65 and above

Childs Response to Death


1. Infants and toddlers - toddlers may insist on seeing a significant other long after that persons death. 2. Preschoolers - may see death as temporary; a type of sleep or separation. 3. School-age See death as a period of immobility. - Feel death is punishment. 4. Adolescents - Have an accurate understanding of death.
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The Family with an Infant

Growth and Development (Infant)


Weight

Birthweight is doubled 4 to 6 months; triple it by 1 year


Height

Increases by 50%
Heart rate

120 to 160 bpm


Respiratory rate

20 to 30 breathes/min

Developmental Milestones
1 month
Can see at 18 in (46 cm) distance

2 months
Posterior fontanel closed

2 month
Social smiles Enjoys bright-colored

3 month
Holds head and chest up when prone Beginning eye-hand coordination

4 - 5 months
Birth weight doubles Can turn from abdomen to back Can approximate lips to the rim of a cup

5- 6 months

Teething may begin with eruption of two lower central incisors Chews and bites May hold own bottles; but may not drink from it Recognizes parents; begins to fear strangers Rolls from back to abdomen

7 months

Eruption of upper central incisors Has unidextrous approach and grasp Responds to own name

Teeth
6 to 10 months lower central incisors erupts 8 to 12 months upper central incisors erupts

8 months

Sits steadily unsupported


9 months

Creeps on hands and knees

10 - 11 months

Cruises or walks holding onto furniture or with both hands held

12 months (1 yr old)

Has total of six to eight deciduous teeth Anterior fontanel almost closed Walks with one hand held

12 months (1 yr old)

Likes toys that fit inside each other; pull toys Vocabulary of two words plus mama and da-da Tend to cry when scolded

Management
1.

Promote infant safety Aspiration prevention Fall prevention Car safety Safety with siblings Bathing and swimming safety Childproofing

2. Promoting Nutritional Health of the Infant Breast milk Best food for first 12 months If with formula fortified iron is necessary High-protein, high-caloric diet necessary

2. Introduction of solid food

6 month reasons:
1. 2. 3.

Immature kidneys to concrete the solutes Prevent allergies Immature GI deficit in amylase and lipase secretion (3-4 months)

Biting 3 months Chewing 7 to 9 months

INFANCY (0 to 1 yr)
I ron supplement (4 to 6 months),

Immunization N o choking hazard F ear of stranger peaks at 8 months A llow to use a pacifier if NPO N ote the weight changes T rust V.S. mistrust S olitary play
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Cereal with fortified vitamins and iron First type food introduced because it has less allergen
Vegetables Second type of given Given at noon meal Fruits Offered 1 month after beginning vegetables

Meat and Egg Introduced at 9 months Beef and pork has high iron Chicken has low cholesterol Egg yolks are given 10 months Egg white contains a lot of allergens Hard boiled egg not soft

3. Promoting Sensory Stimulation 4. Promoting infant development in daily activities

Parental Concerns and Problems Related to Normal Infant Development


1. 2.

3.
4.

5.
6.

Teething Thumb sucking Use of pacifiers Head banging Constipation Loose stools

7. Colic 8. Spitting up 9. Diaper dermatitis 10. Miliaria or prickly heat


11. Baby-bottle syndrome

12. Obesity

The Family with Toddler

Toddler Growth & Development


Weight

Gains only about 5 to 6 lb (2.5 kg) a year


Height

5 in (12 cm) a year

Teeth 2 years old Canines and molars erupts Language Able to talk two-word

15 mons (1 year & 3 months)


Creeps up stairs

Builds tower of 2 cubes


Negativism Great imitator

(domestic mimicry)

18 mons (1 yr & )
Anterior fontanel closed Temper tantrums Awareness of ownership (my toy) Develops dependency on transitional objects, such as security blanket Uses pronouns, I, me, you Stage of parallel play

24 mons ( 2 yrs old)


Chest circumference exceeds head circumference Daytime control of bowel and bladder

30 (2 & yrs old)


May be have daytime

bowel and bladder control Good hand-finger coordination; holds crayon with fingers rather than first Begins to notice gender differences; knows own gender

Promoting Toddler Development in Daily Activities 1. Dressing 2. Sleep 3. Bathing 4. Care of Teeth 5. Promoting Healthy family functioning

Parental Concern associated with the Toddler Period 1. Toilet training 2. Ritualistic Behavior 3. Negativism 4. Discipline 5. Separation anxiety 6. Temper Tantrums

Care of the Family with a Preschooler

PRE SCHOOLER
Weight
Weight gain is slight

Height
Minimal

Teeth
20 deciduous teeth by 3 years old

PRE SCHOOLER
Language Constantly asked questions of how and why 3 years old Uses primarily telegraphic speech

3 yrs old
Play is parallel and associative play; begins to learn simple games, but often follows own rules; begins to share Very imaginative; cannot differentiate between fantasy and reality

4 yrs old

Aggressive physically and verbally Tells exaggerated stories Play is associative Imagery playmates common Sexual exploration and curiosity demonstrated Dos and donts become important Identifies strongly with parents of opposite sex

5 yrs Eruption of permanent dentition may begin Handedness is established

Planning and Implementation for Health Promotion of the Preschooler and Family
1. 2. 3.

Promoting Preschooler safety Promoting Nutritional Health Promoting development of daily activities 3.1. Dressing 3.2. Sleep 3.3. Exercise 3.4. Bathing 3.5. Care of Teeth

Parental concerns associated with preschool period

Fear of dark 2. Fear mutilation 3. Fear of separation or abandonment 4. Telling tall tales 5. Imaginary friends 6. Difficulty sharing 7. Regression 8. Masturbation
1.

Care of a Family with School-age Child

School-age
6 years
Sometimes steals money or attractive items Has difficulty owning up to misdeeds Will cheat to win Has own way of doing things Is a boaster Deciduous teeth are lost and permanent teeth erupt

7 years old

May steal Boys prefer playing with boys; girls prefer playing with girls
8 to 9 years old

Always on the go Hate to lose during games; will change rules at the middle of the games to avoid losing

10 years old Brain growth is complete Fine motor coordination becomes refined Learns rules and fairness during plays

10 to 12 years

Boys slow growth and rapid weight gain Girls changes may begin to appear in the body Chooses friends more selectively; may have best friend Likes father, who is admired and may be idolized

Health Promotion of the School-age Child and Family


1.
2. 3.

Promoting school-age safety. Promoting Nutritional Health Promoting Daily Activities dressing; sleeping; exercising; hygiene and care of teeth

Common Fears and Anxieties


1.
2. 3.

4.
5.

6.
7.

Anxiety related to beginning of school School phobia Sex education Stealing Violence or Terrorism Bullying Recreational Drug use

The Family with Adolescent

Adolescent
11-14 yrs

Rapidly accelerating growth Conformity to group norms

15 17 yrs

Stature reaches 95% in adult height Has a rich fantasy life Idealistic Major conflicts over independence and control Behavioral standards set by peer group Feeling of being in love

18-20 yrs

Comfortable with physical growth Social roles defined and articulated

Cessation of body growth

Most girls are 1 to 2 inches (2.4 to 5 cm) taller than boys; stops growing with 3 years from menarche
Apocrine sweat glands (glands present in the axillae and genital area) produce strong odor in response to emotional stimulation
Secondary sex characteristics distinguish the sexes from each other

Promotion of the Adolescent and Family


1.
2. 3.

Safety Nutritional Health Daily Activities Dress and hygiene; care of teeth; sleep

Common Health Problems


1. Concern regarding sexuality and

sexual activity 2. Concerns about substance abuse 3. Concerns regarding attempted suicide 4. Concerns regarding runaways

Communicating with Adolescents


Build a Foundation

Spend time together Encourage expression of ideas and feelings Respect their views Tolerate differences Praise good points Respect their privacy Set a good example

Communicate effectively Give undivided attention Listen, listen, listen Be courteous, calm, and open minded Try not to overreact, if not take a break Avoid judging or criticizing Choose important issues when taking a stand After taking a stand Think through all options Make expectations clear

A Child Lives What He Practice


If a Child lives with criticism He learns to condemn If a Child lives with hostility He learns to fight If a Child lives with ridicule He learns to be shy

If a Child lives with shame He learns to be guilty If a Child lives with encouragement He learns to be confident If a Child lives with praise He learns to appreciate If a Child lives with security He learns to have faith

If a Child lives with fairness - He learns to have justice If a Child lives with approval He learns to like himself If a Child lives with acceptance and friendship He learns to find love!!!

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Immediate Newborn Care


1. Establish and maintain a patent airway

Never stimulate to cry unless secretions

have been drained out. Head lower than the rest of the body (except in increased ICP) Suction secretions properly

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Immediate Newborn Care


1. Establish and maintain a patent airway
MOUTH before NOSE (prevent inhalational reflex) AVOID PROLONGED and DEEP SUCTIONING

(stimulates vagus nerve) BRADYCARDIA OCCLUDE ONE NOSTRIL AT A TIME Newborns are obligate nasal breathers!

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Immediate Newborn Care


2. Maintain appropriate body temperature.
Body temperature is about 37.2C at the moment of birth

(confined in an internal body organ) There is heat loss due to immature temperatureregulating mechanisms. COLD STRESS due to large losses of heat (Convection, Conduction, Radiation, Evaporation)

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Immediate Newborn Care


2. Maintain appropriate body temperature

Effects of Cold Stress: Metabolic acidosis (breakdown of brown fat found in INTRASCAPULAR AREA, THORAX and PERIRENAL REGIONS) Hypoglycemia (due to use of glucose stored as glycogen)

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Immediate Newborn Care


2. Maintain appropriate body temperature Prevention Place the newborn near the mothers skin Dry the newborn immediately Wrap him with warm sheets Put him under a droplight Close windows and door

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NEONATAL ASSESSMENT
Initial assessment
Ongoing assessment Physical assessment Sensory assessment Behavioral assessment

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2 forms of neonatal assessment


1.

IMMEDIATE ASSESSMENT
APGAR scoring Ballard scoring Gestational Age assessment: BESTS

2.

SECONDARY ASSESSMENT
Head-to-toe physical assessment Neonatal Reflexes Sensory and Behavioral

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APGAR Score
Virginia Apgar

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Babys Apgar scores (1 min & 5 mins.)


Interpretation:
7-10 the baby is in the best possible health
4-6 the babys condition is guarded, he needs more extensive clearing of airway-suctioning and monitoring 0-3 the baby is in serious danger and needs immediate resuscitation.

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BESTS
Criteria B- reast nodule 0 to 36 weeks 2 mm 37-38 weeks 4 mm 39 weeks & above 7 mm

E ar lobe
S calp hair

No cartilage
Fine and fuzzy

Some cartilage
Fine and fuzzy

Thick cartilage
Coarse and silky

T testes/Scrotum

Testes in lower Intermediate; Testes sac; scrotum scrotum with pendulous; with no rugae some rugae scrotum with rugae
Anterior transverse crease only
Pediatric Nursing

S ole creases

Creases over Entire sole anterior 2/3 covered with creases


181

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Ballards Scoring
A. Neuromuscular Maturity Posture Square window Arm recoil Popliteal angle Scarf sign Heel to ear B. Physical Skin Lanugo Plantar surface Breast Eye-ear Genitalia
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Head-to-toe Assessment
Physical Examination: Vital signs

HR = 120 - 140/min (Apical) RR = 30 - 60/min


(diaphragmatic and abdominal, irregular, rapid, quiet and shallow)

BP = 80/46 100/50 mmHg after 10 days Temp = maintained at 35.5C - 36.5C


(rectal route preferred to check patency of anus)

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Head-to-toe Assessment
Anthropometric measurements

Length = 47.5 - 53 cm (Ave: 50 cm) HC = 33-35 cm (measure center of forehead and the prominence of occiput) CC = 31-33 cm (measure at the level of nipples) AC = 31-33 cm (measure at the level of umbilicus) Weight = 6.5-7.5 lbs (3.0-3.4 kg)

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Head-to-toe Assessment 5- 10% physiologic weight loss (6- 10 oz)


during the 1st 10 days
Reasons: 1. no more maternal hormone influence 2. voids and passes stools 3. limited caloric intake

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185

Head-to-toe Assessment
Skin

Normally ruddy because of increased RBC concentration and decreased amount of subcutaneous fats Acrocyanosis mottling (normal in 24-48 hrs); HARLEQUIN SIGN generalized mottling (Cutis Marmorata) may sometimes be seen desquamation (drying of skin)
Pediatric Nursing 186

CJT3

Head-to-toe Assessment
Common skin marks of the newborn:

Desquamation - peeling of skin; indicates postmaturity Mongolian spots - bluish-black/slate gray pigmentation across the sacrum or buttocks; disappear by SCHOOL AGE. Vernix caseosa - cheese-like material; serves as insulator Lanugo - fine, downy hair at shoulders, back and upper arms; disappear by 2 wks. Milia - plugged or unopened sebaceous gland on the cheek or across the bridge of the nose; disappear by 2-4 weeks
Pediatric Nursing 187

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Head-to-toe Assessment
Common skin marks of the newborn:

Nevi (Stork bites) - pink or red flat areas of capillary dilatation seen on upper lids, nose, upper lip, nape and neck; disappears at 1st and 2nd year. Erythema toxicum - aka fleabite rash; pink papules with vesicles seen at nape, back and buttocks; appears usually 2nd day; no treatment needed. Forceps marks - disappears in 1-2 days

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Head-to-toe Assessment
Head Fontanelles - should be flat; not indented or bulging

Anterior (diamond-shaped) closes 12-18 months Posterior (triangular shaped) closes 2-3 months.

Molding - some overlapping of sutures Craniotabes - localized softening of the cranial bones caused by pressure of fetal skull against the mother's pelvic bone; more common in firstborn infants Caput succedaneum vs. Cephalhematoma

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Head-to-toe Assessment
Criteria Cause Caput succedaneum Cephalhematoma Scalp edema Collection of blood between periosteum and skull bone Does not cross sutures Several weeks
190

Extent of Involvement

Both hemispheres (Crosses sutures)

Absorption
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About 3 days
Pediatric Nursing

Head-to-toe Assessment Eyes (Assess by putting infant in upright position)


tearless due to immature lacrimal

ducts cornea is round, pupil is dark, iris is gray temporary cross-eyed (STRABISMUS)
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Head-to-toe Assessment Ears


The level of top part of the external

ear should be on a line drawn from the inner canthus to the outer canthus of the eye
Low-set ears Down's syndrome

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Head-to-toe Assessment
Nose
appear large for the face; no septal

deviation
obligate nasal breathers

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Head-to-toe Assessment
Mouth

should open evenly when crying tongue appears large palate intact; lips should have no breaks EPSTEIN PEARLS: small, round glistening cysts on the palate (due to hypercalcemia of the mother) NATAL TEETH: if loose, should be extracted

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Head-to-toe Assessment Neck


short and chubby; creased with folds thymus is palpable (triples at 3 yrs;

stops growth and recedes by 10 years old) head should rotate freely

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195

Head-to-toe Assessment Chest


should be symmetrical
breasts may be engorged WITCH'S MILK: due to maternal

hormones

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196

Head-to-toe Assessment
Abdomen

slightly protuberant; dome-shaped if scaphoid diaphragmatic hernia liver, spleen and kidneys are palpable umbilical cord - 2 arteries and 1 vein (stump falls off 6- 10 days)

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Head-to-toe Assessment
Anogenital region

Pseudomenstruation epispadias, hypospadias, hydrocele Foreskin should be retracted to test for phimosis and paraphimosis testes should be descended (if not, Cryptorchidism)

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198

Head-to-toe Assessment

Back appears flat when prone mass, hairy nebule or a dimple along axis Spina bifida

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Head-to-toe Assessment
Extremities

arms and legs are short and plump

Side Notes: ERB DUCHENNE'S PARALYSIS

Absent Moro reflex on affected arm

Extra digits (polydactyly); fused digits (syndactyly) Simian line: a single palmar crease Downs syndrome Ortolanis sign: congenital hip dislocation

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200

Systemic Assessment
Meconium
within 24 hours sticky, tarlike, blackish-green, odorless mucus, vernix, lanugo, hormones and carbohydrates that accumulated during intrauterine life.

Transitional stools
- 2nd to 3rd day up to 10th day slimy green and loose resembling diarrhea to the untrained eye

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Systemic Assessment
Criteria Color Consistency Frequency of passage Breastfed Infant Golden yellow Mushy, soft 3-4x/day Bottle-fed Infant Pale yellow Firm 2-3x/day

Smell

Sweet-smelling

Slightly Malodorous

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202

Systemic Assessment
Urine

about 15 ml of urine per void females: form a strong stream when voiding males: small projected stream when voiding should void within 24 hours.

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203

NEONATAL SENSES
HEARING:
able to hear in the utero
within hrs after birth, hearing in NB becomes acute

VISION:
focus on black and white objects distance of 9-12 inches pupillary reflex present at birth

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NEONATAL SENSES
TASTE:
developed before birth

TOUCH:
MOST developed sense at birth react to painful stimuli

SMELL:
present as soon as the nose is cleared of mucus ability to respond to odors can be used to document

alertness

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205

Neonatal Reflexes
Reflexes Rooting reflex Sucking Reflex Extrusion Reflex Palmar grasp Stepping (Walk-in-place/Dancing) Reflex Tonic neck (Fencing/Boxer) Reflex 6 weeks 6 months 4 months 6 weeks-3 months 3 months Disappearance

2-3 months

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206

Neonatal Reflexes
Reflexes Moro reflex Disappearance 4-5/6 months

Babinski Reflex
Landau Reflex (Parachute Reaction) Bauer's (Crawling) Reflex Blink Reflex (see objects 9-12" at midline) Swallowing Reflex

3 months
3 months 6 weeks Do not disappear Do not disappear

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BEHAVIORAL ASSESSMENT
First Period of Reactivity 30 minutes after birth Awake and active VS are increased Mother infant bonding breastfeeding Resting Period 2 to 4 hours VS returning to baseline 1 sleep and difficult to be aroused Second Period of Reactivity 4 to 6 hours
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Implementation
Routine Care of the Newborn: Give initial oil bath to cleanse the baby of blood, mucus and vernix. Dress umbilical cord (70% alcohol or PNSS) Crede's prophylaxis - against Ophthalmia neonatorum
2 gtts 1 % AgN03 on lower conjunctival sac; flush with

NSS Erythromycin/Terramycin ointment

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210

Implementation

Routine Care of the Newborn:


Vitamin K (Phytomenadione) administration inject at vastus lateralis,

middle third
1.0 mg full term infants 0.5 mg preterm infants

Identification
Bands; footprints

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Implementation
Routine Care of the Newborn:

Feeding
NSVD = within 30 mins C/S = within 3-4 hours Initial feeding - with sterile water only; glucose is irritating to the lungs if aspirated (1 oz) Subsequent feeding - per demand

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Implementation
Composition Calories CHO Human Milk 20 cal/oz High (Lactose) Low (Lactalbumin/ Whey) Same (Linoleic Acid) Cow'sMilk 20 cal/oz Low

CHON
COOH

High (Casein)
Same

Minerals
Iron
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Low
Low
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High
Low
213

Implementation
Bathing
done anytime but not within 30 minutes

after feeding sponge baths done until cord falls off

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214

Implementation
Constipation
add more fluids or carbohydrates/sugar

Loose stools - management depends on cause Colic Causes:


Overfeeding, gas distention, too much carbohydrates tense and unsure mother

Mgt:

Feed by self-demand Burp the baby twice during a feeding feed in upright position change milk formula if needed reduce sugar content
Pediatric Nursing 215

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Implementation
Spitting up - due to poorly developed sphincter Mgt: feed in upright position position on right side after feeding burp more frequently

Skin irritation - may be due to poor hygiene, or irritation from urine, feces or laundry products Mgt: expose to air careful washing and rinsing of skin starch bath (for Miliaria or prickly-heat rash)

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216

Implementation
Seborrheic dermatitis/cradle cap - involves sebaceous glands; due to poor hygiene Mgt:
apply mineral oil or Vaseline on the scalp at night giving shampoo bath in the morning

Clothing
If mother feels warm, keep the baby cool. If the mother feels cold, keep the baby warm.

Sleep patterns
need 16-20 hours of sleep a day

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217

Implementation
Jaundice

Use natural light and blanch skin on the chest or tip or the nose Inability to conjugate bilirubin (decreased GLUCORONYL TRANSFERASE) Physiologic jaundice: 2nd to 7th day Breastfed babies have longer physiologic jaundice because human milk has PREGNANEDIOL depresses glucoronyl transferase

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218

Implementation
Pathologic jaundice - within 24 hours

Management of Pathologic Jaundice:


Phototherapy (photoisomerization of indirect bilirubin) cover eyes and scrotum with an opaque mask monitor temperature and adequate hydration turn q 2H to expose all body areas measure I & O Exchange transfusion

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219

Pre term

T he absence of plantar crease xcessive lanugo E R ed wrinkled skin uscle hypotonic M


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Post term

P rofuse scalp hair On long finger nails S kin is dry & leather like T he absence of vernix caseosa
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223

Infancy
FIRST "period of rapid growth and

development" 1 month to 12 months Weight gain:


Double Triple Quadriple

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224

Infancy: PHYSICAL GROWTH


Height 50% increase of the birth length during the 1st year average height: 30 inches (76.2 cm) at 1 year old should be taken with the child lying supine or standing erect against measuring board.

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225

Infancy: PHYSICAL GROWTH


Height

Summary of height pattern:


0-3 mos 3-6 mos 6-9 mos 9-12 mos 9 cm 8 cm 5 cm 3 cm 25 cm

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226

Infancy: PHYSICAL GROWTH

Head Circumference a reflection of rapid brain growth at the end of 1 st year, brain has already reached 2/3 of adult size

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227

Infancy: Pertinent Systemic Assessment


Physiologic anemia occurs because

fetal RBC's life span is through and new replacement is not adequate yet serum iron levels decrease

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228

Infancy: Pertinent Systemic Assessment


Dentition 1st tooth erupts at 6 months (LOWER CENTRAL INCISORS)

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229

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Growth and Development


Month 0-1 Gross Motor Largely reflex Fine Motor Hands fisted Follow objects to midline Social smile Follows objects past midline

2 3

Holds head up when prone Holds head & chest up when prone

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Growth and Development


Month 4 Gross Motor Grasp, Stepping, Tonic neck reflexes fading Turns front to back, No head lag Turns both ways, Moro reflex fading Uses palmar grasp Fine Motor

5 6

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Growth and Development


Month 7 Gross Motor Reaches out to be picked up, sits steadily Sits securely without support Creeps or Crawls Fine Motor Transfer objects hand to hand

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Growth and Development


Month 10 Gross Motor Pulls self to stand Fine Motor Uses pincer grasp

11
12

Walk with support


Stands alone, First step Holds cups and spoon, helps in dressing

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234

Growth and Development

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Growth and Development

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Growth and Development

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Growth and Development


Month 0-1 2 3 Cooing sounds, Differentiates cry Laughs out loud, squeals with pleasure Socialization / Language Play Listening to smooth sounds Bright colored mobile Spends more time looking at hand

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Growth and Development


Month 4 5 Socialization / Language Babbling, gurgling Play Playpen Handles rattles well

6 7

Vowel sounds oh-oh Shows beginning fear of strangers

Bathtub toys, rubber rings for teething Objects that are good size for transferring

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Growth and Development


Month
8

Socialization / Language
Peaked fear of stranger

Play
Rattle toys of different textures

9
10

Say first word da-da bye-bye, no


Says two words plus mama & dada
Pediatric Nursing

Needs space for creeping


Peak a boo games

11 12

Cruises Nursery rhymes

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240

Language:
0 2 = cooing
3 -6 = mono syllabic babbling 6 9 = linking syllable

9 12 = simple words

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241

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Infant

Nutrition

6 - 12 months
Introduction of solid foods starts with cereal (usually rice cereal), which is continued until 18 months. Sequence: R ice cereals I ntroduce Yellow Fruits & vegetables C unod green F & V unod Meat (9 mos) / Cheese E gg yolk till 1 year old ( >1 ok egg white)

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Infant
6 - 12 months

D. Nutrition

4 7 days at a time AVOID: D o not feed with seed O popcorn Hotdog piece N uTs No honey Pls raisin S Grape S

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Infant
6 - 12 months

D. Nutrition

Special consideration:

C up use 12 13 mos U will not mix meds w/ food P ruit juice is limited d/t high sugar; try fresh

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246

skills 2

4
8 9

5
10

12
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247

Fine skill
1 6 123 7 4 9 12

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248

Infant
Play (Solitary)

V - VERBAL T - Tactile V - Visual

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249

Infant
Play (Solitary)

a. Provide variety of brightly colored objects, different sizes and textures. b. Hang mobiles within 8-10 inches of infants face.

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250

Infant
Play (Solitary)

a. Provide brightly colored toys to hold and squeeze. b. Allow infant to splash in bath. c. Provide crib mirror.

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251

Infant
Play (Solitary)
a.

Provide toys with movable parts and noisemakers; stack toys, blocks; pots, pans, drums to bang on; walker and push-pull toys.

b. Plays games: hide and seek, pat-a-cake.

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Infant
Fears 1. Separation from parents a. Searches for parents with eyes. b. Shows preference for parents. c. Develops stranger anxiety around 6 months, peak at 8 months 2. Pain a. hold and comfort infant b. reduce painful procedures if possible

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Infant
PROMOTING SENSORY STIMULATION
VISION
Teach parents to make eye-to-eye contact with the

infant to stimulate vision and to promote socialization. Infants enjoy mobiles and crib mirror Photos of family members may be posted near the baby's crib.

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Infant

HEARING
Infant's toys should have soft, musical

or cooing sounds. An audiotape of family voices might be soothing reminder of their presence when they are not around.

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256

Infant
TOUCH
Clothes should feel

comfortable and diaper should always be dry. Teach parents to handle the infant with assurance and with gentleness. Kangaroo hold" promotes close physical contact.

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Implementation
INFANTS DAILY ACTIVITIES

BATHING Bath serves many functions:


a. to promote cleanliness. b. to provide opportunity for the baby to exercise c. to give parents time to talk, touch and

communicate with the baby. d. to give the baby the opportunity to learn different textures and sensations.

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Implementation
SLEEP Infants need 10-12 hours of sleep a night and one or several naps during the day. Caution parents not to place pillows to avoid possibility of suffocation.

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259

Implementation
PARENTAL CONCERNS AND PROBLEMS RELATED TO INFANCY

1. Teething use of cool teething rings

2. Thumb sucking reassure parents, provide sucking pleasures 3. Use of Pacifiers ensure cleanliness 4. Head Banging pad rails and reassure parents

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260

Implementation
PARENTAL CONCERNS AND PROBLEMS RELATED TO INFANCY 5. Sleep Problems provide soft toys and music
6. Constipation increase fluid intake and fiber 7. Loose Stools assess and intervene 8. Colic assess, burp, make feeding stimulating

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Implementation
PARENTAL CONCERNS AND PROBLEMS RELATED TO INFANCY
9. Spitting up upright position feeding, burp

baby, bib during feeding 10. Diaper Dermatitis frequent change, air dry 11. Miliaria bathing with baking soda 12. Baby bottle syndrome avoid bottle during sleep

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Implementation
IMMUNIZATION BCG
Infants

.05 ml 0.1 ml Right deltoid School Entrants

Intradermal

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263

Implementation
BREAST FEEDING

ADVANTAGES: Readily available Economical Promotes facial muscles, jaw and teeth Mother infant bonding Reduced incidence of allergies Reduced incidence of maternal breast cancer Transfer of maternal antibodies
CJT3 Pediatric Nursing 264

Implementation
BREAST FEEDING ADEQUATE feeding? Wets 6 to 8 diapers a day Gaining weight Sleeps well

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265

Implementation
BOTTLE FEEDING DISADVANTAGES: Cost Greater preparation and effort Hands should be clean Requires refrigeration and storage No transfer of maternal antibodies Doesnt benefit mother physiologically

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266

Implementation

Safety

A Ve sure age appropriate toys ut of reach mobile O strangulation nfant protection I o not hold hot while holding D the infant
void offering small piece way from curtain
CJT3 Pediatric Nursing

CAR safety: Semi reclined rear facing position

< 20 lbs

267

Summarizing the INFANT


1 month to 1 year Double weight at 6, triple weight at 12 months First tooth at 6 months GROSS: lift chest at 2, sits at 6-8, creeps at 9, cruise at 10, walks after 12 FINE: transfers object at 7, pincer grasp at 9-10 LANGUAGE: Cries at 2, Mama-Dada at 9 VISION: Past midline at 3, focus object at 6 PLAY: Solitary, toy: mobile, rattles, mirror Theory: Oral, Id, Trust vs Mistrust, Sensori-motor

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INFANCY (0 to 1 yr)
I ron supplement (4 to 6 months),

Immunization N o choking hazard F ear of stranger peaks at 8 months A llow to use a pacifier if NPO N ote the weight changes T rust V.S. mistrust S olitary play
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INFANCY (0 to 1 yr)
COMMON ACCIDENTS P revent further absorption O ff, shower or wash off I - dentify S - upport O ngoing safety education N otify local poison control center

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Assessing the Average Toddler


Freuds: Anal Ericksons: Autonomy vs. shame & doubt Speaks in two-word sentences 20 deciduous teeth present at 2.5 years HR: 90 110 bpm CC > HC at 2 years Pouchy abdomen from weak abdominal

muscles Noticeable lordosis baby fat begins to disappear CJT3 Pediatric Nursing Wide-based gait

272

Milestones of Toddler Growth and Development


Months 15 Fine Motor Puts small pellets into small bottles Scribbles voluntarily with a pencil or crayon Holds a spoon well but may still turn it upside down on the way to the mouth Gross Motor Walks alone well Can seat self into a chair Can creep upstairs

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Milestones of Toddler Growth and Development


Months 18 Fine Motor No longer rotates a spoon to bring it to mouth Gross Motor Can run and jump in place Can walk up and down stirs holding onto a persons hand or railing Places both feet on one step before advancing

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274

Milestones of Toddler Growth and Development


Months Fine Motor Gross Motor

24

Can open doors by turning doorknobs, unscrew lids

30

Walks up stairs alone still using both feet on same step at same time Makes simple lines Can jump down from or strokes for crosses chairs with a pencil

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275

Milestones of Toddler Growth and Development


Months 15 Language 4 6 words Play can stack 2 blocks Enjoys being read to Drops toys for adult to recover (exploring sense of permanence) Imitates household chores, dusting, etc. Begins parallel play (playing beside not with another child)
276

18

7 20 words Uses jargoning Names 1 body part

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Pediatric Nursing

Milestones of Toddler Growth and Development


Months 24 Language 50 words 2-word sentences (nounpronoun & verb) Daddy go, me,come verbal language increasing steadily Knows full name Can name one color Holds up fingers to show age Play Parallel play evident

30

spends time playing house imitating parents actions Play is rough- housing or active

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Toddler ( 1-3) T
O D D L E R s

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T
N

Toddler ( 1-3) ANTRUMS = LACK OF VOCABULARY WORDS


OILET TRAINING

Negativism O IS THE FAVORITE WORD: 1. offer choices 2. limit question D o not offer 3 large meals (SFF) rink well from the cup D et the baby talk L E at: do not let play with food R isk: Aspiration & poisoning
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TANTRUMS
D/T LACK OF VOCABULARY WORDS
300 WORDS

2 WORD SENTENCES MNGT: 1. I gnore 2. T ime 1 min/ age

I nstitute warning M ove to corner E xpalin well


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Toilet training
> 18 mos complete myelination of spinal colums Signs of readiness:
Pulls/tugs soild diaper Please parent

Pants able to remove


Potty chair 5-10 min w/o fussing Patience

Pwede ng SIT, SQUAT & WALK

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Toilet training
> 18 mos complete myelination of spinal colums Timing of good control
2 3 Day time bladder control 3 4 Night time bladder control

* 3 good bowel control

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282

Separation anxiety
> 18 mos Steps: Protest - cry 2. Despair widrawn 3. Denial repression of feeling
1.

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283

Play
ParAllel P arallel play; PUSH & PULL A ttention span short R emovable/ replaceable

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284

Safety:
Car: Lock all doors
Upright forward facing

position in convertible restraint > 20 lbs - < 40 lbs


Forward facing booster seat > 40 lbs - , 60 lbs < 49 tall

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285

Language:
1 y/o = 50 words 2 y/o = 300 words

3 y/o = 900 words


4 y/o = 1500 words 5 y/o = 2100 words

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286

Skills toddlers

12

12
3

2
3

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287

Skills toddlers
Fine: undressing building blocks

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Growth and Development ( PRESCHOOL)


Years 3 Fine Motor Undresses self Stacks tower blocks Draws a CROSS Can do simple buttons Draws a 6-part man Can lace shoes
Pediatric Nursing

Gross Motor Runs Alternates feet on stairs Rides tricycle Stands on one foot Constantly in motion, jumps, skips Throws overhand

4 5

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Growth and Development ( PRESCHOOL)


Years 3 Language Vocabulary at 900 words Play Able to take turns Very imaginative Pretending is a major activity Likes games with numbers or letters

4
5

Vocabulary at 1.500 words Vocabulary at 2,100 words

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PRESCHOOL
Freuds: phallic
Ericksons: initiative vs. guilt Dentition: 3 y/o = complete primary teeth

6 y/o = erupt of the first permanent teeth Note: food fads & strong taste preference P primary teeth is completed R regular dental care E eating social aspect; manners; willingness to feed S sleep 12 hours CJT3 Pediatric Nursing 293

PRESCHOOL ( BOWEL & BLADDER CONTROL)


4 y/o = bed wetting accidents @

night 5 y/o = bed wetting @ stressful situations


ENURESIS involuntary passage of

urine Types: 1. nocturnal 2. diurnal

S
Pediatric Nursing 294

PRESCHOOL ( BOWEL & BLADDER CONTROL)

S
Mngt:

o common in boys tress mall bowel capacity

V oid before sleeping O n limit fluids before sleep I nvolve child in care of sheets D o reward

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PRESCHOOL ( Car Safety)


Upright forward facing

position in convertible restraint > 20 lbs - < 40 lbs


Forward facing booster

seat > 40 lbs - , 80 lbs < 49 tall

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PRESCHOOL ( Safety)
P
R

E
S

C
H
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PRESCHOOL ( Safety)
P ractice safety: follow simple instruction
R Estrained booster seat

E ducate abt identifications


S
Hould be tought never point a gun

C Ommon molestation/ stranger acts


HAve a knowledge what to do for safety
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Emotional Development
Developmental Tasks Initiative Imitation Fantasy Oedipus and Electra Complexes
Gender Roles Socialization Impt. Person: Basic family

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Common Fears of the Preschooler


F ear of the Dark E njury to body; body mutilation

A bondonment
R oom dark

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Behavior Variations

Telling tall tales Imaginary friends Difficulty sharing Regression Sibling rivalry

PLAY A ssociative/ Cooperative S imple & imaginative

W/o rules All girls only Beware of girls Dress up Papers & scissors Puzzle
301

S imilar age; socialize


On expression

CJT3 Pediatric Nursing

Parental Concerns associated with the Pre-school Period


Preparing for a new sibling Sex education Choosing a preschool or childcare center Preparing a child for school Broken fluency

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SCHOOL-AGE
Freud: latency

Erickson: industry vs. inferiority


Girls grow faster than boys

Sleep: 10 12 hours
Dentition: 6 y/o = 1st permanent teeth Proper dental care Soft nylon toothbrush & length of 6 inches
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SCHOOL-AGE
Play: competitive

Ollectibles Heck rules & rituals

O N rules in games MUlti tech task: Articipate in team sports, peer P & scout
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SCHOOL-AGE
SAFETY

S C H Elmet O N water safety N O to stranger ess fear = safety rules L


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Eat belts ( shoulder belt fit across chest & shoulder) Lap belts (across the thigh) Ause of injuries: Bicycle, skateboard & team sports

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Adolescent
puberty
Freuds: Puberty / genital

Ericksons: identity vs. role confusion


Maturational Hormonal

Growth
Reproductive organ begin to function Secondary sex characteristics Body mass index

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Adolescent
Safety:

Impt. Person: peers Fear: separation fr friends

A D O L
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Dolescents are risk taker Natural urge to experiment Angers of vices Ther choices is present if danger arises

Ay out result of violence, piercing, injuries, drugs etc


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Concerns and Problems of a School-Age Child & adolescent


Common Fears and Anxieties
Anxiety related to beginning school School Phobia

Home Schooling Latchkey children

Sex education
Stealing Violence or terrorism

Bullying
Recreational drug use

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Keys to Success!
Confidence

Test taking strategies


Ample test preparation and study habits Review of frequent board examination topics

Focus on your goals


Above all- PRAYERS

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COMMON PROBLEMS, DISORDERS AND DISEASES IN INFANTS


A. PREMATURITY: - birth before 37th week of gestation 1. Associated Medical Problems Maternal
Placenta previa Abruptio placenta Cervical incompetence

Hypertensive disease of pregnancy

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Respiratory Distress Syndrome


Hyaline Membrane Disease
Dec.surfactantcollapse alveoli Inc. pulm resistanceshunts FO/DAtissue

hypoxiainc. CO2 respiratory acidosis CXR-ground-glass appearance Tx: penicillin/aminoglycoside

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314

Meconium Aspiration Syndrome


Causes: hypoxia, vagal stimulation

relaxation of rectal sphincter Respiratory distress due to mechanical plugging Tx: suction, intubation, CPT, O2

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315

Apnea
Pause in Respiration >20 mins with bradycardia
Causes: preterm, infection, hypoglycemia,

hypothermia, hyperbilirubinemia Tx: stimulation,suction, warmth

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Nursing Interventions

Feed slowly Keep infant warm Maintain clear airway Rub back or soles of feet to stimulate

infants breathing. Transport infant to special care facility as soon as possible. Avoid handling infant more than necessary for feeding and changing of diapers.
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Nursing Interventions Prevent infection


Establish extra uterine circulation.
Establish proper waste elimination. Establish body temperature control.

Expose the child to adequate stimulation.

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Establish and maintain adequate respiration. Ensure ability to take in adequate nourishment. Foster the development of an infant-parent bond. Nurses should be familiar with the most frequently encountered physical anomalies so that they can make truthful statements

Nursing Interventions

regarding the childs condition to the parents.

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319

General Nursing Care of Infant with Physical Anomalies


Assessment Determine the childs immediate physiologic needs to sustain life Know the parents immediate emotional needs to promote bonding between child and parents

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Nursing Diagnosis

Anticipated grief related to the loss of perfect child. Self-esteem disturbance related to interference with establishing parent-infant bond Altered nutrition, less than body requirements, related to malabsorption of necessary nutrients

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Nursing Intervention:
Provide opportunities for parents to

participate in the childs care. Promote open parent visiting. Support sibling and grandparent visitations. Ample analgesia, including techniques of distraction or imagery; traditional comforts such as a change of clothing or positions; and reading to the child.

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Nursing Intervention:
To assure children that their bed is an area that is safe, all painful procedures should be done in the treatment room away from the bed.
Offer children a sense of control. Explain to the children the procedures and give choices whenever possible to limit their fear of hospitalization.

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