Week 2 - Growth and Development - Health Promotion

All Elsevier items and derived items 2013, 2009,
Mosby, Inc., an imprint of Elsevier Inc.
* Biologic development
* Proportional changes
* Weight gain is 5 to 7 ounces per week
* Double the birth weight by age 6 months
* Triple the birth weight by age 1 year
* Height increases by 1 inch per month for 6 months
* Double the length by age 1 year
* Growth occurs in spurts rather than in a gradual
pattern

* Respiratory
* Cardiovascular
* Hematopoietic changes
* Digestive processes
* Immunologic
* Thermoregulation
* Renal function
* Sensory

* Grasping object at 2 to 3 months

* Palmar grasp at 6 months
* Transfer object between hands at 7 months
* Pincer grasp at 10 months
* Remove objects from container at 11 months
* Build tower of two blocks at 12 months


* Head lag in first 2 months

* Head control at 4 months
* Rolling over (from abdomen to back) at 5 to 6
months
* Parachute reflex by 7 months

* Sit alone by 7 months
* Move from prone to sitting position by 10
months




* Cephalocaudal direction of development

* Increased coordination of extremities at 4
months
* Crawling at 6 to 7 months (usually backward)

* Creeping at 9 months
* Walk with assistance at 11 months
* Walk alone at 12 months

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11
* Piaget
* Sensorimotor phase (six stages, birth to 24
months)
* Reflex stage: Birth to 1 month

* Primary circular reactions: 1 to 4 months
* Secondary circular reactions: 4 to 8 months
* Imitation
* Play
* Affect
* Coordination of secondary schema: 8 to 12 months
* Beginning of intellectual reasoning

12
* Concept of object permanence

* By end of first year, child recognizes that he or
she is distinct from the parents
* Increased interest in image

* As motor skills develop, the child learns that the
body is useful

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14

15
* Attachment
* Reactive attachment disorder (RAD)
* Separation anxiety
* Stranger anxiety
* Play as a major socializing agent

16
* Crying is the first verbal communication

* Vocalizations by 6 weeks
* Coo, gurgle, laugh aloud at 3 to 4 months
* Imitate sounds and add consonants at 8 months
* Comprehend No; follow commands at 9 to 10
months
* Ascribe meaning to a word at 10 to 11 months

* Three to five words with meaning by age 1 year

17
* Influences the type of interaction that occurs

between the child and parents
* May be affected by the environment and family

* The Early Infancy Temperament Questionnaire is
for infants 1 to 4 months.
* Assists in determining temperament
* Revised Infant Temperament Questionnaire

* Assists in determining temperament
* Designed for infants older than age 4 months

18
* Child-rearing practices related to temperament

* Separation and stranger fear
* Childcare arrangements
* Limit setting and discipline
* Thumb sucking and use of a pacifier
* Teething

19
* Nutrition: Breast milk is the first choice only for the first 6
months of life
* NO need for additional fluids in the first 4 months
* NO honey in the first year of life
* Introduction of solid foods after age 6 months
* Introduce foods at intervals of 4 to 7 days to allow for identification of

food allergies
* May need fluoride supplements
* Finger foods at 9 months

* Weaning from breast or bottle to cup after 1 year

20
* Nocturnal pattern of 9 to 11 hours by

3 to 4 months
* Total daily sleep: 15 hours

* Back to Sleep campaign
* Sleep problems
* Sleeping arrangements
* Infant walkers

21
* Avoidance of early childhood caries

* Cleaning begins when primary teeth erupt
* First dental visit at 6 months (eruption of first
teeth)
* Water is preferred to toothpaste until after

age 2 years
* Consider need for fluoride supplements

22
* Aspiration of foreign objects

* Suffocation
* Motor vehicle injuries
* Falls
* Poisoning
* Burns
* Drowning

23

* Vitamin imbalances
* Complementary and alternative medicine (CAM)
* Mineral imbalances
* Vegetarian diets
* Proteinenergy malnutrition
* Kwashiorkor
* Marasmus

25
MyPyramid for Kids. (From Food and Nutrition Service, U.S. Department of Agriculture:
MyPyramid for kids [FNS-381], Washington, DC, April 19, 2005, The Service. Available
Allonline
Elsevier at
items
and derived items 2013, 2009,
mypyramid.gov.)
26
* Food allergy
* Immunoglobulin E (IgE)mediated immune
response (e.g., cows milk allergy)
* Food intolerance
* Non-IgEmediated immune response (e.g.,
lactose intolerance)

27
* Failure to thrive (FTT)

* Inadequate caloric intake
* Inadequate absorption
* Increased metabolism
* Defective utilization

28
* Dyssomnias
* Trouble falling or staying asleep
* Trouble staying awake during the day
* Parasomnias
* Confusional arousals
* Sleepwalking
* Sleep terrors
* Rhythmic movement disorders

29
* Colic
* Abdominal pain
* Cramping
* Crying 3s
* Drawing up legs to abdomen
* Symptoms increase in late afternoon
* Younger than 3 months of age

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* Sudden infant death syndrome (SIDS)

* American Academy of Pediatrics Back to Sleep
Campaign to reduce the risk of SIDS
recommendations
* Place the infant in a supine position while sleeping

* No co-sleeping or prone sleeping
* Remove pillows, blankets, and moldable
mattresses
* Encourage breastfeeding

32
* Positional plagiocephaly has increased since

the implementation of the Back to Sleep
Campaign

33

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* Infant experiencing an ALTE may exhibit

* Apnea
* Change in color or muscle tone
* Choking, gagging, or coughing
* The ALTE requires significant intervention

* Infants who experience an ALTE are discharged
with home apnea monitors
* Parents are taught how to administer CPR

35
* Pathologic apnea in infants more than 37 weeks

of gestation
* Clinical presentation of ALTE

* Therapeutic management
* Theophylline, caffeine
* Home apnea monitors
* Family support
* CPR training

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37

* The terrible twos

* Age 12 to 36 months
* Intense period of exploration
* Temper tantrums and obstinacy occur frequently
* Successful mastery of developmental skills
depends on the trust and guidance of parents

39
* Weight gain slows to 4 to 6 pounds per year

* Birth weight should be quadrupled by 2 years
* Height increases about 3 inches per year
* Growth is steplike rather than linear
* Adult height is 2 times the height at age 2 years
* Anterior fontanel closes by 12 months

40
* Visual acuity of 20/40 is acceptable

* Development of hearing, smell, taste, and touch
increases
* Uses all senses to explore the environment

41
* Most physiologic systems are relatively mature by the end of

toddlerhood
* Inner ear structures are short and straight, tonsils are large
and, therefore, upper respiratory tract infections, otitis media,

and tonsillitis are common
* Voluntary control of elimination

* Sphincter control at age 18 to 24 months
* Neurobehavioral organization improves

42
* Locomotion
* Walks by 12 months; runs by 18 months
* Climbs stairs by age 2 years
* Has improved coordination between 2 and 3 years

* Fine motor development
* Has improved manual dexterity at 12 to 15 months
* Throws a ball by 18 months
* Draws circles by age 3 years

43
* Begins development of independence and selfcontrol
* Erikson: Autonomy versus shame and doubt

* Negativism
* Ritualization provides a sense of comfort
* Id, ego, and superego (conscience)

44
* Piaget
* Sensorimotor phases
* Tertiary circular reactions at 13 to 18 months
* Invention of new means through mental
combinations at 19 to 24 months
* Imitation and domestic mimicry are common

* Awareness of causal relationships between two
events (problem solving and operations)
* Learns spatial relationships

45

46
* Begins at about age 2 years and lasts until age

4 years
* Transition between self-satisfying behaviors of

infancy and socialized relationships
* Increased use of language

* Concern with why and how
* Prelogical thinking

47
* Spiritual development often parallels cognitive

development
* Spiritual routines can be comforting

* Religious teachings and moral development
influence toddler behavior

48
* Body image closely parallels cognitive

development and self-awareness
* Refers to body parts by name

* Avoid negative labels about physical
appearance
* Recognizes gender differences by age 2 years

49
* Exploration of genitalia is common

* Gender roles are understood by a toddler
* Gender identity is established by age 3 years
* Playing house

50
* Differentiation of self from mother and from

significant others is a major task
* Separation
* Individuation
* Increased understanding and awareness of

object permanence and ability to tolerate
frustration diminished stranger fear
* Transitional objects provide security

51
* Increasing level of comprehension

* Increasing ability to understand
* Comprehension of 300 words by age 2 years
* At age 2 years, can use two- or three-word
phrases
* At age 3 years, can use simple sentences and
acquires five to six new words a day
* Gestures precede each language milestone up
to 30 months of age

52
* Toddlers develop skills of independence

* Sudden mood swings are common
* Skills of independence may result in tyrannical,
strong-willed, volatile behaviors
* Skills include feeding, playing, dressing, and

undressing self

53
* Parallel play
* Imitation
* Little emphasis on gender-stereotyped toys
* Increased locomotive skills
* Educational toys and books
* Tactile play
* Appropriate safety in relation to size, shape, risk for toxins, and
sturdiness of toys

54
* Toilet training
* Sibling rivalry
* Temper tantrums
* Negativism
* Regressive behavior

55
* Voluntary sphincter control

* Ability to stay dry for 2 hours
* Fine motor skills to remove clothing
* Willingness to please parents
* Curiosity about adults or siblings toilet habits
* Impatience with wet or soiled diapers

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* Nutrition
* Phenomenon of physiologic anorexia

* Grazing
* MyPlate recommendations
* Drinks an average of 24 to 30 ounces of milk per
day and eats 1 cup of fruit per day
* Sleep and activity
* Sleeps for 11 to 12 hours per day

* Has an adult sleep pattern by age 3 years

58
* Motor vehicle injuries (car seat safety)

* Drowning
* Burns
* Poisoning
* Aspiration and suffocation
* Bodily damage (falls, being struck, bites or stings)

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60

61

62

* The preschool period lasts from age 3 to 5

years
* Preparation for the most significant lifestyle

change: going to school
* Experiences brief and prolonged separations

* Uses language for mental symbolization
* Has an increased attention span and memory

64
* Physical growth slows and stabilizes

* Average weight gain remains about 5 pounds
per year
* Average height increases 2 to 3 inches per

year
* Body systems mature and stabilize; can adjust

to moderate stress and change

65
* Gross motor skills should be well-established

* Walking
* Running
* Climbing
* Jumping

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67
* Fine motor skills include refinement in eyehand and muscle

coordination
* Drawing, dressing, artwork, skillful manipulation

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* Erikson: Developing a sense of initiative

* Chief psychosocial task of the preschool period
* Feelings of guilt, anxiety, and fear may result from
thoughts that differ from expected behavior
* Development of superego (conscience)

* Learning right from wrong; moral development

70
* Readiness for school

* Readiness for scholastic learning
* Successful achievement of cognitive goals at
this stage is needed for learning, which is

among the reasons children enter school at 5 to
6 years old

71
Piaget: Preoperational Phase Spans

age 2 to 7 years
Divided into two stages
Preconceptual phase at 2 to 4 years
Intuitive thought phase at 4 to 7 years
Shifts from egocentric thought to social awareness

Able to consider other viewpoints
Egocentricity is still evident

72
* Language continues to develop

* Concept of causality is beginning to develop
* Concept of time is incompletely understood
* Uses magical thinking frequently

73
* Basic level of moral judgment

* Punishment and obedience orientation
* Naive instrumental orientation: Actions to satisfy
ones own needs and less concern about the
needs of others
* Concrete sense of justice and fairness

74
* Knowledge of faith and religion is learned from

significant others and religious practices
* Development of conscience is strongly linked to

spiritual development
* May misinterpret illness as punishment from

God

75
* Increasing comprehension of desirable

appearances
* Aware of racial identity, differences in

appearances, and biases
* Poorly defined body boundaries

* Fear that if the skin isbroken,all ones blood
andinsidescan leak out
* Frightened by intrusive experiences

76
* Forms a strong attachment to the opposite-sex

parent while identifying with the same-sex
parent
* Becomes concerned with modesty

* Sex role limitation; dressing up like Mommy or
Daddy
* Sexual exploration is more pronounced

* Questions arise about sexual reproduction

77
* Individuationseparation process is completed

* Overcomes stranger anxiety and fear of
separation from the parents
* Still needs parental security and guidance

* Security from familiar objects
* Play therapy is beneficial for working through
fears, anxieties, and fantasies

78
* Major mode of communication and social

interaction
* Vocabulary increases dramatically between age

2 and 5 years
* Complexity of language use increases between

age 2 and 5 years

79
* Minimal help with toileting, eating, or dressing

* Is willing to please
* Has internalized values and standards of family
and culture
* May begin to challenge parental values

80
* Associative play
* Imitative play
* Imaginative play and imaginative playmates
* Dramatic play

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* Preschool and kindergarten

* Developmental screening tool to assess
readiness for school
* Importance of infection control in school setting

* Introduction of child to school

83

84
* Find out what children know and think

* Be honest
* Avoid overanswering the question
* Sexual exploration and sexual curiosity

85
* Dark
* Being left alone
* Animals (e.g., snakes, large dogs)
* Ghosts
* Objects or persons associated with pain
* Technique of desensitization to overcome fears

86
* Minimum amounts of stress can be beneficial

* Parental awareness of signs of stress in the
childs life
* Prevention of stress
* Schedule adequate rest
* Prepare the child for upcoming changes to
maximize coping strategies

87
* Behavior that attempts to hurt another person or

destroy property
* May be influenced by biologic, sociocultural,

and familial variables
* Factors that increase aggressive behavior

include gender, frustration, modeling, and
reinforcement

88
* Stuttering
* Stammering
* Dyslalia (articulation problems)
* Denver Articulation Screening Examination
(DASE) as a tool for assessing speech
problems

89
* Nutrition
* Caloric requirements are approximately
90 kcal/kg
* Fluid requirements are approximately
100 mL/kg, depending on activity and climate
* Food fads and strong tastes are common

90
* Sleeps for 12 hours per night; infrequent naps

* Free play is encouraged
* Emphasis is on fun and safety

91
* Thorough assessment of sleep problems

* Nightmares
* Sleep terrors
* Encourage consistent bedtime routine

92
* Safety education
* Development of long-term safety behaviors
* Bike helmets

93
* Childcare focus shifts from protection to

education
* Children begin questioning previous teachings

of parents
* Children begin to prefer the companionship of

peers

94
* Aphthous ulcers
* Herpes simplex virus
* Hand, foot, and mouth disease (HFMD)
* Nursing priorities
* Relief of pain
* Prevention of spread
* Ensure hydration

95
* Helminths (worms): Pinworms

* Protozoa: Giardiasis
* Nursing priorities
* Assist with identification of the parasite (tape test)
* Assist with education and treatment
* Anticipatory guidance (family and preschool)

96
* Agent is human parvovirus

* Rash in three stages
* Slapped face appearance disappears between 1
and 4 days
* Maculopapular rash on extremities lasts 7 days or

more
* Rash subsides but reappears if skin is irritated or

traumatized by heat, cold, friction, and so on

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* Children younger than age 6 years are at risk

for injury
* Cosmetics and personal care products

* Cleaning products
* Plants
* Foreign bodies, toys, and miscellaneous
substances
* Hydrocarbons (gasoline)

100
* Poison control center: 800-222-1222

* Call first, before initiating any interventions
* Assessment
* Gastric decontamination
* Induce vomiting, absorb toxin, or use gastric
lavage, depending on the agent ingested
* Prevention of recurrence

101
* Lead ingestion is most common

* Mercury toxicity occurs less frequently

102
* Peeling lead-based paint in older homes

* Microparticles of lead contaminate bare soil
* Food and water contamination
* Pottery and dishes; folk remedies
* Impoverished, urban area; older rental homes
* Can be inhaled or ingested

103
* Rarely symptomatic but affects renal, neurologic,

and hematologic systems (bone marrow)
* Diagnosis
* Anemia
* In venous blood sample the blood lead level is 10
g/dL or higher
* Screening for lead poisoning at age 1 and 2 years
* Chelation therapy
* Prognosis
* Nursing priorities of care

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* Neglect (60% of cases)

* Intentional physical abuse (11%)
* Emotional abuse (4%) or neglect
* Sexual abuse of children (8%)

106
* Physical neglect
* Deprivation of food, clothing, shelter, supervision,
medical care, and education
* Emotional neglect
* Lack of affection, attention, and emotional
nurturance
* Emotional abuse
* Destroys or impairs childs self-esteem

107
* Deliberate infliction of physical injury on a child

* States define abuse according to individual
reporting laws (nonuniversal)
* Shaken baby syndrome (SBS)

108
* Caregiver exaggerates or fabricates signs and symptoms of

illness in a child (the proxy) to gain attention or gratification
* Child may undergo needless and painful procedures and

treatments; in 10% cases, they may be fatal to the child
* Maltreatment may be physical, emotional, and psychological

* Common symptoms

109
* Parental characteristics
* Age, single parent, unrelated partner

* Low self-esteem, poor parenting knowledge, poor
role model
* Characteristics of the child
* Age from newborn to 1 year

* Physically disabled, hyperactive, premature
* Environmental characteristics
* Social isolation, poor support systems

* Chronic stress, poverty, substitute caregivers

110
*Defined as the use, persuasion, or coercion of any child

to engage in sexually explicit conduct or simulation of
such conduct for producing visual depiction of such
conduct
*Rape or molestation
*Prostitution
*Incest with children
*Exhibitionism
*Child pornography or prostitution
*Pedophilia

111
* Typical abuser is a man who the victim knows,

but it may be ANYONE
* All socioeconomic backgrounds

* Adults in 80% of cases
* May be generational

112
* Identify abusive situations as early as possible

* Detailed history and thorough physical examination
pertaining to the incident
* Evidence of maltreatment
* Pattern or combination of indicators that arouse
suspicion and further investigation

* Child and caregiver histories of events do not match
* Inconsistent or incongruent behaviors
* Protect the child from further abuse

* Support the family

113
All Elsevier items and derived items 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.
* School age is generally defined as age

6 to 12 years
* Gradual growth and development

* Progress with physical and emotional maturity
115
* Height increases by 2 inches per year

* Weight increases by 2 to 3 kilograms per year
* Males and females differ little in size
116
* Bladder capacity increases

* Heart is smaller in relation to the rest of the
body
* Immune system is increasingly effective

* Bones increase in ossification
* Physical maturity is not necessarily correlated
with emotional and social maturity
117
* Defined as the 2 years preceding puberty

* Typically occurs during preadolescence
* Varying ages from 9 to 12 years (in girls, it
occurs about 2 years earlier than in boys)
* Average age of puberty is 12 years in girls and

14 years in boys
118
* Relationships center around same-sex peers

* Freud described it as the latency period of
psychosexual development
119
* Eager to develop skills and participate in

meaningful and socially useful work
* Acquires a sense of personal and interpersonal

competence
* Growing sense of independence

* Peer approval is a strong motivator
120
121
* Feelings may derive from self or the social

environment
* May occur if incapable or unprepared to assume

the responsibilities associated with developing a
sense of accomplishment
* All children feel some degree of inferiority

regarding skill(s) they cannot master
122
* Concrete operations
* Use thought processes to experience events and
actions
* Develop an understanding of relationships

between things and ideas
* Able to make judgments based on reason

(conceptual thinking)
123
* Development of conscience and moral

standards
* In a child age 6 to 7 years, reward and

punishment guide choices
* Older school-age child is able to judge an act by

the intentions that prompted it
* Rules and judgments become more founded on

the needs and desires of others
124
* Children think in concrete terms

* Children expect punishment for misbehavior
* May view illness or injury as punishment for a
real or imagined misdeed
125
* Importance of the peer group

* Identification with peers is a strong influence in
a child gaining independence from parents
* Sex roles are strongly influenced by peer

relationships
126
* Parents are the primary influence in shaping a
childs personality, behavior, and value system
* Increasing independence from parents is the

primary goal of middle childhood
* Children are not ready to abandon parental

control
127
* Involves physical skill, intellectual ability, and

fantasy
* Form groups, cliques, clubs, secret societies

* Rules and rituals
* See the need for rules in games they play
128
* Team play
* Quiet games and activities
* Ego mastery
129
130
* Definition: A conscious awareness of a variety of

self-perceptions (e.g., abilities, values,
appearances)
* Importance of significant adults in shaping a

childs self-concept
* Positive self-concept leads to feelings of selfrespect, self-confidence, and happiness
131
132
* Generally, children like their physical selves less

as they grow older
* Body image is influenced by significant others

* Increased awareness of differences may
influence feelings of inferiority
133
* School experience
* Second only to the family as a socializing agent
* Transmission of values of the society
* Peer relationships become increasingly important
134
* Teachers
* Parents
* Latch-key children
* Limit setting and discipline
* Dishonest behavior
* Stress and fear
135
* Nutrition
* Importance of balanced diet to promote growth
* Quality of the diet related to the familys pattern of
eating
* Quality of dietary choices in the school cafeteria

* Fast food concerns
136
* The average amount of sleep a night is 9
hours in school-age children, but this is highly

individualized
* May resist going to bed at age 8 to 11 years

* Children of 12 years and older are generally
less resistant to bedtimes
137
* Sports
* Controversy regarding early participation in
competitive sports
* Concerns with physical and emotional maturity in

competitive environment
* Acquisition of skills
* Generally like competition
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* Sex play as part of normal curiosity during

preadolescence
* Middle childhood is the ideal time for formal sex

education
* Life span approach

* Information on sexual maturity and the process of
reproduction
* Effective communication with parents
141
* Treat sex as a normal part of growth and

development
* Questions and answers

* Differentiation of sex and sexuality
* Values; problem-solving skills
* Open for communication with parents
142
* Responsibilities of parents, schools, and health

departments
* Ongoing assessment, screening, and referrals

* Routine services, emergency care, safety and
infection control instruction
* Increase knowledge of health and health habits
143
* Most common cause of severe injury and death
in school-age children is motor vehicle crashes,

pedestrian and passenger
* Bicycle injuries; benefits of bike helmets

* Appropriate safety equipment for all sports
144
145
* Parents adjust to the childs increasing

independence
* Parents provide support as unobtrusively as

possible
* Child moves from narrow family relationships to

a broader world of relationships
146

* Transition between childhood and adulthood

* Rapid physical, cognitive, social, and emotional
maturation
* Generally defined as beginning with the onset of

puberty and ending with the cessation of body
growth at 18 to 20 years

148
* Prepubescence: About 2 years before puberty,

heralding physical changes
* Puberty: Sexual maturity is achieved

* Postpubescence: 1 to 2 years after puberty;
skeletal growth is complete and reproductive

functions become established
* Adolescence: Time of growing into
psychological, social, and physical maturation

149
* Primary sex characteristics

* External and internal organs necessary for
reproduction
* Secondary sex characteristics

* Result of hormonal changes: Voice change, hair
growth, breast enlargement, fat deposits
* Play no direct role in reproduction

150
* Role of anterior pituitary and hypothalamus

* Hormones stimulate gonads
* Gonads produce and release gametes
* Gonads secrete sex-appropriate hormones

151
* Secreted by ovaries, testes, and adrenal glands

* Produced in varying amounts by both sexes
throughout the life span
* Adrenal cortex causes small amount of secretion

before puberty
* Maturation of gonads produces biologic changes

of puberty

152
* Feminizing hormone
* Low production during childhood
* In males, there is gradual production throughout
maturation
* In females, levels increase until about 3 years

after menarche; estrogen then remains at this
maximum level throughout reproductive life

153
* Masculinizing hormones
* Secreted in small and gradually increasing
amounts up to 7 to 9 years; then rapid increase

in both sexes until 15 years
* Responsible for rapid growth of the early

teenager
* Testes secrete testosterone; levels increase to a

maximum level at maturity

154
* Tanner stages of sexual maturity

* Stages of development of secondary sex
characteristics and genital development
* Defined as a guide for estimating sexual maturity

155
* Thelarche (8 to 13 years): Breast buds

* Adrenarche (8 to 13 years): Pubic hair growth
* Menarche: About 2 years after thelarche,
menstruation begins
* Puberty delay: No thelarche by age 13 years

156

157

158
* Stage 1 (91/2 to 14 years): Testicular

enlargement and sparse pubic hair
* Stage 3: Penile enlargement, voice changes,
early facial hair; gynecomastia (temporary

breast enlargement) occurs in 1/3 of males in
midpuberty
* Stage 5: Penile growth, first ejaculation, axillary,

groin, and facial hair, final voice change

159

160
* Dramatic increase in growth accompanies

sexual maturation
* Adolescent growth spurt

* 20% to 25% of total height is achieved during
puberty
* Usually occurs within a 24- to 36-month period
* Characteristic sequence of changes

161
* Appear to be the result of hormonal effects

during puberty
* Skeletal growth
* Voice changes
* Lean body mass
* Nonlean body mass
* Skin, glands, and hair

162
* Size and strength of heart, blood volume, and

systolic blood pressure increase
* Pulse rate and basal heat production decrease

* Adult values for all formed elements of blood
* Respiratory volume and vital capacity increase
* Increased performance capabilities

163
* Erikson: Sense of identity

* Early adolescent: Group identity versus alienation
* Development of personal identity versus role
diffusion
* Sex role identity

* Emotionality

164
* Formal operations period

* Abstract thinking
* Think beyond present
* Mental manipulation of multiple variables
* Concerned about others thoughts and needs

165
* Internalized set of moral principles

* Questioning of existing moral values and
relevance to society
* Understand duty and obligation, reciprocal

rights of others
* Concepts of justice, reparation

166
* Some may question the values and beliefs of

the family
* Capable of understanding abstract concepts

and interpreting analogies and symbols
* May fear that others will not understand their

feelings
* Tendency for introspection and emotional

intensity

167
* Goal is to define ones identity independently

from parental authority
* Much ambivalence
* Intense sociability; intense loneliness
* Acceptance by peers

168

169
* Roles change from protectiondependency to

mutual affection and equality
* Process involves turmoil and ambiguity

* Struggle of privileges and responsibility
* Emancipation from parents may begin with the
rejection of parents by the teenager

170
* Peers assume an increasingly significant role in

adolescence (best friend)
* Peers provide a sense of belonging and a

feeling of strength and power
* Peers form a transitional world between

dependence and autonomy
* Role of social media and advanced technology

171
* Dating
* Sexual orientation
* Sexual experimentation (wide range)
* Reasons for sexual experimentation
* Curiosity
* Pleasure
* Conquest
* Peer pressure to conform

172
* Feelings of confusion in early adolescence

* Acute awareness of appearance, comparison of
appearance with others
* Blemishes and defects are magnified out of

proportion
* Matures to self-concept based on uniqueness

and individuality

173
* Responses differ depending on the stage of

development
* Curiosity in early adolescence

* Concerns with Am I normal?
* Concerns for late-maturing teens
* Concept of perfect body achievement

174
* Assumption of responsibility for health

* Assess for risk factors (GAPS)
* Immunizations
* Nutrition
* Eating habits and behaviors
* Healthy lifestyle habits

175
* Sleep and rest

* Exercise and activity
* Dental health
* Personal care
* Vision, hearing
* Posture
* Body art (piercing and tattooing)
* Suntanning, ultraviolet damage

176
* Stress reduction
* Sexuality education and guidance
* Media influences
* Knowledge from peers, TV, movies, magazines
* Need factual information, presentation based on
developmental maturity and ability to ask
questions
* Role modeling

177
* Motor vehicle crashes are the single greatest

cause of serious and fatal injuries in teens
* Other vehicles
* Firearms and other weapons
* Sports injuries
* Water safety
* Poisoning, tobacco, alcohol, and other drugs

178
* Parents need support and guidance

* Information needs regarding developmental
changes and process of gaining independence
* Help letting go and promoting independence

179

* Bed-wetting
* More common in boys
* Usually ceases between 6 and 8 years of age
* Diagnosis
* Chronologic or developmental age over 5 years
* Two times per week or more for 3 months
* May have urgency or frequency

181
* Primary enuresis
* Onset of wetting in children who have never been

dry for extended periods of time
* Secondary enuresis
* Onset of wetting after established urinary continence
* Monosymptomatic enuresis (most common)

* Dry during the day
* Polysymptomatic enuresis
* Daytime urgency

182
* Bladder volume of 300 to 350 mL is sufficient to

hold a nights urine
* Childs age + 2 = Expected bladder capacity in

ounces

183
* Sleeps more soundly than other children

* Emotional factors
* Familial tendency

184
* Drugs
* Imipramine (Tofranil)
* Oxybutynin
* Desmopressin (DDAVP)
* Bladder training
* Fluid restriction in evenings
* Interruption of sleep to void
* Conditioned reflex response device

185
* Repeated voluntary or involuntary passage of feces of normal

or near normal consistency into places not appropriate for
that purpose
* Not caused by any physiologic effect (e.g., laxative or medical

problem)
* Primary encopresis is fecal incontinence after age 4 years

* Secondary encopresis is fecal incontinence after a period of
prior established fecal continence after age 4 years

186
* More common in males

* May follow psychological stress
* May be secondary to constipation or impaction
* Determine the cause
* Dietary intervention; management of constipation
* Psychotherapeutic interventions

187
* Occur with relatively high frequency

* Most are caused by an altered number of sex
chromosomes

188
* Absence of one of the X chromosomes (45,X)

* Females
* Incidence is 1 in 2500 female births
* Manifestations
* Sterile
* Short stature
* No secondary sex characteristics
* Webbed neck, shield-shaped chest, widely
spaced nipples, low posterior hairline

189
* Most common of all chromosomal abnormalities

(1 in 850 male births)
* Presence of one or more additional X
chromosomes (complement of 47,XXY is most

common)
* Occurs in males
* Rarely seen before puberty
* Adolescent virilization fails

190
* May not be diagnosed until a patient is seen for

infertility
* Azoospermia; small testes

* Defective development of secondary sex
characteristics
* Cognitive impairment of varying degrees;
behavioral problems; possibly, gross motor

difficulties

191
* Testosterone administration to enhance

masculine characteristics

192
* Primary amenorrhea
* No secondary sex characteristics and no
menarche by 14 to 15 years of age
OR
* Secondary sex characteristics are present but

menarche has not occurred by age 16 to 16
years
* No uterine bleeding after attaining SMR 5 for
1 year or after breast development for 4 years

193
* Absence of menses for 6 months or absence of

three cycles after menstruation was previously
established
* Most common cause is pregnancy (even with

primary amenorrhea)
* Other causes are eating disorders, stress, and

other causes of severe weight loss

194
* Primary dysmenorrhea
* Secondary dysmenorrhea
* NSAIDs
* Estrogen therapy
* Oral contraceptives
* Dietary changes
* Exercises; comfort measures

195
* Causes may be physical, chemical, or infectious

* Diagnosis is confirmed by vaginal examination
and microscopic evaluation of vaginal
secretions
* Health teaching

196
* Most anomalies are identified in early childhood

* Infections (e.g., urethritis)
* Hematuria
* Penile problems (phimosis, trauma, carcinoma)
* Scrotal varicocele
* Testicular torsion

197
* May occur with normal achievement of male

puberty and resolves within 1 year
* Can be caused by anabolic steroid use or

endocrine disorders
* Testosterone supplementation may aggravate

gynecomastia
* Plastic surgery?

198
* Sexual activity
* Adolescent pregnancy
* Contraception
* Sexually transmitted diseases (STDs)
* Pelvic inflammatory disease

199
* Sexual assault nurse examiners (SANEs)

* Diagnostic evaluation
* Obtain an account of the incident

* Be sensitive to the victims emotional status
* Collect physical evidence
* Vaginal secretions for evidence of sperm, blood,
DNA
* Genital culture to rule out a preexisting condition
* Testing for human immunodeficiency virus (HIV) and
other STDs initially and at appropriate intervals

200
* Acute phase of disorganization

* Long-term reorganization process
* Nightmares, fears, phobias, panic reactions
* Feelings of helplessness, powerlessness
* Victim recovery

201
* Obesity
* Anorexia nervosa
* Bulimia

202
* Defined as an increase in body weight due to
accumulation of excessive body fat relative to a

lean body mass
* Obesity is generally considered when weight is

more than the 95th percentile for age, gender,
and height
* Overweight is generally considered when weight

is more than the 90th percentile
* 25% to 30% of children are obese

203

204
* Increase in type 2 diabetes

* Risk of adult obesity
* Hypertension, hyperlipidemia, cardiovascular
disease
* Social isolation, low self-esteem, depression

205
* In 5%, the cause is underlying disease (e.g.,
hypothyroidism, other metabolic disease, central

nervous system disorders)
* Role of heredity
* Inactivity
* Patterns of eating behaviors

206
* Skinfold measurements
* Body mass index calculations
* Body fat measurements
* Diagnostic tests to rule out metabolic and
endocrine disorders

207
* Assessment, planning, implementation

* Diet, exercise, behavioral and group therapy
* Prevention, evaluation
* Medical therapies
* Pharmacologic therapies are generally not
recommended in children
* Surgical therapies are hazardous in children

208
* Eating disorder involves refusal to maintain a

normal body weight
* Primarily in adolescent and young adult females

* Mean age of onset is 13 years; ranges from
10 to 25 years of age or older
* Life-threatening disorder

209
* Etiology is unclear
* Distinct psychological component
* Diagnosis is based on psychological and
behavioral criteria
* Relentless pursuit of thinness

* Distorted body image
* Media impact
* Concept of control

210
* Severe weight loss

* Altered metabolic activity
* Amenorrhea
* Bradycardia, decreased blood pressure
* Hypothermia, cold intolerance
* Dry skin, brittle hair and nails
* Appearance of lanugo

211
* Nutrition therapy
* Intravenous and tube feedings
* Monitor cardiovascular status
* Psychotherapy
* Pharmacologic therapy
* Results have been disappointing

212
* Eating disorder characterized by binge eating

* May be followed by purging behaviors
* Laxative abuse
* Self-induced vomiting
* Diuretic abuse
* Rigorous exercise regimens
* Up to eight or more cycles per day

213
* Weight may be normal or slightly above normal

* Weight may be low (bulimorexia)
* Tooth erosion, esophageal damage, other
gastrointestinal concerns
* Psychological issues
* Self-deprecating thoughts, depressed mood

* History of unsuccessful dieting; overweight in
childhood
* Low impulse control

214
* Similar to that for anorexia

* Hospitalization to treat potassium depletion and
esophageal damage
* Cardiac monitoring is indicated

* Behavioral management

215

216
* ADHD: Inattention, impulsiveness, and

hyperactivity
* Typical onset is before age 7 years
* LD: A heterogeneous group of disorders with

difficulties in acquisition and use of listening,
speaking, reading, writing, reasoning,
mathematical, and/or social skills

217
* Quality of motor activity

* Developmentally inappropriate inattention,
impulsivity, and hyperactivity
* Wide variation of severity

* Diagnostic criteria have been developed by the
American Psychiatric Association

218
* IQ
* Handeye coordination
* Visual and auditory perception
* Comprehension
* Memory

219
* Classroom
* Family education and counseling
* Behavioral therapy and/or psychotherapy for the
child
* Environmental manipulation
* Medication

220
* Not all children benefit from pharmacologic therapy

* Stimulants
* Dextroamphetamine (Dexedrine), amphetamine and
dextroamphetamine (Adderall)
* Methylphenidate (Ritalin)
* Side effects
* Insomnia, anorexia and weight loss, hypertension
* If used over the long term, they may suppress
growth

221
* Primarily educational interventions

* Wide variation of diagnostic severity

222
* Community settings
* School nurses
* Hospital settings

223
* Defined as extreme reluctance to attend school

for a sustained period as a result of severe
anxiety or fear of school-related experiences
* Also called school refusal and school avoidance

* Treatment depends on the cause

224
* Physical symptoms
* Symptoms subside after staying at home
* No symptoms on weekends or holidays
* Nursing considerations

225
* May have psychogenic origin

* May have real pain
* Psychological aspects

226
* Temporary depression is acute depression

precipitated by a traumatic event
* Chronic depression
* May accompany chronic illness or disability
* Familial circumstances

227

228
* Drug abuse, misuse, and addiction

* Voluntary behaviors
* Culturally defined
* Use of drugs for other than an acceptable medical
purpose
* Drug tolerance and physical dependence

* Involuntary physical responses

229
* In 2002, 28.2% of high school students reported

tobacco use
* More students are using smokeless tobacco or

cigars
* Although numbers have declined in recent

years, tobacco use is considered the chief
avoidable cause of death

230
* Increasing popularity
* Serious hazards
* Carcinogenic
* Periodontal disease, tooth erosion, soft tissue
damage

231
* Third leading cause of death in teens

* Suicide
* Suicidal ideation
* Suicide attempt; parasuicide

232
* Etiology
* Methods
* Motivation
* Diagnostic evaluation and therapeutic
management

233

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All Elsevier items and derived items 2013, 2009,

Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Grasping object at 2 to 3 months

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Head lag in first 2 months

* Parachute reflex by 7 months

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Cephalocaudal direction of development

* Crawling at 6 to 7 months (usually backward)

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Reflex stage: Birth to 1 month

All Elsevier items and derived items 2013, 2009,

* Concept of object permanence

* Increased interest in image

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Crying is the first verbal communication

* Ascribe meaning to a word at 10 to 11 months

All Elsevier items and derived items 2013, 2009,

* Influences the type of interaction that occurs

* May be affected by the environment and family

* Assists in determining temperament

* Revised Infant Temperament Questionnaire

All Elsevier items and derived items 2013, 2009,

* Child-rearing practices related to temperament

All Elsevier items and derived items 2013, 2009,

* Introduce foods at intervals of 4 to 7 days to allow for identification of

* Finger foods at 9 months

All Elsevier items and derived items 2013, 2009,

* Nocturnal pattern of 9 to 11 hours by

* Total daily sleep: 15 hours

All Elsevier items and derived items 2013, 2009,

* Avoidance of early childhood caries

* Water is preferred to toothpaste until after

* Consider need for fluoride supplements

All Elsevier items and derived items 2013, 2009,

* Aspiration of foreign objects

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Failure to thrive (FTT)

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Sudden infant death syndrome (SIDS)

* Place the infant in a supine position while sleeping

All Elsevier items and derived items 2013, 2009,

* Positional plagiocephaly has increased since

All Elsevier items and derived items 2013, 2009,

All Elsevier items and derived items 2013, 2009,

* Infant experiencing an ALTE may exhibit

* The ALTE requires significant intervention