Peds Unit 1 Growth-Develop

olanjones's version from 2017-02-02 04:54

Professional Role & Ethics

Question Answer
HIPAA-health infocannot be released w/o pt’s consent (exceptions: tx team, duty to warn, protect third parties)
Privacy 3 instances you can violate HIPPA: self-harm, harm to others, child maltx
Consentunder informed consent, explain dx, describe tx, outcome, benefits, risks, alternative tx’s, answers to questions, inform parent right of refusal
Assentvol agreement to accept tx & to participate in a research project. Child Needs basic u/s of what will be done and what is req for participation, allowed right of refusal. Parents make final decision. Child dissent should be respected in research (not necessarily in tx)
Emancipated minorseconomically self-supporting
Mature minor (14-18 yrs, able to understand tx risks) can get BC, preg tx, and STI tx; mental health/substance abuse; donate blood, w/out parental consent
Negligencefailure to exercise the standard of care that a reasonably prudent person would exercise in a similar situation
Malpracticeact or an omission to act that breaches the duty of care & results in or is responsible for a person’s injuries. Elements to prove Malpractice: Duty, Breach of duty, Injury to client, Proximate cause (injury was directly caused by breach)
Futilitya situation in which treatments do not provide a clear clinical benefit. Physicians are not obligated to offer interventions that cause extreme pain and suffering when there is no or limited potential benefit
Role of RNcomprehensive assmt, teaching, discharge, admission
Role of LPNfocused assmt, daily care,
Focus of careis the family; many definitions of family
Nursing researchresearch that directs care
EBP examples ofdistraction techniques, withdrawal scores
Quality Improvementuse research/metrics to improve practice

Aspects of Care

Question Answer
Family centered carephilosophy in hc, mutually benedfical partnership dev between fam, nurse and other providers
Concepts of family centered care-Model and encourage open, supporting communication with child and family
-Identify health issues through active listening and “fact finding”
-Affirm strengths of child and family
-Identify shared goals
-Develop joint plan of action based on stated goals
-Follow up to sustain the partnership
-The family is the expert on the child!
Professional Communicationaspects of handoff, conflict resolution, customer service.
Handoff safety considerationsYou should have the opportunity to ask questions, safety checks – wt. based med sheet, resuscitation equipment, check IV site
Conflict Resolutionstart at lowest level, move up
Customer Servicepatient centered care
Shared Governancenurses make decisions w/ unit-based councils, advise providers on care since RN is with patient more.
Professional Boundariestough in peds, Parents may initiate contact after d/c but nurses should not
Therapeutic relationshipsbenefit should be focused on family
Social Mediadon’t do it. Don’t friend patients
Giftsfor unit = ok, for nurse not ok and vice-versa

Growth & Development Concepts

Question Answer
Cephalocaudaldevelopment occurs head->foot, head of infant is larger proportionally to body Lift head first->sit up->crawl->walk
Proximodistallydevelopment proceeds from center of body -->extremities. Control trunk->arms->fine motor
Physical and cognitive skills differentiate the general to the specificGrowth pattern by developmental stage. Ex. rake->pincer, crawl->walk. Sensorial->concrete thought.
Birth weightsome genetic component but largely a measure of maternal nutrition
Weight at 6 monthsDouble the birth weight
Weight at 1 yearTriple the birth weight
Weight greater than one year – influencesGenetic and/or environmental influence, Illness / Health
BMIGreater than 95 percentile obese, 85-94 percentile overweight, Less than 5percentile underweight
Length/HeightAverage @ birth = 20 inches
Rate of growth (height)-1st yr = 10 in
-2nd yrs = 5 in (@2 yrs approx. ½ adult height)
-3+ yrs = 2.5 in per year until puberty (birth length doubles by age 4)
Head circumferenceAssess in child < 3 yrs
Birth = HC > chest
6-24 months = HC = chest
>24 months = HC < chest
Further work up needed ifBMI >85%, Length is < / = 5% (stunting shortness), “falling off growth chart”; notify PCP / Nutritionist, discuss RF

Developm'l Milestones

Question Answer
1 moLift head, Track with eyes, Coo, Recognize parent
3 moSocial smile, Turns toward noise, Notices own hands, Babbles
6 moSitting up, Raking grasp, Babbles, Stranger anxiety
9 moWalk w/ assistance, 3 finger grasp, Might say mama/dada, Waves bye-bye, Plays Pat-a-cake
12 moWalks (gross motor), 2 finger pincer grasp (fine motor), Says mama/dada, Imitates parent (social/cognitive)
18 moUsually time for well child visit screening for developmental delay & autism
24 mo2 steps(climbs stairs), 2 word phrases, 2 step commands, Will stack 6 blocks
36 moRides tricycle, 3 word sentences, Brushes teeth, Draws a circle
48 moHops, Can copy a cross, Plays with others

G&D Infant (0-12 months)

Question Answer
Developm’l Milestones2 mo: Posterior fontanel closes; 4 mo: stomach to back; 5-6 mo: back to stomach, 9 mo: “Object permanence”
Language3 mo babble, 4 mo laughs, 6 mo: babbles in response to sounds/cont. babble, 10 mo mamma dada, 12 mo: says 5 words; understands more
0-12 months reflexesRooting, Palmer/Plantar grasp, Moro, Stepping, Tonic neck (fencing), Babinski (this one should disappear by age 2, if not may signal developmental prob)
NutritionExclusive breastfeeding for 4-6 months then add infant food until age 1 (AAP)
Breastfeed newborns q 2-3 hrs (8-12x in 24hrs)
Formula feed: newborns 2-3oz/feeding (20oz x 24hr); 4 mo 30 oz x 24 hr; >6 mo 24-32 oz x 24+solids
SafetyCribs- slats <2&3/8 in, side up, no loose bedding, Do not shake baby, SIDS (rebreathing air-no couch), Water temp @ 120 , No smoking, Rear facing car seat (20lbs + 1 yr)
ScreeningGo to PCP if not producing wet diapers, stool, has temp, is inconsolable, won’t wake/very fatigued
Anticipatory GuidanceWatch for hunger cues, NO BOTTLE PROPPING. Feeding success = wet diapers + weight gain
Erikson/PiagetTrust v Mistrust / Sensorimotor

G&D Toddler

Question Answer
Developm’l Milestones12-18 months: anterior fontanel closes
12-16 months: walks
18-24 months: interesting in toilet training
21 months: climbs stairs
24 months: runs/jumps, bladder reaches adult functioning
Language10 months = 5 words, 18 months = 50 words, 24 months = 400 words & 2-3 word phrases, Says own name
PlayLacks concept of sharing, “side by side” play, learns through interaction w/ environm’t , is repetitive/imitative
NutritionGetting teeth, know when they are hungry, need sleep/rest
SafetyMove furniture away from windows, Limit screen time, Supervise all play
Toilet trainingDry for 2 hrs, Knows when wet, Praise attempt to use potty
Anticipatory GuidanceEgocentric, Separation anxiety / temper tantrums, Recognizes self in mirror
Erikson/PiagetAutonomy v Shame / Sensorimotor

G&D Pre-schooler (3-5 yrs)

Question Answer
Developm’l MilestonesDresses self, Throws ball overhead, Jumps/skips/hops
Language11,000 words, recognizes letters, counts; word/sentence similar to age (3-4 words @ 3 years old)
Playlearns through role playing, has imaginary mates, uses imaginative/dramatic play
Nutrition3 meals 2 snacks, Food jags, Avoid battles over food
Safetywater/drowning risk, helmets, firearms, automobile
Screeningvision (LEA symbols/Allen figures), Lead, TB
Anticipatory GuidanceTeach safety around adults (no secrets, no interest/asking for help w/ private parts
Erikson/PiagetInitiative vs Guilt / Preoperational

G&D School-Aged Child (6-12 yrs)

Question Answer
Developm’l MilestonesMakes 1st true friends, Sense of morality
Female: age 10 breast dev, age 11 pubic hair, age 12 menarch (long bones seal)
Male: age 11 testicular enlargement, age 12 pubic hair, age 13-14 height spurt
LanguageSense of time/place, cause/effect, consequences, possibly using different verb tense, etc
PlayCan cooperate/compromise, Enjoys games with strategy
Nutrition 3 meals, 2 snacks, help w/ shopping, use MyPlate
Safetylimber/prone to bone fx, enter water feet first, life vests, role modeling, firearms
Screeningvision matures by age 6 - eye exams essential prior to this age
Anticipatory GuidanceMonitor computer access, Limit screen time, Know friends, Prevent access to liquor/meds, Suicide (impulsive), Sex
Erikson/PiagetIndustry v Inferiority / Concrete operational

G&D Adolescent

Question Answer
Developm’l MilestonesAble to perform abstract thinking, Peer group very important
PlayFootball not recommend
NutritionWatch BMI, eating disorders
Safetyimpulsive behavior leading to injury, STIs, pregnancy
ScreeningImportant to give option to speak w/out parent present
Anticipatory GuidanceSafe driving practices, sexuality is developing
Erikson/PiagetIdentity v Role Confusion / Formal operational

Piaget & Erikson Developmental Stages

Question Answer
Piaget - birth to 2 yrsSensorimotor: learn about the world by sensory input/motor activity
Piaget - 2-7 yrsPreoperational: thinks by using words as symbols, but logic not well developed
Piaget - 7-11 yrsConcrete operational: child can reason quite well is concrete objects are used in teaching/experimentation
Piaget - 11-end of lifeFormal operational: fully mature intellectual thought is now attained
Erikson - birth to 1 yrTrust vs Mistrust: if basic needs not met, infant will eventually learn to mistrust others
Erikson - 1-3 yrsAutonomy vs Shame: children who are criticized for autonomy (or lack of control) will feel shame (or doubt their abilities)
Erikson - 3-6 yrsInitiative vs Guilt: constant criticism for initiating activities will lead to feelings of guilt and lack of purpose
Erikson - 6-12 yrsIndustry vs Inferiority: a child takes pride in accomplishments, if they cannot accomplish what is expected they will feel inferior
Erikson - 12-18 yrsIdentity vs Role Confusion: an adolescent who cannot est. meaningful definition of self will experience confusion in one or more roles in life
Erikson - 19-40 yrsIntimacy vs Isolation: success in love leads to strong relationships, failure results in loneliness and isolation
Erikson - 40-65 yrsGenerativity vs Stagnation: success results in a sense of having contributed to the world, failure results in a feeling of being unproductive and uninvolved in the world
Erikson - 65-end of lifeEgo Integrity vs Despair: success results in a general sense of satisfaction and wisdom, failure results in regrets, bitterness, despair, and a feeling that life has been wasted

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