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pediatric nursing Edison O. Dangkeo,RN

pediatric nursing Edison O. Dangkeo,RN

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It is my life!
It is my life!

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Published by: Edison Olad Dangkeo, RN,RM on Oct 25, 2009
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05/26/2013

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 Pedia
COMPREHENSIVE LECTURE ON PEDIATRIC NURSING
PART 1. GROWTH AND DEVELOPMENT
GROWTH- in physical size of a structure or whole (Quantitative)
2 PARAMETERS
WEIGHT- most sensitive
Birth weight: 2X by 6 mos3x by 1 yr 4X by 2-2½ yrs
LENGTH/HEIGHT
1 inch/mo. In 1
st
6 mos
½ inch/mo. At 7-12 mos
Ave. in ht. during 1
st
yr is 50%
Approx. ½ of adult ht. at 2 yrs
DEVELOPMENT- in the skills or capacity to function (Qualitative)
How to Measure Development
by simply observing a child doing specific task
by noting parent’s description of the child’s progress
by DDST
DDST 4 Main Rated Categories
Language
Personal-Social
Fine Motor Adaptive
Gross Motor Skills
MATURATION- synonymous with development , also known as READINESS
COGNITIVE DEVELOPMENT- is the ability to learn (to change behavior) and understand from experience,to acquire and retain knowledge, to respond to a new situation and to solve problems.
Basis of Mental Retardation
IQ= mental age X 100chronological age
0-20 profound MR (infant)
20-35 severe (0-2 yo)
35-50 moderate (2-7 yo) trainable
50-70 mild (7-12 yo) educable
70-90 borderline
90-110 normal (average IQ)
130 giftedBASIC DIVISIONS OF LIFE
1
st
Stage- Prenatal (from conception to birth)
2
nd
Stage- Infancy
Neonatal: 1
st
28 days of life
Formal Infancy: 29
th
day to 1 yr 
3
rd
Stage- Early Childhood
Toddler: 1-3 yrs
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Preschool: 4-6 yrs
4
th
Stage- Middle Childhood
School age: 7-12 yrs
5
th
Stage- Late Childhood
Preadolescent: 11-13 yrs
Adolescent: 12-18 yrs (or 21)PRINCIPLES OF GROWTH AND DEVELOPMENT1.Growth and development is a continuous process (from womb to tomb)2.Not all parts of the body grow at the same time or at the same rate (Principle of Asynchronism)PATTERNS OF GROWTH AND DEVELOPMENT
Renal, GIT, Musculoskeletal, CVS- fairly, smoothly during childhood
CNS- rapidly at 1-2 yrs
Immune System- rapidly during infancy and childhood
tonsils: of adult proportion by 5 yrs
Reproductive System- rapidly during pubertyRATES OF GROWTH AND DEVELOPMENT
Fetal and Infancy- most rapid
Toddler- slow
Preschool- alternating rapid and slow
School age- slower 
Adolescent- rapid1.Each child is unique
2 Primary Factors
Heredity (Non-modifiable) or “Nature”
R
ace
I
ntelligence
S
ex
N
ationality
Environment (Modifiable) or “Nurture”
Q
uality of Nutrition
S
ocioeconomic status
H
ealth
O
rdinal position in the family
P
arent-child relationship4.Growth and Development occurs in a regular direction reflecting a definite and predictable patterns or trendsDIRECTIONAL TRENDS- occurs in a regular direction reflecting the development of neuromuscular functions:these apply to physical, mental, social and emotional developments
Cephalo – caudal:
“ head to tail”. It occurs along body’s long axis in which control over head, mouth andeye movements and preceeds control over upper body torso and legs.
Proximo–distal:
from center of the body to extremitiese.g. baby uses whole arm in crawling then hand pincers
Symmetrical:
each side of the body develop on the same direction at same time and rate
Mass-Specific (Differentiation):
the child learns from simple operations before complex functions or movefrom a broad general pattern of behavior to a more refined pattern. E.g. Crying infant suggests wet diaper,hunger, thirst or pain until can use words for milk etc.
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SEQUENTIAL TRENDS- involves a predictable sequence of growth and development to which the child normallypassesa. locomotionb. language and social skillsSECULAR TRENDS-refers to the worldwide trend of maturing earlier and growing larger as compared tosucceeding generations5. BEHAVIOR is the most comprehensive indicator of developmental status.6. PLAY is the universal language of the child.7. A great deal of skill and behavior is learned by PRACTICE.8. There is an optimum time for initiation of experience or learning.9. Neonatal reflexes must be lost first before development can proceed.e.g. Spitting/extrusion reflex must be overcome before infant can be fed with solid foodsREFLEXES- different involuntary reactions to specific forms of stimulation
Importance:
For neonate’s survivale.g. feeding reflexes: rooting, sucking, swallowingprotective reflexes: blink, gag, cough, Moro
Reflects how well CNS is functioning
Forms the basis for later, more sophisticated behavior 
A. Blink
- rapid eyelid closure when strong light is shown, To protect the eyes, Disappears at death
B. Palmar Grasp
- when a solid object is placed in the palm, the baby will grasp the object
To cling to the mother for safety
Beginning ability to hold then release objects
Disappears at 6 wks to 3-4mos
C. Step-in/Walk-in Place–
neonate placed on a vertical position with their feet touching a hard surface will takefew quick, alternating steps, Present at birth, Disappears at 1 mo*
Placing
 – almost the same with step in place reflex only that you are touching the anterior surfaceof a newborn’s leg
Normal: flex hip and knee, place stimulated foot on top of the table
Abnormal: no response; consider paralysis if born breech
Disappears at 6 wks
D. Plantar grasp
 – when an object touches the sole of a newborn’s foot at the base of the toes, the toes grasp inthe same manner as the fingers do
Disappears at 8-9 mos in preparation for walking
E. Tonic-neck/ Boxer/ Fencing-
when newborn lie on their backs, the head turn to one side. The arm and theleg on the side to which the head turns extend, and the opposite arm and leg contract.
Disappears within 3-4 mos
F. Moro/ Startle-
test for neurological integrity
upon exposure to loud voice or jarring the crib, the baby will assume “letter C” position: throws arms forwardand draws legs up
Abnormal- assymetrical response
To protect the baby from attacker 
Present at 36 wks AOG
Disappears at 4-5 mos when baby can roll over 
G. Magnet
 – when there is pressure at the sole of the foot, the baby pushes back against the pressure
H. Crossed extension-
test for spinal nerve integrity; when sole of foot is stimulated by sharp object, that footflexes and the other foot extends
I. Trunk incurvation/ Galant
- while in prone, when the paravertical area is stimulated, the trunk flexes and thepelvis swings towards the touch
J. Landau-
test for muscle tone; while in prone, with the examiner’s hands supporting the baby’s trunk, the babyexhibits some muscle tone
Abnormal: collapse of the baby in limp, concave position
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