The Family With A Toddler

NCM 107- PEDIA LECTURE- MIDTERM
Week 7 - THE FAMILY WITH A TODDLER
LEARNING OBJECTIVES:
After the lecture, the students will be able to:
1. Describe the normal growth and development of the family with a toddler.
2. Discuss the normal growth and development of the family with Pre-schooler and the family with a
School-age child.
3. Explain the normal growth and development of the family with an adolescent using the nursing
process.
4 and 5. Discuss the health promotion and disease prevention in the different stages of growth and
development.
Week 7: The FAMILY WITH A TODDLER – 1-3 Years Old
Nursing Process Overview
FOR HEALTHY DEVELOPMENT OF A TODDLER
ASSESSMENT
Assessment is done with careful history taking and asking parents about a toddler’s ability to carry out
activities of daily assessment offers information not only on the child’s daily progress but also parent-
child relationship.
Nursing Diagnosis:
Focus more on parent’s eagerness to learn more about the normal growth and development or issues of
safety. Examples:
1. Health seeking behaviors related to normal growth toddler development.
2. Deficient knowledge related to the best method of toilet training.
3. Risk for injury related to impulsiveness of the toddler.
4. Interrupted family process related to the need for close supervision of a two-year-old.
5. Readiness for enhanced family coping related to the parent’s ability to adjust to the new needs of the
child.
Outcome Identification & Planning:
 To help parents resolve a concern during the toddler period, focus largely on family education
and anticipatory guidance.
 Urge them to establish realistic goals and outcomes so they can meet the rapidly changing
needs of the toddler.
Implementation:
 Teach parents that a good rule is to think of a toddler like a visitor like a visitor from a foreign
land who wants to participate in everything the family is doing but doesn’t know the custom or
language.
 Health visits provide opportunities to help parents learn healthier coping techniques.
Outcome Evaluation
Must be done frequently during the toddler period because children change and learn so many new
skills during the time. Examples:
 Parents state the child maintains a consistent bedtime routine within the next 2 weeks.
 Parents state that they have childproofed their home by putting a lock on kitchen cupboards by
the next clinic visit.
Nursing Assessment of Growth & Development
Physical growth
 Physical growth actually begins to slow.
Weight, Height & Head circumference
 Gains only 5 to 6 lb (2.5kg) & 5 inches 12cm) a year during toddler period.
 Subcutaneous tissue or fat begins to disappear toward the end of second year from plump to
leaner.
 Appetite decreases
 Head circumference equals chest circumference at 6 mo. to 1 year of age.
 2 years, chest circumference increases only about 2 cm during the second year.
Body Contour
 Toddlers –prominent abdomen- pouchy belly.
 Lordosis- forward curve of the spine at the sacral area.
Body System
 Continue to mature, RR slow slightly but continue to be mainly abdominal.
 HR slows from 110 to 90 bpm, BP- increases to about 99/64 mm Hg.
 Stomach capacity-eat 3 meals/day.
 Control of urinary & anal sphincters becomes possible w/ complete myelination of the spinal
cord.
 IgG & IgM production becomes mature at 2 years. No more passive immunity.
Teeth
 8 new teeth canines & the first molars) erupt during the 2 nd year.
 20 deciduous teeth are present by 2.5 to 3 years of age.
Developmental Milestone
 Less numerous but no less dramatic than infant because of the period of slow & steady, not
sudden growth.
Language Development
 Toddlerhood is a critical time for language development, although this varies among children
because to master language, children need to practice talking.
 A 2-year-old child & does not talk in two-word, noun-verb simple sentences needs careful
assessment to determine the cause because it implies underdevelopment- Autism
 Autonomy- frequently use “no,”-may use the word to mean they are refusing the task but do
not understand it.
 Need exposure to conversation, always answering the child’s question, simple & brief.
 Imitate what they hear.
Emotional Development
 Developmental task- According to Erickson -Autonomy vs. Shame or Doubt
 To develop a sense of autonomy is to develop a sense of independence, achieved when parents

are able to balance independence with consistently sound rules for safety.
Socialization
 15 months - enthusiastic about interacting with people, provided those people are willing to
follow the toddlers where they go.
 18 months - imitate the things they see a parent doing
 2 or more years, children become aware of gender differences, identify them as boy or girl
Play Behavior -Play beside the children next to them, not with them. Side by side play is called parallel
play, is not unfriendly.
 Toys they enjoy most are those they can play with by themselves & require action. Example:
trucks, squeaky frogs, rocking horses, pegs, toy telephones.
 15 months- Put in, take out stage, continue to enjoy stacks of boxes, throwing toys out of a play
pen, pick them as long as someone will pick them & return.
 18 months- walks securely enough to enjoy pulling toys.
 2 years begin to spend time imitating adult actions.; wrapping a doll, setting a table
Cognitive Development- Piaget
 Enters the 5th & 6th stages of sensorimotor thought referred to stage 6 (between 12 & 18 mo.) as
a tertiary circular reaction stage,
 Describing the toddler as a little scientist because of the child’s interest in trying to discover new
ways to handle objects.
 Stage 6 between 18 to 24 mo.) able to try various actions mentally rather than having to actually
perform them - beginning of problem solving or symbolic thought.
 Deferred imitation- able to remember an action & imitate it later.
 Pre-logical reasoning-faulty reasoning that can lead them to wrong conclusion & faulty
judgment.
 End of the toddler period, enter a second major period of cognitive development-
preoperational thought-& begin to use a process termed assimilation – because they are not
able to change their thoughts to fit the situation, they learn to change the situation, (or how
they perceive it).
Freud’s Psycho-Analytic Theory
Toddler
 Anal phase because their main focus is on the anal region.
 Elimination takes on new importance- find pleasure in both retention of feces & defecation as
part of self-discovery, a way of exerting independence. – toilet training.
Erickson Theory of Psychosocial Development -Toddler
 Developmental task- autonomy vs. shame or doubt. Self-government or independence) builds

on children’s new motor & mental abilities.
 Take pride on new accomplishments& wants to do everything independently; if parents
recognized that toddlers need to do what they are capable of doing, children will develop a
sense of being able to control their muscles, & impulse.
Kohlberg’s Theory of Moral Development -Toddler
 Begin to formulate a sense of right or wrong, but their reason for doing right is centered most
strongly in mother’s or father’s says so, rather than any spiritual or societal motivation.
 Referred as a punishment obedience orientation (the child is good because a parent says the
child must, & not because it is right to be good.
Piaget’s Cognitive Development- TODDLER
 Is the transition as children complete the final stages of sensorimotor period as tertiary circular
reaction & invention of new means) & begin to develop some cognitive skills of the preoperative
period, such as symbolic thought & egocentric thinking.
 In the tertiary circular reaction schema, children use trial & error to discover new characteristics
of objects & events.
 Period of preoperational thought, children learn on a conceptual level some of the lessons they
mastered as infants as the sensorimotor level, before having language.
 Now children are able to use symbols to represent objects but can’t view one object as
necessarily being different from another.
Week 8- THE FAMILY WITH A PRE-SCHOOLER -3-5 years old & SCHOOL-AGE- 6-12- Years OLD
Growth & Development –include physical, cognitive & Developmental
Physical Growth – slimmer, taller, - ectomorphic- (slim body build) or endomorphic (large body build)
 A major step forward is the child’s ability to learn extended language, which is affected not only
by motor but also by cognitive development. Able to master 2 languages with relative ease
because of increased cognitive ability.
 Lymphatic tissue begins to increase in size, particularly the tonsils & increases levels of IgG & IgA
antibodies, making them to have more localized illnesses.
 Physiologic splitting of heart sounds may be present for first time auscultation; heart murmurs
may also be heard for the first time- owing to changing size of the heart in reference to the
thorax.
 Pulse rate decreases to 85 bpm; BP about 100/60 mm Hg.
 Bladder easily palpable above symphysis pubis; voids 9 to 10x a day, accidents may occur if child
becomes absorbed in an activity.
 Muscles are noticeably stronger & make activities –gymnastics possible.
 Beginning of the period exhibit genu valgus (knock-knees); disappears with increased skeletal
growths at the end of the preschool period.
Weight., Height, & Head Circumference
 Weight is slight, average child gains only 4.5 lb (2 kg) a year. Appetite same as toddler years.
 Height gain minimal; only 2 to 3.5 inches (6 to 8 cm a year on averaged. Not routinely measured
on children over 2 years.
Teeth
 has 20 deciduous teeth by 3 years; rarely new teeth erupt during.
Developmental Milestones
 3- year –old has a vocabulary of 900 words. Constantly ask questions: how, & why. Need simple
answers to such questions so curiosity, vocabulary building & questioning are encouraged,
-depth of child’s understanding is deceptive.
 4-5 years old children continue to ask questions. Enjoy participating in mealtime conversation.
Imitate language exactly. Egocentric.
Play
 Do not need many toys. Their imaginations are keener – enjoy games that use imitation, such as
playing house; imitate what parents do; have imaginary friends, exist until they formally begin
school.
 4 to 5 –year- old divide their time between rough-housing & imitative
Developmental Tasks: Initiative vs. Guilt
 A well- developed sense of initiative has discovered that learning new things is fun.
 If criticized or punished for attempts at initiative, develop sense of guilt for wanting to try new
activities or experiences.
 Urge parents to provide play materials that encourage creative play, such as finger paints, soapy
water to splash or blow into bubbles, mud to make pies.
 Active imaginations that they need little guidance, smear both hands into clay or finger paint &
create instinctively.
Imitation
 Need free rein to imitate the roles of the people around them.
Fantasy
 Preschoolers become so intense about fantasy role, - part of “magical thinking”.
Oedipus & Electra Complexes
 Oedipus complex refers to the strong emotional attachment of a preschool boy to his mother.
 Electra complex is the attachment of a preschool girl to her father. Each child competes with the
same-sex parent for the love & attention of the other parent
Gender Roles
 Need exposure to an adult of the opposite gender so they can become familiar with opposite
gender roles.
Socialization
 Bec. 3- year-olds are capable of sharing, they play with other children their age much more
agreeable than do toddlers., which is why the preschool period is sensitive & critical time for
socialization.
 4 –year- old continue to enjoy play groups, they become involved in arguments more than they
did at age 3, esp. As they become certain of their role in the group.
 5-year-old begin to develop “best” friendships, on the basis of who they walk to school.
Cognitive Development
 At 3 years, cognitive development is still preoperational, they enter a second phase called
intuitional thought, they lack the insight to view themselves as others see them or put
themselves in another’s place, they feel they are always right. Argue that comes from believing
that they are 100% correct.
 Are not aware of the property of conservation- means that if they have 2 balls of clay w/ equal
size, but 1 is squashed flatter & wider than the other, will insist that the flatter one is bigger
( because it is wider).
Moral & Spiritual Development
 They determine right from wrong based on their parents’ rules. Little understanding of the
rationale for these rules. Ex. Why is it wrong for you to steal at neighbor’s house? Bec. Mother
says so.
 Preschoolers begin to have elemental concept of God if they have been provided some form of
religious training. Belief in an outside force aids in the development of conscience (Kohlberg),
tend to do good out of self- interest, rather than strong spiritual motivation.
Freud’s Psychoanalytic Theory- Preschooler
 Children’s pleasure zone appears to shift from anal to the genital area called phallic phase.
 Masturbation is common during this phase –show exhibitionism,
Erickson’s Psychosocial Theory- Preschooler
 Period as learning initiative vs. guilt.
 Learning how to do things. When given much freedom & opportunity to initiate motor play such
as running, biking, sliding, their sense of initiative is reinforced.
 Encouraged when parents answer the child’s questions (intellectual initiative) & do not inhibit
fantasy or play activity, if made to feel their motor activity is bad, questions are nuisance-
develop a sense of guilt.
Kohlberg’s Theory of Moral Development -Preschooler
 Do good out of self-interest rather than out of true intent to do good or because of a strong
spiritual motivation.
Piaget’s Cognitive Development -Preschooler
 Intuitive thought- children tend to look at an object & see only one of its characteristics referred
to as centering.
 Ex. They see that banana is yellow but do not notice that it is also long.
 Centering contributes to the preschooler’s lack of conservation( the ability to discern truth, even
though physical properties change)or reversibility.(ability to retrace steps).
 Preschool thinking is also influenced by role fantasy, or how children would like something to
turn out.
 They use assimilation (taking in information & changing it to fit their existing ideas).
 Perceive animals & even inanimate objects as capable of thought & feeling, saying that the dog
took the doll because the dog was feeling sad called magical thinking.
 Children learn accommodation-they change their ideas to fit reality, rather than the reverse).
 Egocentrism or perceiving that one’s thoughts & needs are better or more important than those
of others.
THE FAMILY WITH A SCHOOL-AGE - 6-12 years old
Healthy Development of the School-Age Child
Assessment
 Use both history & physical examination to assess growth & development of the school-age
child.
 During physical examination, show respect for the child’s adult-level modesty by having him use
a cover gown.
Nursing Diagnosis
 Health-seeking behaviors related to normal school –age growth & development
Outcome Identification & Planning
 keep in mind the school age child’s tendency to enjoy small or short -term projects rather than
long involved ones.
Implementation
 Interested in learning about adult roles, watch you to see your attitude as well as actions in a
given situation.
Outcome evaluation
 Parents states he will allow child to make own decisions about how to spend allowance.
Nursing Assessment of Growth & Development of the School –Age Child
Physical Growth
 Grow slowly but steadily. Annual average weight gain is 3 to 5 lb. (1.3 to 2.2 kg; the increase in
height is 1 to 2 inches (2.5 to 5 cm). Loose their lordosis & knock-kneed appearance. Posture
becomes erect.
 10 years, brain growth is complete, fine motor coordination becomes refined.
 The appendix is lined with lymphatic tissue & swelling of this tissue in the narrow tube can lead
to trapped fecal material & inflammation(appendicitis) in the early school-age.
 Left ventricle of the heart enlarges to become strong enough to pump blood to the growing
body.
 Pulse rate decreases to 70 to 80 bpm; BP-112/60
Sexual Maturation
 The hypothalamus transmits an enzyme to the anterior pituitary gland to begin production of
gonadotropic hormones, which activates changes in testes & ovaries & produce puberty.
 Timing of onset of puberty changes varies widely between 8-14 years of age.
 Sexual maturation in girls occurs between 12 & 18 years; in boys between 14 & 20.
 Puberty is occurring increasingly earlier.
 Sex education must be introduced as part of the school curriculum.

Sexual & Physical Concern
 Changes in physical appearance lead to problems & worries for both children & parents.
 School age is a time for parents to discuss with children the physical changes & the sexual
responsibility they require.
 In both sexes, puberty brings changes in the sebaceous glands.
 Under the influence of androgen, glands become more active, setting stage for acne.
Concerns of Girls.
 Prepubertal girls are usually taller, about 2 inches(5cm) or more, than preadolescent boys
because their typical growth spurt begins earlier.
 Girls notices a change in her pelvic contour.
 Conscious of breast development.
 Early preparation for menstruation is important preparation for future childbearing & for the
girl’s concept of herself as a woman.
 Need to know that vaginal secretions will appear.
Concern for Boys
 Boys who are not prepared for physical changes of puberty worry about them in the same way
girls do.
 Aware of increasing genital size. Tend to measure their manliness by penis size.
 Hypertrophy of breast tissue(gynecomastia) can occur in puberty, will fade as soon as his male
hormones become more mature & active.
 Concerned because although they have pubic hair, they can’t yet grow a beard or do not have
chest hair- outward, easily recognized signs of maturity.
 Nocturnal emissions -As seminal fluid is produced, boys begin to notice ejaculation during sleep.
Teeth
 Deciduous teeth are lost, and permanent teeth erupt during school- age. 6-12 years old 28
teeth, central & lateral incisors; first, second, & third cuspids; & first and second molars.
Developmental Milestones
Gross Motor Development
 At the beginning of school age period (6 years, children endlessly jump, tumble, skip, & hop.
Enough coordination to walk a straight line. Ride a bicycle, skip rope w/ practice.
 7- year-old appears quiet compared w/ a rough-&- tumble 6- year-old.
 7-year-old have accuracy in jumping to play hopscotch & to skip rope well.
 Gender differences begin to manifest in play- girls name- dressing dolls, boys names- pretend to
be pirates.
 8 –year-olds are more graceful than younger children, though their arms & legs grow, may
stumble on furniture
 Enjoy sports such as gymnastics, soccer, & hockey.
 9- year- old- on the go constantly, as they have a deadline to meet. Enough eye-hand
coordination to enjoy baseball, basketball, & volleyball.
 10 years old- interested in perfecting their athlete skills than previously.
 11-year-old- feel awkward because of their growth spurt & do less sports.
 12-year-old- plunge into activities w/ intensity & concentration. Enjoy participating in sports
events for charities, cooperative around the house, handle a great deal of responsibility &
complete tasks.
Fine Motor Development
 6-year-old easily tie they shoelaces. Cut & paste well & draw a person w/ good detail, can print
although reverse letters.
 7-year-old concentrate on fine motor skills more than previously- called eraser year because
children are never quite content w/ what they have done. Set too high standad for themselves &
then have difficulty performing at that level.
 8 –years-old eyes were developed enough so they can read regular –size type- makes reading a
greater pleasure & school more enjoyable.
 8-year-olds learn to read & write script rather than print. Enjoy showing off this new skill in
cards, letters, & projects.
 9-year-old begin to evaluate their teacher’s ability & can perform at varying levels, depending on
each teacher’s expectations. Curriculum involve science & mathematics & good in literature- a
child’s first exposure to reading.
Play
 Continues to be rough; discover reading as an enjoyable activity that opens doors to other
worlds, spend quiet time w/ books, playing increasingly video games.
 7 years old require more props for play than when younger. Develop interest in collecting
baseball cards, dolls, rocks or marbles.
 8-year-olds- table games but hate to lose, so avoid competitive games. Change the rules in the
middle of the game to keep from losing.
 8-9 years enter a phase of reading comic book, read quickly so they complement sense of
industry, the developmental task of the school age- if forbid to read comic book, tend to cover
under covers at night or other children’s house. Play hard.
 9-year-old- begin to play music lessons.
 10- year—old - spend most of their time playing handheld or television remote control games.
Talent for music & art.
 Interest in opposite sex is apparent. Boys show off as girls pass their group, girls talk loudly or
giggle at the sight of familiar boy. More interest in the way they look and dress.
 Feel old enough for stockings & lipstick. Slumber parties & campouts increasingly popular, talk,
giggle & roughhouse in the middle of the night.
 10th year- interested in rules & fairness. Club activities become structured, w/ a Pres. Sec, &
rules to order.
 11-12 year- old children enjoy dancing to popular music & playing table games & are
accommodating.
 Time w/ friends spent just talking. Older school-age use their bedroom as a place to meet new
friends.
 12- year -old- like jobs such as raking leaves or baby- sitting for money.
 Both boys & girls anxiously wait to turn 13 & become a teenager.
 6 -year- old- talk in full sentences, using language easily & w/ meaning. Define objects by their
use.
 7- year -old- can tell time in hours, but have trouble w/ concepts such as half past. Know the
months of the year, name months in which holidays fall; can add & subtract & make simple
change, go to the store & make simple purchases.
 9 years old- discover dirty jokes, the like to tell them to friends or try to understand those told
by adults. Use swear words to express anger, short period of intense fascination w/ bathroom
language. As they did in preschooler
 12 years old- a sense of humor. Can carry an adult conversation.
 Enter the school-age period w/ the ability to trust & w/ a sense of respect for their own worth.
Accomplish small task independently because they want to be independent t(sense of
autonomy)
 Mimicked adult roles & opportunity to explore at preschooler or other social environment.
Learned to share, discovered that learning is fun, doing things is more important & more
rewarding than watching things done (a sense of initiative).
Developmental Tasks: Industry vs. Inferiority
Sense of industry- learning how to do things well.
 If children are prevented from achieving a sense of industry or don’t receive rewards for
accomplishment’s they can develop a feeling of inferiority.
 Best type of books for school age children has many short chapters for children; feel a sense of
accomplishment when they finish each chapter. Small chores that can be completed quickly –
reward.
 Hobbies & projects are enjoyed best if they are small & be finished in a short time.
 Home as a Setting to Learn Industry
 8-9 -year- old begin to spend more time w. their peers & less time w/ their family.
 Forget to do household chores they once enjoyed such as setting the table or cleaning the
garage.
School as a Setting to Learn Industry
 Adjusting to & achieving in school are the 2 of the major tasks for this age group.
 Schools are increasingly assuming responsibility for education about sex, safety, avoidance of
substance abuse, & preparation of family living.
 Structured activities
 Boy scouts, girl scouts, campfire & 4Hclubs are respected school-age activities.
 10 years old- ego strength.
 Problems to consider w/ organized sports- possibility of athletic injuries.
Problem solving
 Important part to develop a sense of industry is learning how to solve problems.
 Parents & teachers can help children develop these skills by encouraging parents to practice.
Learning to Live w/ Others
 A good time to urge children to learn compassion & thoughtfulness toward others is during the
early school years, when children are first exposed to large groups of other youngsters.
 Writing thank you letters –help children develop empathy toward others.
 Learning to give a present w/out receiving one in return or doing a favor w/out expecting
a reward.
 Show empathy as early as 20 months
Socialization
 6- year- old play in groups but when tired or under stress prefer to be one-to-one contract.
 7- year-old- increasingly aware of family roles & responsibilities. Promises must be kept because
they view it as definite, firm commitment
 8 -year- old- actively seek the company of other children. Most have close girlfriends; boys have
close boyfriends.
 9 -year- old- take the values of their peer group very seriously. Dress in what their parents say is
proper. The gang age because children form clubs, spite clubs- 3 form a club, 4 th excluded. Ready
for activities away from home- week at camp.
 10- year -old- enjoy groups, also enjoy privacy. Like to have their own bedroom or dresser.
 Girls increasingly interested w/ boys vice versa by 11 years old.
 12- years- old- feel more comfortable in social situations than the year before.
 Boys experience erections on small provocation.
 5 to 7 years of age is a transitional stage when children undergo a shift from preoperational
thought they used as preschoolers to concrete operational thought.
 Decentering- the ability to project the self into other people’s situations & see the world from
viewpoint rather than focusing only on their own view.
 Accommodation- the ability to adapt thought processes to fit what is perceived Conservation-
the ability to appreciate that a change in shape does not necessarily mean a change in size.
 Class inclusion-the ability to understand that objects can belong to more than one classification.
The preschooler can categories items in only one way.
 Decentering enables the school-age child to feel compassion for others.
 Class inclusion is also necessary for learning mathematics & reading, systems that categorize
numbers & words.
 Begins to mature as they enter a stage of preconventional reasoning, sometimes as early as 5

years of age.
 If asked “why is it wrong to steal from your
 neighbor”, they answer the police say so, if you do, you’ll go to jail. They concentrate on
“niceness or fairness & can’t see yet that stealing hurts their neighbor, the highest level of moral
reasoning.
 Begin to learn about rituals & meaning behind religious practice, so that the distinction between
right & wrong becomes more important to them than it was when they were preschoolers.
 Parent role modeling is important.
 Rule oriented; when they pray, they may expect their God to follow rules (if you are good & pray
for something, you should receive it.)
Freud’s Psychoanalytic Theory -School-age Child
Period of latent phase, a time in which children’s libido appears to be diverted into concrete thinking.
 Adolescents
 The genital phase- period to be the establishment of new sexual aims & the finding of new love
objects.
Erickson’s Psychosocial Theory - School-Age Child
 Industry vs. inferiority or accomplishment rather inferiority.
 Interested in learning how to do things well.
 If parents do not appreciate for their children’s effort. May develop a sense of inferiority.
Kohlberg’s Moral Development - School-age child
 Conventional development-adhere to the phase the nice girl, nice boy stage.
 Engage in actions that are nice or fair.
Piaget’s Cognitive Development - School-Age child
Period of during which concrete operational thought begins.
Can discover concrete solutions to everyday problems & recognize cause-and –effect relationships.
Conservation of numbers is learned as early as 7 years, quantity at age 7 or 8 years, weight at 9 years &
conservation of volume at age 11 years.
Reasoning tends to be inductive, proceeding from specific to general.
Week 9 – THE FAMILY WITH AN ADOLESCENT -13-17 Years Old, Late Adolescent- 18-21 Years Old
Growth & Development-
Physical
 The major milestones of development in the adolescent period are the onset of puberty &
cessation of body growth.
 Between these milestones, physiologic growth & development of adult coordination occur.
The gain of physical growth is mostly on weight, leading to the stock, slightly obese appearance
of prepubescence; later comes the thin, gangly appearance of late adolescence.
 Girls 1 to 2 (2.4 to 5cm) taller than boys coming into adolescence & generally stop growing w/in
3 years from menarche.
 Those girls who start menstruating at 10 years of age may reach adult height by age 13.
 Boys grow about 4 to 12 inches (10 to 30 cm) in height & gain 15 to 65 lbs. (7 to 30 kg) during
adolescence.
 Girls grow 2 to 8 inches (5 to 20cm) in height & gain 15 to 55 lb. (7 to 25kg).
 Growth stops at 16 or 17 in girls, boys 18 to 20 with closure of epiphyseal lines of long bones.
 The heart & lungs increase in size more slowly than the rest of the body, blood flow & O2
availability are reduced. Thus, have insufficient energy & become fatigued.
 PR decrease slightly to 70bpm, RR 20breaths pm. Bp120/70mm Hg reaching adult levels by late
adolescence.
 W/ adulthood, Bp becomes slightly higher in males than females because more force is
necessary to distribute blood to the larger male body mass.
 All during adolescence, androgen stimulates sebaceous glands to extreme activity resulting
in acne.
 Apocrine sweat glands (present in axillae & genitalia) form shortly after puberty, producing a
strong odor in response to emotional stimulation. Shower or bath frequently.
Teeth
 Gain their second molars at 13 years of age & third molars (wisdom teeth between 18 & 21
years old.
 Third molars may erupt as early as 14 to 15 years old. Jaw reaches adult size only toward the
end of adolescence.
Puberty
 Adolescence is the physiologic period between the beginning of puberty & the cessation of
bodily growth.
 Puberty is the stage at which the individual first becomes capable of sexual reproduction.
 A girl enter puberty when she begins to menstruate; a boy enters puberty when he begins to
produce spermatozoa. Occur between ages 11 to 14 years.
Secondary Sex Changes
 Secondary sex characteristics (body hair & breast growth) distinguish the sexes from each. Begin
in late school age period continue to develop during adolescence.
 Sexual maturity in males & females is classified according to Tanner stages name after him.
Developmental milestones
 13- year- old children are beyond the age of spending time in any form of childhood play.
 Both sexes spend a great deal in sports.
 Most spend a great deal of time just talking w/ peers as social interaction which some parents
disapprove.
 15- year- old spend a great deal of time in their room or in a quiet corner.
 Beginning age 16, most of them want a part-time - jobs to earn money. Teach how to work w/
persons, accept responsibility, & spend money wisely.
 Engage in charitable endeavors during middle to late adolescence.
 Do well organizing & supervising swimming or gym programs.
Developmental Task: Identity vs Role Confusion
 Developmental task in early & mid adolescence is to form a sense of identity to decide who they
are & what kind of person they will be & if not role confusion.
 In late adolescence, the task is to form a sense of intimacy or form close relationships with
persons of the opposite as well as the same sex versus isolation if not achieved.
FOUR main areas in which adolescents must make gains to successfully achieve a sense of identity:
1. Accepting their changed body image
2. Establishing a value system or what kind of persons they want to be
3. Making a career decision
4 Becoming emancipated from their parents.

 If young persons do not achieve a sense of identity; they develop a sense of role confusion. Lead
to difficulty achieving effectively as adults. Delinquent or exhibit acting –out (attention-getting).
Body Image
 Nurses help educate them to care of their bodies & help them to accept the changes that mark
maturity.
Self-Esteem
 May undergo changes during the adolescent years & can be challenged by all changes during
adolescence.
 Changes in one’s body & physiologic functioning
 Changes in feelings & emotional focus
 Changes in social relationships
 Changes in family & school experiences
 All of these factors can affect adolescence feelings about herself/himself.
Value System
 Develop through talking to peers.

 Need attentive adult ear.
 In early adolescence, girls tend to band together with girls, & boy to boys. Dress identically w/
other members of the group: jeans, sweatshirts, special jackets or whatever is in fashion.
 Knowing who they are not in one step in discovering who they are.
 Some parents worry about intensely close girl=to girl or boy to boy relationship. Teach them
that adolescents must feel secure & pleased with their own sex before relating to opposite sex.
Social Coupling- individuals tend to dress & behave similarly to other members of their peer group.
Bullying behavior may be directed to those who don’t conform.
Career Decisions
 Part of knowing who you are is knowing what kind of job you can do.
 Encourage to wait until they have been in college for 2 years before choosing a major.
Adolescents show increased interest in learning as they select a job filed at the high school level
& come to see education as relevant in their future.
Emancipation from Parents
 Can become a major issue during middle & late adolescent years for 2 reasons:
1. some parents may not be ready for their child to be totally independent
2. some adolescents may not yet be sure that they want to be on their own.
 The closer the tie that adolescents feel with their parents, the more severe is their struggle
because they love & feel loved.
 Encourage parents to give their children freedom & help parents continue to place some
restrictions on adolescent’s behavior.
Late Adolescent Developmental Task: Sense of Intimacy- 18-21 Years Old
 When they achieved sense of identity in early mid adolescence, they are ready to work on a
second developmental task, a sense of intimacy.
 Ability to form intimate relationships is strongly correlated with sense of trust.
 Intimacy involves deeper level of relationships or developing a sense of compassion or concern
for other persons. It means being able to discern when words will hurt, when a companion is
unhappy & needs encouragement.
Socialization
 Both male & female 13- year- old adolescents tend to be loud & boisterous, particularly when
peers of the opposite sex whose attention they would like to attract are nearby
 13- year -old adolescents fall in love spending more time for longing for someone.
 14- year- old are often quieter & more introspective than they were the year before, becoming
more used to their changing bodies, more confidence, & feel more self-esteem.
 Watch adults carefully searching for good role models w/ whom they can identify. Usually have
a hero- film star, doctor etc. with whom they want to grow up to be like.
 Often form a friendship w/ an older adolescent of the same sex, trying to imitate that person in
everything from thoughts to clothing.
 15- year- old fall in love 5 or 6x a year. Many are sexually attracted because of physical
appearance, not because of inner qualities or compatibilities w/ their own.
 16 –year-old boys are becoming sexually mature. Both sexes are better able to trust their bodies
than they were before.
 17 –year -old, they tend to be quitter & thoughtful about interactions. Left behind their childish
behaviors they used in early adolescence= shoving, punching to get attention of the opposite
sex.
Final stage- stage of formal operation thought, begins at 12 or 13 years & grows in depth over
adolescent years. Involves the ability to think in abstract terms & use the scientific method to arrive at
conclusions.
 Because adolescents enlarge their thought processes to include formal reasoning, they are able
to respond to the question “why is it wrong to steal from neighbor’s house?”
 Question the existence of God & any religious practices they have been taught. This a natural
part of forming a sense of identity & establishing a value system at a time in life when they draw
away from their families.
Sun Exposure
 Avoid excessive sun exposure so they don’t develop skin cancer “melanoma,” from ultraviolet
rays.
Promoting Healthy Family Functioning
 When a child reaches age 15, parent-child friction tends to reach a peak.
 By age 15, adolescents have discovered from careful observation that most adults are far
perfect.
 Age 16 years old, adolescents generally become more willing to listen & to talk about problems.
 17 years old, high school seniors leaving school with a feeling of losing security.
 To prove that they are old enough, they engage in drugs, alcohol –mark of being an adult.
Freud’s Psychoanalytic Theory - Adolescents
objects.
Erickson Psychosocial Development
Adolescent
 Identity vs. role confusion- bring together everything learned about themselves as a son
or daughter, if not able to do so, they are left with role confusion- unsure of what kind of person who
they are.
Young Adult
 A sense of intimacy vs. isolation
 Intimacy is the ability to relate well with other people, not only with members of the opposite
sex but with one’s own sex to form long-lasting friendships.
 Need a strong sense of identity before they can reach out fully & offer deep friendship or love.
 Can reach out fully & offer deep friendship or love.
Kohlberg’s Moral Development - Adolescent –postconventional development-capable of abstract

thought, they become capable of internalizing standards of conduct(they do what they think is right
regardless of whether they have social rules or anyone is watching.
Piaget’s Cognitive Development - Adolescent
 The time when cognition achieves its final form, that of formal operational thought.
 Adolescents are capable of thinking in terms of possibility- what could be (abstract thought)-
rather than being limited to thinking about what already is(concrete thought).- using scientific
reasoning.
Common Problems of Adolescents:
Hypertension – present if BP is above 95 th% or 127/81mm Hg girls, Boys 131/81 for 2 consecutive
readings in different settings.
Poor posture- due to imbalance of growth, skeletal system growing a little more rapidly than the
muscles attached to it. Girls slouch so as to appear not taller than boys w/ the belief that males will only
date females shorter than themselves. Diminish the appearance of their breast size if they are
developing more rapidly than their friends.
Body Piercing & Tattoos
 Strong marks of adolescence. Both sexes, away for them to say who they are & are different
from their parents.
Fatigue-assess diet, sleep, & activity schedules
Menstrual Irregularities- major health concern among adolescent girls as they learn to adjust to their
individual cycles.
Acne-self- limiting inflammatory disease that involves the sebaceous glands that empty into hair shafts.
Peak age for girls-14-17, boys-16-19 years of age.
Goal of therapy:
1. decrease sebum formation

2. prevent comedones
3. control bacterial proliferation
 Prescribe medication – Tretinoin (Retin A-m cream) - reduces keratin formation & plugging of
ducts. Avoid prolonged sun exposure, use sun block of SPF 15 or higher- susceptible to
ultraviolet rays.
 Systemic medication- oral antibiotic for pustular & cystic acne- Tetracycline 500 mg - 2x daily for
1 week, the 250mg daily for maintenance-against anaerobic bacteria. Taken w/ empty stomach-
2 hours before or after
 Not taken at 12 years old because it causes permanent staining of teeth, interfere w/ growth of
long bones.
 Isotretinoin (Accutane)- form of Vit. A, effective for reducing sebum production & abnormal
keratinization of gland ducts.
 If extreme- corticosteroids such as prednisone or Nonsteroidal anti-inflammatory drug may be
used. Given w/ caution to adolescent coz may lead to stunted growth- injected directly.
 Estrogen alone or combination w/ progesterone suppresses sebaceous gland activity –for girls.
2 reasons why isotretinoin is prescribed than estrogen:
1. High estrogen levels tend to close epiphyseal centers of long bones causing bone growth to
stop
2. Long-term therapy dangerous side effects –embolism & thrombophlebitis.
Obesity- diet of 1,800 calories / day
Concerns regarding sexuality & sexual activity- exposed to HIV infection or other sexually transmitted
disease.
 Provide information on date rape & rape prevention – high risk for this.
 Caution on dangers of Flunitrazepam (Rohypnol) a benzodiazepine, colorless, odorless &
tasteless –dropped in a drink –effects- drowsiness, impaired motor skills, amnesia.
Stalking- repetitive, intrusive, & unwanted actions directed at an individual to gain the individual’s
attention or evoke fear.
Concerns on Substance abuse- refers to the use of chemicals to improve a mental state or induce
euphoria. Desire to expand consciousness or peer pressure, desire to feel more confident & mature.
Types of substance Abuse:
1. Pain medication- morphine
2. Methylphenidate (Ritalin) –attention deficit or hyperactivity disorder –oral/ IV- feeling of giddiness &
extreme well-being result in pulmonary embolism or emphysema.
3. butane – inhaled- lead to cardiac failure
 Tobacco- 20% smoking

 Alcohol- 90% - lead to cirrhosis
 Anabolic Steroid Abuse- testosterone- Stanozolol, oral compound & testosterone propionate
injectable form – will enhance lean body mass & muscular development, improve appearance.
 Marijuana- (pot or gras or weed) -Cannabis sativa- rolled into cigarettes & smoked, be mixed w/
food or sniffed. Synaptic gaps that can delay electrical brain waves & memory storage.
Effects: euphoria & sense of well-being, temporary impairment of coordination or motor
activities, altered sensory perception, rapid mood swings, altered self-image, decreased
attention span loss of memory for recent events.
 Amphetamines-group of drugs sometimes used in the treatment of hyperactivity & narcolepsy
among other CNS disorders. Called “uppers” or “speed” because they give the user a false sense
of well-being, alertness or self-esteem.
 A newer, stronger form that produces intense symptoms is known as “ice”- side effects:
aggressive or demanding behavior, paranoia, & extreme restlessness.
 Cocaine- 3%-9% - Common street names- “snow” & “white lady”- because its fine, white
powder.
 A stronger form, called “crack”, manufactured by heating cocaine powder with soda & water.
 Dangerous because it uses volatile solvents that explode, resulting crack is called “freebase” or
“rock”- cause cardiac & respiratory arrythmias.
 Inhaled or smoked- absorbed thru mucus membrane into the blood stream. After absorption,
blood levels rise rapidly for the first 29 min. peak at 60 min. & decline over the over the next 3
hours.
 Toxic dose 600-700mg, Toxicity as low as 20 mg single line. Physical side effects- increased PR,
Temp.& RR, BP & decreased appetite.
 Hallucinogens-lysergic acid diethylamide (LSD) dimethyltryptamine (DMT) etc.- use of LSD- cause
bizarre mind reactions –distortions in vision, smell, or hearing. Effect –extremely pleasurable
(good trip) or extremely terrifying (bad trip).
 Ex- mescaline, MDMA (known as ecstasy)-cause brain damage.
 Opiates- such as heroin, meperidine (Demerol) morphine. Dangerous because a of their

tendency to decrease RR- addiction lead to stealing, defraud, prostitution or any method to
secure money to buy the supply. Danger of contacting aids /HIV –sharing needles.
 Methadone or LAAM (Levo –Methadyl-acetate) programs prescribed to wean themselves from

opiates. Adv. Lasts longer-72 hours rather than 24 hours.
Assessments of substance abuse:
 Failure to complete assignments in sch.
 Demonstration of poor reasoning ability
 Decreased sch attendance
 Freq. mood swings
 Deteriorating physical appearance
 Recent change in peer group
 Expressed negative perceptions of parents.
Concerns on Attempted Suicide- Suicide- deliberate self-injury to end one’s life. More in males. 3 rd cause
of death 15-19 years old, school stress bet 3 pm to midnight.
Problems- incest, abuse, increased chemical dependency, marital instability in the family, poor problem-
solving ability, drugs & alcohol use.
Regarding Runaways-an adolescent between the ages of 10 -17 who has been absent from home at
least overnight w/out permission of parent or guardian.
 Characteristics- unemployment, alcoholism, sexual abuse, attempted suicide, poverty- more on

male than female.
 Health reasons- Sexually transmitted diseases, HIV/AIDS, rape, pregnancy, substance abuse,
vaginitis, hepatitis
Concerns on Physically Challenged
 Problems:
 Difficulty in being as independent as they would like, achieving in sch. Establishing intimate
relationships.
 Chronic hospitalization or realization that they will never be free of symptoms can cause
depression placing them in substance abuse.
 Nutrition & chronically ill Adolescent- must be aware of their total calorie intake or as growth
needs decline at the end of adolescence they can become obese. Knowledgeable in meal
planning.
Freud’s Psychoanalytic Theory - Adolescents
objects.
Erickson Psychosocial Development
Adolescent
 Identity vs. role confusion- bring together everything learned about themselves as a son
or daughter, if not able to do so, they are left with role confusion- unsure of what kind of person
who they are.
Young Adult
 A sense of intimacy vs. isolation
 Intimacy is the ability to relate well with other people, not only with members of the opposite
sex but with one’s own sex to form long-lasting friendships.
 Need a strong sense of identity before they can reach out fully & offer deep friendship or love.
 Can reach out fully & offer deep friendship or love.
Kohlberg’s Moral Development - Adolescent –postconventional development-capable of abstract

thought, they become capable of internalizing standards of conduct(they do what they think is right
regardless of whether they have social rules or anyone is watching.
Piaget’s Cognitive Development - Adolescent
 The time when cognition achieves its final form, that of formal operational thought.
 Adolescents are capable of thinking in terms of possibility- what could be (abstract thought)-
rather than being limited to thinking about what already is(concrete thought).- using scientific
reasoning.
Week 10 & 11 - HEALTH PROMOTION IN INFANCY
Promoting Achievement of Developmental Task: Trust vs. Mistrust
Erickson proposed that the developmental task of infant period is to form a sense of trust.
 When the infant is hungry, a parent feeds & makes him comfortable. When wet, a parent
changes her & infant is dry.
 By this process infant s learns to trust that when they have a need or distress, a person will
come & meet them.
 Synonym for trust is love. By way infants are handled, fed, talked to, & held, they learn to love &
recognize that they are loved.
 Infants who have numerous care givers, may be fed one day & the next only when hungry
 Can have difficulty learning to trust anyone. If cannot trust, they cannot enjoy deeply satisfying
interactions with others & can have difficulty trusting themselves.
Promoting Infant Safety
 Accidents are the leading cause of death in children from 1 month to 24 years of age.
Aspiration Prevention
 Round, cylindrical objects are more dangerous than square or flexible objects such as carrot or
hot dog.
 Never prop formula bottles.

 Caution parents that nothing should come within the infants reach that would not be safe to put
into their mouth.
 Store baby products such as powder out of reach; powder is high risk for aspiration
 Children under 5 years should not be offered popcorn or peanuts because of aspiration.
 Parents should check toys for loose pieces when handling to infants.
Fall Prevention
 Second major cause of infant accidents. Preventive measure, no infant beginning newborn,
should be left unattended on a raised surface.
 Place a gate at the top & bottom of stairways.
 Teach parents to be prepared for their infant to roll over about 2 months- vigilant not to leave
the baby unattended.
 If sleeps in a crib, the mattress should be lowered to its bottom position so the height of
siderails increases, rails should be 2 3/8 inches apart, narrow enough so child can’t put his head.
 2 months is the maximum length of time infants sleep in a bassinet.
 Don’t allow an infant to walk w/ a sharp object in the hands or mouth.
 Avoid using an infant walker
Motor vehicle
 Never transport unless the infant is buckled into an infant car seat. Infants who weigh up to 20
lbs. should be restrained in a car seat (convertible restraint) in a semi-reclined, rear-facing
position in the back. Rear-facing infant seats (convertible restraint) side; the child could be
injured seriously if the air bag is released because rear-facing infant seats extend closer to the
dash- board can be suffocated.
Safety w/ siblings
 Children under 5 years old should not be left with the infant unattended. They might introduce
unsafe toys or engage in plat that is too rough for the infant.
 Never vigorously shake an infant- shaken baby syndrome
Bathing & swimming
 Never leave an infant unattended in a tub, even when propped up out of the water or sitting in a
bath ring- slip down.
 Be sure bath water is not hot; don’t leave unattended in bath.
Childproofing
 At 5 to 6 months when infants begin teething, they seek to chew on any object w/in reach to
lessen gumline pain- remind parents to check for possible sources of lead paint
 Parents should baby proof the home, cover electrical outlets- fascinated by the holes & will
probe them w/ their fingers.
 Poisonous substances-chemicals, medications, & plants must be removed from infant’s reach.
 Keep poison control number available
 Keep ipecac syrup available; in the event of poisoning, contact immediately & will give initial
treatment instructions.
 19 months-pincer grasp- infants able to pick up small objects- remind parents to check play
areas for pins or sharp objects that can be swallowed.
 Infants who can walk may venture on streets or swimming pool
Promoting Nutritional health of the Infant
 Breast milk is the best food for the first 6 months to 12 months of life.
 Fluoride be added if not added in the water supply. Prolonged BF till preschooler not
recommended because it may impair the child’s growth.
 Iron-fortified formula for those not BF.
 Infants who change to cow’s milk before 1 year should have vitamin C & iron supplements.
 Iron stores from birth are depleted at 4 mo.
 Whole milk should not be introduced until 1 year of age.
 Skim milk & low-fat milk should not be given because essential fatty acids are inadequate & the
solute concentration of protein & electrolytes is too high.
Recommended dietary allowance for Infants
 Extreme rapid growth- high protein, high-calorie- caloric allowances reduced from 120 / kg of
body weight at birth to 100/kg of body weight at the end of first year.
Introduction of Solid Foods
 Solid foods are introduced at 6 months of age to prevent overwhelming infant’s kidneys w/
heavy solute load, delay the development of food allergies in susceptible infants.
 Physiologically ready for solid food when they are taking more than 32 oz(960ml) of formula &
not satisfied or nursing vigorously every 3-4 hours & not satisfied.
 Amylase is present in the saliva 2-3 months
 Chewing movements don’t beginning until 7-9 months
Techniques for feeding Solids
 NB stomach can hold 2 tablespoons(30ml)
 1 month-2 tablespoon, 1 year 1 cup(240ml)
 Introduce solid foods one at a time, usually 1 week to identify for allergens.
 Sequence of introducing solid foods: rice cereal; fruits, & vegetables, starting w/ yellow & then
green; meats; & egg yolks, avoiding egg whites- introduce toward the end of first year; cheese
substitute for meats & as a finger food.
 Avoid solid foods that put the infant risk for choking.
 Cereals –till first year but ideally until age 3-4 years.
 Vegetables –given at 7 months, cook, blended or strained.
 Fruits offered 1 mo. After beginning vegetables (at 8 months).
 Meat introduced at 9 months- grinded beef & pork have more iron than chicken.
 Egg yolk by 10 months, boiled contain the bulk of iron content of eggs, white contain the bulk of
protein
 Table food- 3- day meal pattern- homemade foods

Weaning- Sucking reflex diminish at 6-9 months, consider weaning, 1 feeding a day & then introduces
fluid, then after 1 wk.
 Self-feeding
 Uses spoon or finger
 Avoid microwaving baby bottles & baby food.
 Never mix food & medications w/ formula.
 Avoid adding honey to formula, water or other fluid to prevent botulism
 Offer fruit juice from a cup (12-13 months) to prevent bottle mouth caries.
 Loss of extrusion reflex-fades at 3-4 months- prevents swallowing or aspirating foreign objects
to mouth
Promoting sensory stimulation
 Vision-eye to eye contact to stimulate vision
 Hearing- enjoy soft, musical sounds, cooing voices
 Touch- need to be touched to experience skin to skin contact. Gentle in handling infants
 Taste- acute sense of taste by turning away from or spitting out a taste they do not enjoy.
 Smell- smell accurately w/in 1 or 2 hours after birth.to prevent seborrhea- cradle cap.
Infant Daily Activities
 Bathing- washed infant face, Hands & diaper area. Scalp every day or other day,
 Diaper area care – change diaper frequently
 Teeth- fluoride – brushing- eliminates plaque, reduces presence of bacteria, creating a clean
environment for the arrival of first teeth. initial dental checkup 2 years, at 6 months interval to
adulthood.
 Dressing- long pants to protect their knees when creeping. soft soled shoes.
 Sleep- 10-12 hours at night, 1 or several naps during day.
 Exercise- beginning 3-5 minutes sunbathing, early AM & Late PM. End of first year need space to
crawl & walk.
Parental concerns & problems related to Normal Infant Development
 Teething- resistant to chewing for a day or two & be slightly cranky. Acetaminophen 10-15
mg/kg every 4 hours.
 Thumb sucking- begins at 3 months, peak at 18 months- normal, and stops at school age.
 Use of pacifiers-wean after 3 months or when after sucking reflex fade at 6-9 months.
 Headbanging-beginning during the second half of first year & continue through preschooler
associated w/ naptime or bedtime for 15 minutes is normal to relax & fall asleep. Head banging
past the preschool period is pathologic basis.
 Loose stools – occur in breastfed
 Constipation- occur in formula-fed infants. If persist beyond 5 or 6 mo. Go to the doctor for
consultation. Maybe due to tight anal sphincter or Hirschsprung disease (Aganglionic
megacolon)- lack of nerve innervation to a portion of the colon, w/ no stool present in the
rectum upon rectal examination.
 Loose stools – breastfed softer than formula fed infants. May begin w/ the introduction of solid
esp. fruit.
Malabsorption syndrome (Celiac disease) or inability to digest fat –s/s- loose stools, distended abdomen
deficiency of fat-soluble vitamins.
Colic- is the paroxysmal abdomen. Pain that generally occurs in infants under 3 mo., cries loudly & pulls
abdomen Red & flushed face, fists clenched & abdomen, tense.
 Cause- overfeeding or swallowing too much air while feeding more on formula fed. Disappears
at 3 mo. Because it is easier to digest food & maintains an upright position.
Spitting up- more on formula fed. Spitting 2 or 3x a day or sometimes after a meal is normal. If spitting
up3 or4 feet away forcefully – it may be pyloric stenosis (an abnormally tight valve between the
stomach & duodenum.
Diaper Dermatitis- diaper rash- sensitive skin.
 Frequent diaper changed, apply A & D or Desitin ointment, expose. If bright red, w/ ow/out
oozing, last longer than 3 days, appear as red pinpoint lesions- fungal (monilial or Candidiasis)
infection.
Miliaria- or prickly heat rash- clusters of pin-point, reddened papules w/ occasional vesicles & pustules
surrounded by erythema at the neck first spread upward to around the ear, face down to trunk due to
warm weather or overly dressed.
 Bathing 2x a day/ small amount of soda, eliminate sweating & reducing clothing.
Baby bottle syndrome- putting an infant to bed w/ a bottle can result in aspiration or decay of all upper
teeth & the lower posterior teeth. Most serious when the bottle is filled w/ sugar, water, formula, milk,
fruit juice.
Obesity in infants- a weight greater than the 90 th to 95th % on a standard height & weight. Occurs when
there is an increase in the number of fat cells due to excessive calorie intake.
 infants may need NGT or gastrostomy feedings, or total parenteral nutrition.
Toddler
 Anal phase because their main focus is on the anal region.
 Elimination takes on new importance- find pleasure in both retention of feces & defecation as
part of self-discovery, a way of exerting independence. – toilet training.
PLANNING & IMPLEMENTATION OF HEALTH PROMOTION OF THE TODDLER & FAMILY
Come to health facility for health maintenance visits & the immunizations. The visits allow the nurse to
focus on health promotion & provide opportunity for early detection of any growth & development
delays.
Promoting Toddler Safety
 Accidents are the major cause of death in children of all ages. Accidental ingestions (poisoning)
are the type of accidents that occur most frequently in toddlers: ingestion of cleaning products.
 Aspiration or ingestion of small objects such as watch, hearing aid batteries, pencil, erasers, etc.
major danger for children at this age.
 Childproof the house by putting all poisonous product, drugs, & small objects out of reach by the
time the infant is crawling & walking.
 Other accidents - Motor vehicle accidents, burns, falls, & playground injuries. Occur because a
toddler’s motor ability jumps ahead of his judgment.
 By the end of toddler period, children can walk surely; if left outside to play, can very quickly
travel a block away because of no judgment of moving cars.
 Can’t swim well, need to be supervised.
 40-60 lb. weight, toddler need a car seat for safety in automobiles. Placed at the back seat if the
car has a passenger seat airbag. Need to wear a helmet as soon as they begin riding in a tricycle.
 15- month-old able to climbs over siderails of their cribs & enjoy exploring the house early in the
morning. Safety gate on the door of his room to keep him contained & safe.
 At 2 years-imitate house- work & repairing a car- parents make sure that he is not using sharp
tools & real cleaning compounds.
Lead Screening- is caused by eating, chewing, sucking on objects –window- sills, paint chips, or furniture
that are covered w/ lead-based paint.
Other sources of lead:
 Toys where restrictions on lead are not enforced, cribs that were painted with lead
 Soil around the exterior of the house
 Dust & fumes due to house renovation
 Pottery made with glazes or jewelry with lead
 A diet high in fat, & low in calcium, magnesium, iron, zinc, & copper may increase absorption of
lead. Toxic to body tissue, lead poisoning can cause serious damage to the brain & nervous
system, kidneys & RBC.
 High levels may result in seizures, cognitive challenge, coma & death.
 Level as low as 10-15 ug dl can cause learning & behavior problem.
 s/s- irritability, headaches, fatigue, abdominal pain.
 Screen all children from ages 9, 12, 24 moths. A small amt. of blood taken from finger prick is
analyzed, Positive-over 10 ug/dl.
Promoting Nutritional Health in Toddlers
Growth slows abruptly after first year of life, the toddler’s appetite is smaller than the infant, insists
on feeding themselves, & will resist eating if a parent insists on feeding them.
 Teach parents to place a small food on plate & all ow the child to eat it & ask for more rather
than serve a large portion that the child can’t finish.
 Allowing self -feeding is a way of strengthening independence & improved the amount of food
consumed. Offering finger foods & two types of food promote independence.
 Do not like that food is mixed up. Prefer brightly colored foods to bland colors.
Recommended Daily Dietary Allowance- ages 1-3 years should consume 1,300kcal daily. Children over 2
years old should consume no more than 30% of total daily calorie from fat. Adequate calcium &
phosphorus intake is important for bone mineralization.
 Whole milk until 2 year- old after which 2% milk can be introduced.
 Promoting Adequate Intake w/ a Vegetarian diet- easily designed for children who prefer
finger food. Use of fortified soy milk prevents fluid, protein, B12 & calcium deficiencies.
Toddler Daily Activities
 Dressing- end of toddler period, most children can put their own socks pants & undershirts to
feel independent.
 Sleep- amount of sleep children need gradually decreases as they grow older. Nap time 2x a day
& sleeping 12 hours each night. Unable to sleep at night, shorten afternoon nap.
 Love bedtime routine: bath, pajamas toothbrushing etc.

 Bathing- depends on the parents & the child’s wishes & schedule. Enjoy bathing & parents
provide toy to make it fun.
Care of Teeth- between –meal snacks are important for growing children, encourage to offer fruit
(bananas, pieces of apple, orange slices.) or Protein foods such as cheese, pieces of chicken
 Toddlers should have toothbrush of their own.
 2.5 years- schedule a first visit t a dentist.
Promoting Healthy Family Functioning-
 Learning self-reliance is the primary goal of the toddler which parents should understand.
Although the child still needs firm limits to feel secure, the child should be given some room of
independent decisions.
 If parents punish the child excessively at each move toward independence, he will not fight but
the child will begin to feel guilty for wanting to do things independently.
Parents Concern w/ Toddler Period
 Toilet Training- biggest task the toddler must achieve. It is an individual task.
 3 important developmental levels, 1 physiologic, & 2 cognitive before the child can be toilet
trained:
1. They must have control of rectal & urethral sphincters.
2. They must have a cognitive understanding of what it means to hold urine & stools until
they can release them at a certain place & time.
3. They must have a desire to delay immediate gratification for a more socially acceptable action.
4. Ready for toilet trained not only when they can understand what their parents want them to do
but also when they feel uncomfortable in wet diapers, by pulling & tugging at soiled diapers.
Ritualistic Behavior- enjoy ritualistic patterns. They will use spoon at mealtime, only their wash- cloth at
bath time.
 Negativism- as a part of establishing their identities as separate individuals, toddlers go through

a period of negativism. They do not want to do anything that a parent wants them to do. Their
reply to every request is a very definite” NO.”
 Make a statement instead of asking a question can avoid a great- negative responses.
Discipline- remind parents that discipline & punishment are not interchangeable terms.
 Discipline means setting rules or road signs’ so children know what to expect of them.
Punishment is a consequence that results from a breakdown in discipline, from a child’s disregard of the
rules that were learned.
 Should begin to instill some sense of discipline early in life because part of it involves setting
safety limits & protecting others property.
2 general rules to follow in discipline:
1. Parents need to be consistent
2. Rules are learned best if correct behavior is praised rather than wrong behavior punished.
Time out is a technique of helping children learn that actions have consequences done only for 1 minute
/ age.
Separation anxiety- begins at 6 months & persists throughout the preschooler- universal fear of this age
group is known as separation anxiety- difficulty accepting being separated from their primary care
givers.
 It helps if parents say goodbye firmly, repeat the explanation that they will be there when the
child wakes in the morning & then leave.
 Prolonged goodbyes only lead to more crying.
Temper Tantrums- are natural consequences of toddler’s development. Independent enough to know
what they want, but they do not have the vocabulary or the wisdom to express their feelings in a more
socially acceptable way.
 A response to difficulty making choices or decisions or to pressure from activities such
decisions or to pressure from activities such as toilet training.
 Best approach is to tell the child that they disapprove of the tantrum & then ignore it. Then
accept the child warmly & proceed as if the tantrum had not occurred.
 Sibling Rivalry- or jealousy of younger siblings, can occur during the toddler period.
PLANNING & IMPLEMENTATION FOR HEALTH PROMOTIONOF A PRE-SCHOOLER -3-5 Years Old
Promoting Pre-schooler Safety
 By age 4, children may project an attitude of independence & ability to take care of their own
needs but still need supervision so they will not injure themselves or others.
 Keeping children Safe, Strong, & Free
 Warning a child never to talk w/ or accept rides from strangers.
 Teaching a child to call for help in an emergency, 911
 Describing what police officers look like that can help in an emergency
 Explaining that if children or adults ask them to keep secrets that make them uncomfortable,
they should tell their parents.
 Explaining that bullying behavior from other children is not to be tolerated but reported
Motor vehicle & Bicycle Safety- buckle them into car seats in the back seat- inform preschoolers the role
of seat belts to prevent injury & or accidents.
 Head injuries are a major cause of death & injury to preschoolers, & Bicycle accidents are the
major causes of injuries- safety helmets.
Promoting Nutrition- offer small servings of food & offer nutritious snacks-fruit, cheese, or ilk rather
than cookies or soft drinks.
Recommended Daily Dietary Allowances- select foods based on the food pyramid offering a variety.
Nutritional Health w/ a vegetarian Diet- if vegetarian diets are deficient, they usually lack calcium,
vitamin B12 & Vit. D. Calcium sources- green leafy vegetables, milk products.
 Vit. D – fortified cereals & milk.

 Vit. B12- animal products.
Preschoolers Daily Activities
Dressing- 3 & 4 -year- old can dress themselves except for difficult buttons, prefer bright colors or prints
& do not match.
 Need to experience of choosing their own clothes.
Sleep- more aware of their needs, when they are tired, they curl up on coach or soft chair & fall asleep.
 Refuse to go to sleep because of fear of the dark. Night walking from nightmares, or night
terrors reaches its peak- night light.
Exercise- so active -they receive a great deal of exercise.
 Love time- honored games- ring- around- the- rosy, London bridge- help develop motors skills.
Hygiene
Bathing- can wash & dry their hands perfectly, temp. of heater at 120 degrees F to prevent scald
Care of Teeth
 Independent tooth brushing should be started. One good tooth brushing period a day is more
effective than more frequent half- hearted attempts.
 Parents should floss their child.
 First visit to a dentist is no later than 2 years old for evaluation of tooth formation.
 Teeth grinding- bruxism- may begin at this age, habit for children- a way of letting go –to release
tension & fall asleep.
Discipline- guide child through the struggles w/out discouraging the child’s right to have an opinion.
 Time out is a good technique to correct behavior for parents to continue through the
preschoolers’ years
Common Health Problems
 Major cause of death-automobile accidents, poisoning, & falls.

 Minor illnesses- colds, flu, ear infections are high
Common Fears of Preschooler- imagination is so active which leads to a number of fears.
Fear of Dark is heightened by a child’s vivid imagination: a stuffed toy by day light becomes a
threatening monster at night.
Fear of Mutilation – intense reaction of a preschooler to even a simple injury or needle inserted.
Fear of Separation or Abandonment – sense of time and distance is limited & distorted.
Behavior Variations
 Telling tall tales- stretching stories to make them more interesting
 Imaginary friends who plays with them
 Difficulty sharing
 Regression-in relation to stress- thumb sucking, negativism, loss of bladder control, & inability to
separate from their parents.
 Sibling rivalry between boys & girls – jealousy – first time children have enough vocabulary to
express how they feel, aware of family roles & how responsibilities at home are divided.
Preparing for a New Sibling
Introduction of a new sibling is a major need for parents to take steps to be certain that preschooler will
be prepared- before the time the child begins to feel the difference the new baby will make, as soon as
she came to know she is pregnant.
Sex Education- be exposed to the genitalia of the opposite sex.
 Masturbation while watching TV- explain to them that it should be done in the right place.
 Teach them to avoid sexual abuse or maltreatment- not allowing anyone to touch their body
unless they & their parents agree that it is alright. Ask permission before touching for nursing
care.
 Age 2 to 6 years old children have some speech difficulty. Broken fluency- repetition or
prolongation of sounds, syllables or words referred to as Secondary stuttering- begins to speak
w/out this problem & then during the preschool years develops it - part of normal development
& if accepted will pass.
HEALTH PROMOTION FOR A SCHOOL-AGE CHILD & FAMILY
PROMOTING SCHOOL-AGE SAFETY
Ready for time on their own without direct adult supervision- need good education & safety practices.
Sources of Unintentional Injuries:
1. Motor vehicle 2. Bicycle
3. Burns 4. Falls
5. Sports injuries 6. Drowning
7. Drugs 8. Firearms
9. General
PROMOTING NUTRIONAL HEALTH OF A SCHOOL-AGE CHILD
Establishing Healthy Eating Patterns
 Should be encouraged to eat a healthy breakfast to ensure the ability to concentrate during the
school day.
 Help prepare a nutritious lunch to take to school.
 If purchased in school, healthy choices should be discussed.
Fostering industry & Nutrition
 Helping to plan meals & prepare meals with healthy ingredients.
 Development of proper etiquette in important- encourage meals to be eaten at the table, not
watching TV.
Recommended Dietary Intakes
 Both boys & girls require more iron in puberty than they did between the ages of 7-10.
 Adequate Calcium & Fluoride important to ensure bone growth & teeth.
 Back- pack – 10 % 0f child’s body weight is enough to cause a child to have lean forward
chronically to bear the weight.
 Sexual maltreatment is too common hazard for children. - box 32.4 pg.867
 Major deficit is fiber because they dislike vegetables.
A Vegetarian Diet
 Need adequate consumption of protein & calcium important for muscle, bone, & dental
development.
 Foods highest in Calcium: green leafy vegetables- spinach, turnip greens, enriched bread, &
cereals.
 High in protein- soy-beans, legumes, grains, & immature seeds such as green lima beans, & corn.
 Sun exposure to increase Vitamin D.
 Iron for girls with heavy menstruation.
PROMOTING DEVELOPMENT OF A CHOOL-AGE CHILD IN DAILY ACTIVITIES
Dress- teach them to care for their own belongings.
Sleep- vary- younger children require 10-12 hours, whereas older children- 8-10 hours.
 Early years- require a reading time at bedtime
 9 years – friends become important- phoning or text messaging friends.
Exercise- need daily exercise
Hygiene- 6-7 years need help in regulating bath water temperature & cleaning their ears. & fingernails.
 8 years old- capable of bathing themselves but do not do it well.
 Both boys & girls are interested in showering as they approach their teens. Encouraged because
perspiration increases with puberty, along with sebaceous gland activity.
Care of Teeth
 Visits dentist twice yearly, brush their teeth daily with a soft brush, fluoridated –based tooth-
paste & dental floss to clean between each teeth.
 Snack s best limited to high protein such as chicken & cheese. Fruits, vegetables & cereals
fortified with minerals & vitamins- for snacks.
PROMOTING HEALTHY FAMILY FUNCTIONING
 6-year- old quote their teacher as the final authority on all subjects.
 Parents need to be reminded that simple tasks require repeated practice before they can be
accomplished.
COMMON HEALTH PROBLEMS OF THE SCHOOL-AGE PERIOD
Dental caries- Caries (cavities) are progressive destructive lesions or decalcification of the tooth enamel
& dentin.
 Proper tooth brushing & use of fluoridated water or fluoride application.
Malocclusion
 Good tooth occlusion in which the upper teeth overlap the lower teeth by a small amount &
teeth are evenly spaced & in good alignment, is necessary for optimal formation of teeth, health
of the supporting tissue, optimal speech development & pleasant physical appearance.
Malocclusion- (a deviation of tooth position from the normal) may be congenital due to conditions such
as cleft palate, small lower jaw, familial traits.
 Abnormal tongue position, thumb sucking -6-7 years old, unintentional injury, loss of teeth,
crossbite (sideways)
 Braces- brush teeth well.
Concerns & Problems of School- Age Period
1. ADHD- Attention Deficit Hyperactivity Disorder- neurodevelopmental disorder in childhood-

trouble paying attention, controlling impulsive behavior, overly active
2. ASD- Autism Spectrum Disorder- broad range of conditions characterized by challenges with
social skills, repetitive behaviors, speech & non -verbal communication.
PROBLEMS ASSOCIATED WITH LANGUAGE DEVELOPMENT
Common problem is articulation- difficulty pronouncing s, z, th, l, r, & w, or substitute w for r –west
room for rest room or r for l- radies for ladies. Disappears at third grade
Common Fears & Anxieties of a School –Age Child
Anxiety related to beginning school
 Adjusting to grade school is a big task for a 6-year old
 Biggest task is learning to read.
 Parents need sometimes to be with their children after school.
School Refusal or Phobia- fear of attending school.
 Type of social phobia similar to agoraphobia (fear of going outside the home) or separation
anxiety disorder (SAD).
 Managing requires coordination among the school, school nurse & the health care provider
identifies the problem.
 Allow the child to do some independence.
Home schooling
Due to religious or personal preferences or disillusionment with the school system.
Assess if children have peer experiences, exposure to other cultures or families so they can
better adjust to people different from themselves.
Children who Spent time Independently
 Children whose parents both work outside the home may spend time alone without adult
supervision.
 A major concern is that they will experience an increased number of unintentional injuries,
delinquent behaviors, alcohol or substance abuse or decreased school performance from lack of
adult supervision.
Sex Education
 Educated on pubertal changes & responsible sexual practices.
They should have adults to turn to for answers to questions about sex.
 Include: - reproductive organ function & physiology menstruation
 Secondary sexual characteristics – what is happening in their bodies
 Male sexual functioning – nocturnal emissions
 Physiology of pregnancy
 Responsibilities of sexual maturity
 Reproductive life planning measures & the principles of safer sex.
Stealing
 Happens at 7 years old- steal loose change from their mother’s purse or father’s dresser, when
they learn to make change & discover the importance of money.
 Child is gaining an appreciation of money, but not yet balanced by strong moral principles or
understanding of ownership.
 Parents should explore the reason for stealing.
 As a rule, early child stealing is best handled without a great deal of emotions.
 8 years-old- require counseling
Shoplifting- but major problem at pre-adolescence – rebellion against authority, peer pressure, ritual for
gang membership.
 Taken seriously because it is punishable crime.

 Confronted immediately. Needs counseling if done twice
 Parents should set examples – honesty.
Violence or Terrorism
 Recommendations:
 Assure children are safe
 Observe for signs of stress such as sleep disturbances
 Do not allow to view footage of traumatic events
 Watch new programs
 Explain that there are bad people in the world & do bad things.
Bullying
Traits include:
 Advanced physical size & strength for their age
 Aggressive temperament
 Parents who are indifferent to the problem
 Parents who typically resort to physical punishment
Recreational Drug Use
 Marijuana, cocaine, & amphetamines, At 7 th - 8th grade.
 Use of hard drugs & alcohol
 Inhalants
 Use of androgenic steroids or human growth hormone – cardiovascular irregularities,

uncontrolled aggressiveness, & cancer
Cigarette smoking- cancer of the lungs
Concerns of the School-Age child with Unique Needs
 The Child with Alcohol Parents- emotional problems because of disruptions in their lives.
 Genetic based
Problems:
 A feeling of guilt that they are the cause of the parent’s drinking.
 Constant worry that parents will be sick or die
 Feeling of shame that prevents child from inviting friends at home
 Decreased ability to trust adults
 Poor nutrition & decreasing grades in school
 Anger at the alcoholic parent helplessness to change the situation.

The Child with Long Term Illness or Physical Cognitive Challenge
 Time lost from school- threatens their academic achievement but also their relationships with
peers because it may make the child “odd person out” with respect to making friends or clubs.
 Help them to keep in contact with friends by texting, email, or letters- socialization
 Attend regular schools & classes
 Urge parents to assign them in household chores
 Choose short term activities that can be completed independently.
Nutrition & the School-Age Child with a Challenge
 A school-age child who can’t be involved in food preparation & washing dishes because of a
physical challenge may need extra time during the day to make up for lost experiences.
The Child who is Overweight or Obese – endomorphic child tends to become obese
Endomorphic- accumulate body fat
Mesomorphic- Normal
Ectomorphic- slender
Children of obese parents tends to be obese- hypertension, type 2 diabetes, high cholesterol
Life -style Changes:
 1,200 calories a day -30% fat, eliminate sugar
 Active exercise program
 Counseling program to discuss aspects as self-image & motivation to reduce weight
PLANNING & IMPLEMENTATION FOR HEALTH PROMOTION OF ADOLESCENT & FAMILY SAFETY
 Accidents those involving motor vehicles, are the leading cause of death among adolescents. For
their safety & others, parents need to have the courage to insists on emotional maturity rather
than age as the qualification for obtaining a driver’s license.
 Encourage them to take driver education courses to learn not only the techniques of driving but
responsibility to others.
 Dangerous for adolescents are motorcycles, motor bikes, & motor scooters appealing due to low
cost. & convenience in parking.
 Drowning is another chief accident of adolescents. Teach them to swim.
 18 years old they have survived high school, are in college or a beginning job & begun to
manage their own lives. Enjoy their new independence that they find it difficult to understand
why adulthood is thought to be challenging.
 Second most common cause of death is homicide, related to the easy accessibility of guns to
teenagers.
 Both water & fire safety must be taught creatively by encouraging problem solving rather than
lecturing.
Promoting Nutritional Health for the Adolescent
 Parents who stock more nutritious foods, always keeping plenty of milk, & healthy snacks such
as fruits & vegetables will be more certain their child is eating nutritious foods during the day.
 Giving them some responsibility such as food planning or meal may teach them important
lessons about nutrition without conflict.
 Those who are obese due to prepubertal changes may begin in low-calorie or starvation diets to
lose excess weight. Eating disorders such as bulimia or anorexia nervosa.
Recommended Dietary Allowances
 Needs increased amounts of calories to maintain a raid period of growth.
 Foods that supply carbohydrates, proteins, minerals & vitamins.
 Deficient in iron, calcium, & zinc on both sexes.
 Large amount of iron is needed to meet expanding blood volume requirements. Females require
high iron intake not only because of increasing blood volume but because of menstruation.
 Increased calcium necessary for skeletal growth to prevent osteoporosis.
 Zinc necessary for sexual maturation.
 Meat & green leafy vegetables are good sources of iron, milk & milk products for calcium, meat
& milk for zinc.
Promoting Nutritional Health w/ a Varied Diet
Vegetarian Diet- vegetables contain fewer calories than meat, adolescents need to consume large
amounts of them to achieve an adequate calorie.
 Glycogen loading is a procedure used to ensure there is adequate glycogen to sustain energy
through an athletic event.
 sustain energy through an athletic event.
 eating a well-balanced diet.
Promoting Development of Adolescent in Daily Activities
Dress & Hygiene
 Capable of total self- care, wash their hair every day, use shampoo, toothpaste, deodorants, &
breath fresheners.
 Aware of what they are wearing.
Care of Teeth
 Very conscientious about toothbrushing because of fear of developing bad breath. Use fluoride
paste.
Sleep- 8 hours
Exercise –everyday to maintain muscle tone & provide an outlet for tension. Athletes receive daily
exercise.
Nursing Role in Health Promotion of Adolescent & Family
Promoting Healthy Family Functioning
 When a child reaches age 15, parent-child friction tends to reach a peak.
 By age 15, adolescents have discovered from careful observation that most adults are far
perfect.
 Age 16 years old, adolescents generally become more willing to listen & to talk about problems.
 17 years old, high school seniors leaving school with a feeling of losing security.
 To prove that they are old enough, they engage in drugs, alcohol –mark of being an adult.
Common Problems of Adolescents:
Hypertension – present if BP is above 95 th% or 127/81mm Hg girls, Boys 131/81 for 2 consecutive
readings in different settings.
Poor posture- due to imbalance of growth, skeletal system growing a little more rapidly than the
muscles attached to it.
 Girls slouch so as to appear not taller than boys w/ the belief that males will only date females
shorter than themselves. Diminish the appearance of their breast size if they are developing
more rapidly than their friends.
Body Piercing & Tattoos
Strong marks of adolescence. Both sexes, away for them to say who they are & are different from their
parents.
Fatigue-assess diet, sleep, & activity schedules
Menstrual irregularities
Acne-self- limiting inflammatory disease that involves the sebaceous glands that empty into hair shafts.
Peak age for girls-14-17, boys-16-19
Goal of therapy:
1. decrease sebum formation

2. prevent comedones
3. control bacterial proliferation
 Prescribe medication – Tretinoin (Retin A-m cream) - reduces keratin formation & plugging of
ducts. Avoid prolonged sun exposure, use sun block of SPF 15 or higher- susceptible to
ultraviolet rays.
 Systemic medication- oral antibiotic for pustular & cystic acne- Tetracycline 500 mg -
 2x daily for 1 week, the 250mg daily for maintenance-against anaerobic bacteria. Taken w/
empty stomach-2 hour before or after
 Not taken at 12 years old coz it causes permanent staining of teeth, interfere w/ growth of long
bones.
 Isotretinoin (Accutane)- form of Vit. A, effective for reducing sebum production & abnormal
keratinization of gland ducts.
 If extreme- corticosteroids such as prednisone or Nonsteroidal anti-inflammatory drug may be
used. Given w/ caution to adolescent coz may lead to stunted growth- injected directly.
 Estrogen alone or combination w/ progesterone suppresses sebaceous gland activity –for girls.
2 reasons why isotretinoin is prescribed than estrogen:
1. high estrogen levels tend to close epiphyseal centers of long bones causing bone growth to stop
2. long-term therapy dangerous side effects –embolism & thrombophlebitis.
Obesity- diet of 1,800 calories / day
Concerns regarding sexuality & sexual activity- exposed to HIV infection or other sexually transmitted
disease.
 Provide information on date rape & rape prevention – high risk for this.
 Caution on dangers of flunitrazepam (Rohypnol) a benzodiazepine, colorless, odorless &
tasteless –dropped in a drink –effects- drowsiness, impaired motor skills, amnesia.
Stalking- repetitive, intrusive, & unwanted actions directed at an individual to gain the individual’s
attention or evoke fear.
Concerns on Substance abuse - refers to the use of chemicals to improve a mental state or induce
euphoria. Desire to expand consciousness or to feel response
 More confident & mature
Types of substance Abuse
1. Pain medication- morphine
2. Methylphenidate (Ritalin) –attention deficit or hyperactivity disorder –oral/ IV- feeling of
giddiness & extreme well-being result in pulmonary embolism or emphysema.
3. butane – inhaled- lead to cardiac failure
Tobacco- 20% smoking
Alcohol- 90% - lead to cirrhosis
Anabolic Steroid Abuse- testosterone- Stanozolol, oral compound & testosterone propionate injectable
form – will enhance lean body mass & muscular development, improve appearance.
Marijuana-pot or grass-Cannabis cativa- rolled into cigarettes & smoked, be mixed w/ food or sniffed.
Synaptic gaps that can delay electrical brain waves & memory storage.
 Effects: euphoria & sense of well-being, temporary impairment of coordination or motor

activities, altered sensory perception, rapid mood swings, altered self-image, decreased
attention span loss of memory for recent events
Amphetamines-group of drugs sometimes used in the treatment of hyperactivity & narcolepsy among
other CNS disorders. Called uppers or speed because they give the user a false sense of well-being,
alertness or self-esteem. A newer, stronger form that produces intense symptoms is known as “ice”-
side effects: aggressive or demanding behavior, paranoia, & extreme restlessness.
Cocaine- 3%-9% - Common names- snow & white lady- because it is supplied as a fine, white powder
that can be inhaled or injected white powder that can be inhaled or injected. Stronger form called crack-
manufactured by heating cocaine powder w/ baking soda & water. Dangerous because it uses volatile
solvents that explode, resulting crack is called freebase or rock- cause cardiac & respiratory arrythmias.
Inhaled or smoked- absorbed thru mucus membrane into the blood stream. After absorption, blood
levels rise rapidly for the first 29 min. peak at 60 min. & decline over the next 3 hours. Toxic dose 600-
700mg, Toxicity as low as 20 mg single line. Physical side effects- increased PR, Temp.& RR, BP &
decreased appetite.
Hallucinogens-lysergic acid diethylamide (LSD) dimethyltryptamine (DMT) etc- use of LSD- cause bizarre
mind reactions –distortions in vision, smell, or hearing. Effect –extremely pleasurable (good trip) or
extremely terrifying (bad trip).
 Ex- mescaline, MDMA (known as ecstasy)-cause brain damage.
Opiates- such as heroin, meperidine (Demerol) morphine. Dangerous because a of their tendency to
decrease RR- addiction lead to stealing, defraud, prostitution or any method to secure money to buy the
supply. Danger of contacting aids /HIV –sharing needles.
Methadone or LAAM (Levo –Methadyl-acetate) programs prescribed to wean themselves from opiates.
Adv. Lasts longer-72 hours rather than 24 hours.
Assessments of substance abuse:
 Failure to complete assignments in sch.

 Demonstration of poor reasoning ability
 Decreased sch attendance
 Freq. mood swings
 Deteriorating physical appearance
 Recent change in peer group
 Expressed negative perceptions of parents.
Concerns on Attempted Suicide- Suicide- deliberate self-injury to end one’s life. More in males. 3 rd cause
of death 15-19 years old, school stress bet 3 pm to midnight.
Problems- incest, abuse, increased chemical dependency, marital instability in the family, poor problem-
solving ability, drugs & alcohol use.
Regarding Runaways-an adolescent between the ages of 10 -17 who has been absent from home at
least overnight w/out permission of parent or guardian.
Characteristics- unemployment, alcoholism, sexual abuse, attempted suicide, poverty- more on male
than female.
 Health reasons- Sexually transmitted diseases, HIV/AIDS, rape, pregnancy, substance abuse,
vaginitis, hepatitis
Concerns on Physically Challenged
Problems:
 Difficulty in being as independent as they would like, achieving in sch. Establishing intimate
relationships.
 Chronic hospitalization or realization that they will never be free of symptoms can cause
depression placing them in substance abuse.
Nutrition & chronically ill Adolescent- must be aware of their total calorie intake or as growth needs
decline at the end of adolescence they can become obese. Knowledgeable in meal planning.

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NCM 107- PEDIA LECTURE- MIDTERM

Week 7 - THE FAMILY WITH A TODDLER

After the lecture, the students will be able to:

Week 7: The FAMILY WITH A TODDLER – 1-3 Years Old

Nursing Process Overview

FOR HEALTHY DEVELOPMENT OF A TODDLER

1. Health seeking behaviors related to normal growth toddler development.

2. Deficient knowledge related to the best method of toilet training.

3. Risk for injury related to impulsiveness of the toddler.

Outcome Identification & Planning:

Nursing Assessment of Growth & Development

 Physical growth actually begins to slow.

Weight, Height & Head circumference

 Head circumference equals chest circumference at 6 mo. to 1 year of age.

 Toddlers –prominent abdomen- pouchy belly.

 Lordosis- forward curve of the spine at the sacral area.

 Continue to mature, RR slow slightly but continue to be mainly abdominal.

 HR slows from 110 to 90 bpm, BP- increases to about 99/64 mm Hg.

 Stomach capacity-eat 3 meals/day.

 20 deciduous teeth are present by 2.5 to 3 years of age.

 Developmental task- According to Erickson -Autonomy vs. Shame or Doubt

 To develop a sense of autonomy is to develop a sense of independence, achieved when parents

 18 months- walks securely enough to enjoy pulling toys.

Cognitive Development- Piaget

 Deferred imitation- able to remember an action & imitate it later.

Freud’s Psycho-Analytic Theory

 Anal phase because their main focus is on the anal region.

Erickson Theory of Psychosocial Development -Toddler

 Developmental task- autonomy vs. shame or doubt. Self-government or independence) builds

Kohlberg’s Theory of Moral Development -Toddler

Piaget’s Cognitive Development- TODDLER

Growth & Development –include physical, cognitive & Developmental

 Pulse rate decreases to 85 bpm; BP about 100/60 mm Hg.

 Muscles are noticeably stronger & make activities –gymnastics possible.

Weight., Height, & Head Circumference

 has 20 deciduous teeth by 3 years; rarely new teeth erupt during.

Developmental Tasks: Initiative vs. Guilt

 Preschoolers become so intense about fantasy role, - part of “magical thinking”.

Oedipus & Electra Complexes

Moral & Spiritual Development

Freud’s Psychoanalytic Theory- Preschooler

 Masturbation is common during this phase –show exhibitionism,

Erickson’s Psychosocial Theory- Preschooler

 Period as learning initiative vs. guilt.

Kohlberg’s Theory of Moral Development -Preschooler

Piaget’s Cognitive Development -Preschooler

THE FAMILY WITH A SCHOOL-AGE - 6-12 years old

Healthy Development of the School-Age Child

 Health-seeking behaviors related to normal school –age growth & development

Outcome Identification & Planning

Nursing Assessment of Growth & Development of the School –Age Child

 10 years, brain growth is complete, fine motor coordination becomes refined.

 Pulse rate decreases to 70 to 80 bpm; BP-112/60

 Puberty is occurring increasingly earlier.

 Sex education must be introduced as part of the school curriculum.

 In both sexes, puberty brings changes in the sebaceous glands.

 Girls notices a change in her pelvic contour.

 Conscious of breast development.

 Need to know that vaginal secretions will appear.

Concern for Boys

Gross Motor Development

 7- year-old appears quiet compared w/ a rough-&- tumble 6- year-old.

 Enjoy sports such as gymnastics, soccer, & hockey.