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Growth and Development Psychosexual Psychosocial Cognitive Moral Hospitalized Child Common Complications in Pediatrics High risk Newborn
Growth and Development
Growth- increase in physical size of a structure or whole. -quantitative change. Two parameters of Growth weight- most sensitive measure of growth, especially low birth rate. Wt doubles 6 months 3x 1yr 4x 2-2 ½ yrs 2. Height- increase by 1µ/mo during 1st 6 months - average increase in ht - 1st year = 50% stoppage of ht coincide with eruption of wisdom tooth.
Development- increase skills or capability to function qualitative How to measure development Observe child doing specific task. Role description of child·s progress DDST- Denver development screening test. MMDST (Phil) Metro Manila Developmental Screening Test. DDST measures mental
INFANT- 0-12 months
Fears- Stranger Anxiety Type of play- Solitary Toys- rattle and others
TODDLER- 1- 3 years
Fear- Separation Anxiety Type of play- parallel Toys- Push pull toys
PRESCHOOL 3-6 years
Fear- Ghost/Mutilation Type of play- Housekeeping toys,puzzles
SCHOOL AGE 6-12 years
Fear-Failure at school Type of play- competitive Toys- TV, video, bicycles
ADOLESCENCE 12- 18 years
Fear- relationship with opp.sex Play- competitive
THEORIES IN GROWTH AND DEVELOPMENT
SIGMUND FREUD ERIC ERICKSON PIAGET LAURENCE KOHLBERG
Psychosexual Development ( Sigmund Freud)
Sigmund Freud 1856-1939 Austrian neurologists. Founder of psychoanalysis - offered personality development Psychosexual theory
² Id ² pleasure principle ² Ego ² reality testing- out in contact realitydistorted ego ² during toddler ² SE
a.) Oral Phase 0-18 months - Mouth - site of gratification -activity of infant- biting, sucking crying. -why do babies suck?- enjoyment and release of tension. -provide oral stimulation even if baby was placed on NPO. -pacifier. -never discourage thumb sucking.
b.) ANAL- 18 months-3 years -site of gratification- anus
-activity- elimination, retention or defecation of feces make take place - principle of holding on or letting go. -mother wins or child wins -child wins- stubborn, hardheaded anti social. (anak pupu na, child holds pupu, child wins) -mother wins- obedient, kind, perfectionist, meticulous -help child achieve bowel and bladder control even if child is hospitalized.
c.) Phallic- 3-6 years site of gratification -genitals activity- may show exhibitionism -increase knowledge of a sexes -accept child fondling his/her own genitalia as normal exploration -answer Childs question directly. Right age to introduce sexuality ² preschool
d.) Latent- 7-12 years -period of suppression- no obvious development. -Childs libido or energy is diverted to more concrete type of thinking -helps child achieve (+) experience so ready to face conflict of adolescence
e.) Genital- 12-18 years -site of gratification -genitals -achieve sexual maturity -learns to establish relationships with opposite sex. -give an opportunity to relate to opposite sex.
PSYCHOSOCIAL/ PSYCHOANALYSIS ERICKSONS
T-rust VS. Mistrust A-utonomy VS. Shame and Doubt ² offer choices I ² nitiative VS. Guilt I ² ndustry VS. Inferiority ² sense of control - teacher I ² dentity VS. Role confusion ² WHO AM I? I ² ntimacy VS. Isolation ² love, work and play G ² enerativity VS. Stagnation ² guiding next generation E ² go integrity VS. Despair - late adolescent
STAGES OF PSYCHOSOCIAL
Trust vs mistrust ² 0-18 months. -foundations of all psychosocial task -to give and receive is the psychosocial theme -know to develop trust baby 1. satisfy needs on time - breastfeed 2. care must be consistent and adequate -both parents- 1st 1 year of life 3.) give an experience that will add to securitytouch, eye to eye contact, soft music.
Autonomy vs shame and doubt 18-3 years --- independence /self gov·t develop autonomy on toddler give an opportunity of decision making like offer choices. encourage to make decision rather then judge. set limits
industry vs inferiority 7-12 yrs -child learns how to do things well -give short assignments and projects
Identity vs role confusion or diffusion 12-18 yrs - learns who he/she is or what kind of person he/ she will become by adjusting to new body image and seeking emancipation form parents -freedom from parents.
Intimacy vs isolation 20-40 yrs looking for a lifetime partner and career focus Generatively vs stagnation 40- 60 45-65 yrs Ego integrity vs. despair 60-65
COGNITIVE DEVT. ² JEAN PIAGET
JEAN PIAGET- Swiss psychologist -develop reasoning power 0-2 sensory motor-´practical intelligenceµ- words and symbols not yet available baby communicates through senses and reflexes 2-7 pre²operational ² intuitive phase-concept of dying i 7-11 ²concrete operational ² start to sort, make an order, collect items, sorting cards 11-19 ² formal operational- stage of abstract and logical thinking, stage of irreversible ²activity -will sort out opinions and current events.
MORAL DEVELOPMENT - kOHLBERG
KOHLBERG- recognized the theory of moral dev·t as considered to closely approximate cognitive stages of dev·t -sabay with cognitive dev;t P ² unishment reward I ² nstrumental exchange G ²ood boy/ Good girl L ² aw and Order S ² ocial Contract ² welfare of others U ² niversal Ethics ² principle conscience. Welfare of universe
HOSPITALIZED CHILD Separation Anxiety
3 phases of separation anxiety (in order) 1. P- protest 2. d despair 3. d- denial -don·t prolong goodbye -say goodbye firmly to develop trust- say when you·ll be back
Hospitalized Adolescent Child
Fear of physical - body image disturbance Fear of rejection from peers ² lack of confidence; privacy
Make the child feel comfortable with the nurse Let the child play with objects (play tx)- effective; but not needles Offer choices ² obey the choice and respect the choice
Infants ² 1-12 months ²oral phase Anterior fontanel ² annum 12-18 mos. Posterior fontanel 2-3 mos. Safety ² aspiration, choking ²age app. Toys, no raisins, hotdog, grapes, nuts Car seat ² 20 lbs ² center backseat rear facing Crib ² measurement 2.375; away from curtains and blinds
Toddlers- 1-3 yr. old (1236 mos) -Anal phase
Weight gain ² slow growth, slower than infant 2x 22-27 lbs Child seat ² 20-40 lbs front facing Bowel and bladder control ² toilet training- how? Baby is dry for 2 hrs Safety ² explore the world, supervised play, prone to accidents MVA, falls,burns,drowning, poisoning.oral ingestions ² locked all cabinets!
Preschooler ² 3-6 yrs
Magical thinking Bowel and bladder control ² normal bedwetting age & 4 accidental bedwetting; enuresis- cont. polyuria- IDDM, post traumatic exp/stress (rape/ violence) Mimic superheroes Carseat ² booster seat
School Age Child ² 6 y
Safety ² car safety belts, use of helmets when biking, roller blades, skateboards Biking ² parallel to the flow of traffic
Risk takers ² 1. motor VA 2. suicide Safety ²effects of drugs + alcohol ² head and spinal cord injury
Head injury ² (hemorrhage, hematoma,accident) Assessment ² ICP cerebral hypoxiaEarly ² restlessness Late ² bradycardia ² irreg breathing , widening pulse pressure, decorticate, decerebrate Interventions ² check airway, breathing, CSF leak, dec. secretions ² suction as ordered, Mannitol, decadron,
Neural tube defects and anomalies of head Increased head circumference; sunset eyes Increased ICP Positioning ² unoperated Assessment ² check ICP; HOB elevated 1530 degree Shunt for older children
Neural tube defect Sac Positioning Meningocele ² meninges, CSF, Sac, Myelomeningocele ² spinal cord, meninges, CSF,sac After surgery, position prone ² tension in the sac
Acute encephalopathy Etiology ² intake of aspiration after viral illness or fever with unknown origin children below 18
Inflam. of meninges ² bacterial or viral ² resp. inf Increased ICP ² fever seizure
Cerebral hypoxia ² dec. blood supply Priority ² airway and safety, placed on side, slide on the floor Drug- Phenobarbital
Aggressive, impulsive, hyperactive, dec. concentration, inc. motor coordination R italin - effect: inc. concentration D exadrin side effects: insomnia + loss of appetite S tranera AM or last dose 2 pm or 6 hrs prior to bedtime C ylert AM just after breakfast C onserta Monitor ht. and wt. ² failure to thrive - active
Child Abuse- mandatory report
Assess ² transcultural nrsg., physical, neglect, sexual Physical ² burns, bruises, cigarette burns, belt bruises Sexual ² inspect genital swelling, anal perforation Neglect ² malnutrition, poor hygiene Nursing Responsibility ² child protective agency Safety- report! ² place in havens support group
Cause poor feeding technique ² s/s: lead to meningitis Feeding Technique ² upright position Head pain, rolling, ear tugging Ear medications ² ABT tx completed; side of ear canal to prevent dizziness Ear plugs ² equalize pressure in the inner ear, prevent infection Swimming. Take a bath, shampooing No submerging or diving
Positioning ² prone/ side lying-post op MGT. ² Liquids ² clear, cool, non-citrus, non carbonated, non-red ² No kool aid ² cherry and strawberry Frequent swallowing ² s/s of bleeding No clearing of throat
Epiglotitis - Croup
Bacterial or viral Emergency Assessment-inspiratory, stridor, nasal flaring Positioning-wt. dependent- arms ² tripod position Avoid- no tongue blade, throat culture, do not visualize pharynx Don·ts ² No restraints Vaccine ² HIV conjugated vaccine
inflam.of larynx, trachea upper bronchi Assessment- bronchospasm ² barking cough Priority- maintain patent airway For hospitalized child-humidified O2 via cool mist tent Hypoxemia - vaporizer
LTB/Group- viral laryngotracheo bronchitis
Mode of Transmission ² hands/contact transmission ² inanimate objects Room Precaution- contact isolation ² private-same org. cohort ² 3 ft -36 in Positioning- 30-40°angle Antiviral-Ribavirin- Virazole ² Acrozole- mist tent/hood Nurse- wear goggles
Streptococcal Primary Atypical- mycoplasma School aged Viral- no meds. Med dx: C+S group B beta-haemolytic Streptococcus, which only occurs in the newborn
Emergency/vigorous mngt. ² obstruction ² silent chest- diminished resp. distress Positioning for younger children- tripod Complication ² ventillatory failure, asphyxia Medications- beta agonist, steroids Allergen Control- no to allergens, weather changes Home Care Measures- eliminate allergens
Status Asthmaticus / bronchospasm
Mucovisciodosis- thick, tenacious sputum body fluids Most common symptoms- early meconium ileus, sticky, greenish to black stool (small intestine) Common respiratory problems ² bronchopnea, bronchitis Skin-salty when kiss, malabsorption, steatorrhea Diagnostic Test- sweat chloride test, Priority Intervention ² patent airway, chest physiotherapy, bronchodilator,pancreatic enzymes, meds, inc. vit ADEK, increase sodium in the diet
SIDS/ Sudden Infant Death Syndrome
CRIB death Age- 3-6 mos peak/ under age 1 Prevention-supine pos. never prone, avoid bed sharing, no large stuff toys Cause- cocaine during preg., effect of season ² winter with adults
Failure to the heart to pump blood in response to venous Assessment of early signseyebrow sweating; dec. cardiac output ² tachycardia and profuse cough Interventions- monitor V/S, I & O, small frequent feedings Medications- digoxin,Ace inhibitors, lasix, K supplementshypokalemia
Defects with Increased Pulmonary Blood Flow/ L Acyanotic
ASD-Atrial septal defect ² L to R shunting- inc. pressure @ the R side of heart, inc. pulm artery VSD-ventricular SD ² L to R shunting, inc. pressure @ the R ventricle, inc. pulm artery PDA- inc. aortic blood flow ² machinery murmurs
Coarctation of Aorta-narrowing of the aorta ² dec. O2 upper Rw/ O2 lower R ² no O2 check temp, check V/S Aortic Stenosis- Marpan syndrome
Defects with Decreased Pulmonary Blood Flow
TOF-tetralogy of Fallot PS ² pulmonary stenosis VSD-vent. Septal defect OA ² overriding of the aorta RVH- complete repair TA-tricuspid Atresia- creation ASD TOGV- transfer of great vessel; aorta ²R vent. Pulm. Artery ² R ventricle Intervention- Prostaglandin E Complication- CHF
Major Concern- Resp/GI, neurological alkalosishypokalemia ² weakness - DHN Position- side lying - aspiration - pyloric stenosis- non bile stain ² Projectile vomiting ² with altered LOC I&O
Diarrhea ² acidosis Acid base Imbalance Fluids
Interventions ² post op ² use rubber tipped/ dropper Positioning ² side lying or supine, logan bar, sterile Cheiloplasty- 2 mos. Cleft palate ² interventions ² palatoplasty 12- 18 mos Positioning ² abdomen, prone, use CUP Restraints ² soft elbow, jacket restraint, no formula with NSS, elbow restraint
Esophageal Atresia/ TEF
Polyhydramnios- inc. in amniotic fluid- blind pouch- obstruction Assessment ² drooling, frothy mouth and nose Intervention-pre op- resp. distress, NPO, IV fluids Intervention-post opgastrostomy tube ² ABC
Narrowing in pyloric region-projectile vomiting Assessment ² olive-shape mass, non bile stain, visible peristalsis Pyloromyotomy ² removal of stenosis Pre-op ² fluids, I&O, NGT Post op- airway, I&O, IV, pos. after feeding-upright for 30 min - GERD
Gluten Sensitive Enteropathy ² profused watery diarrhea no to BROW Intervention -Gluten free diet Diet- rice, corn, small seed crops- certain type of cereal Exposed to infection and ingesting of gluten
HIRSCHSPRUNG DISEASE- child
Megacolon Aganglionic Ribbon like stool- constipation 50 y/o-Colorectal CA Mgt; Colostomy- temporary
OLDER- Colostomy- permanent
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