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NURS 342 Pediatric Nursing Module 1 Study Guide: Growth and Development

revised for SP19

Resources:  

Maternal and Child Nursing Care text: Chapters 31, 33, 39, 40 ATI Content Mastery Series: RN Nursing Care of Children – Chapters 1, 2, 9 o Additional ATI Resources: Chapter 10

Instructions: Complete the following questions as you progress through the assigned chapters. Utilize this study guide for quizzes and exams. Some portions of this study guide will be included in your assigned worksheet that you will submit for a grade. Some of the tables and questions in this study guide are the same as your worksheet to be submitted in Canvas for a grade. You can copy your work from this study guide.

 CHAPTER 31: Growth and Development  Describe Cephalocaudal development in terms of the infant’s activity, control, and what they learn to do: o development proceeds from the head downward. o Infants gain control of head and neck before the trunk and limbs. o Infants learn to hold their head up before sitting and to sit before standing. o Walking involves the legs and feet develop last in infancy.  Describe Proximodistal development in terms of activity, control, and what they learn to do: o Proceeds from the center of the body outward towards the extremities. o Infants are able to control the trunk, then the arms; only later are fine motor movements of the fingers possible. o The child controls arm movements before hand movements. 

How is anticipatory guidance used by nurses? To predict upcoming developmental tasks or needs of a child and to perform appropriate teaching related to them.

Briefly describe each theorist’s explanation of each developmental age in the table below: (The following table is a section of your worksheet that you will submit for a grade) Identify each level and Birth – 1year Toddler 1 – 3 Preschool 3 – 6 School Age 6 – Nursing Applications for years years 12 years each theory below: Freud’s Theory of Development Erickson’s Theory of Development Piaget’s Theory of Development

Adolescent 12 – 18 years

Define the Common Defense Mechanisms used by Children defined in the table below and give an example of each: (page 747) Defense

Definition

Example

NURS 342 Pediatric Nursing Mechanism Regression

Repression Rationalization Fantasy

Return to an earlier behavior.

Involuntary forgetting of uncomfortable situations. An attempt to make unacceptable feelings acceptable. A creation of the mind to help deal with unacceptable fear.

A child who has been previously toilet trained becomes incontinent when a new infant is born into the family. An abused child cannot consciously recall episodes of abuse. A child explains hitting another because “he took my toy”. A hospitalized child who is weak pretends to be Superman.

(The following table is a section of your worksheet that you will submit for a grade) Birth – 1year Toddler 1 – 3 Preschool 3 – 6 School Age 6 – years years 12 years Briefly describe the Physical Growth & Developmental Milestones for each age group. Identify Psychosocial Development (Play, Activities) appropriate for each age group while in the hospital. Describe Age Appropriate Communication Strategies for the nurse to use in the hospital setting.

Adolescent 12 – 18 years

 When does an infant’s weight double? 5 - 6 months  When does an infant’s weight triple? 1 year  When does a child weigh four times their birth weight? 30 months of age

 CHAPTER 33: Pediatric Assessment (pages 806 – 813)  When beginning your interview or assessment, what strategies can you utilize in order to build rapport with the family? o Introduce yourself (name, title or position, and role in caring for the child). o Explain the purpose of the interview and why the nursing history is different from the information collected by other health professionals. o Provide privacy and remove as many distractions as possible during the interview. o Direct the focus of the interview with open-ended questions. o Ask one question at a time so that the parent or child understands what piece of information is desired and so that it is clear which question the parent is answering. o Involve the child in the interview by asking age-appropriate questions. o Be honest with the child when answering questions or when giving information about what will happen. o Choose the language style best understood by the parent and child.

NURS 342 Pediatric Nursing o

Use an interpreter to improve communication when not fluent in the family’s

primary language.

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When collecting data, which data pieces about current health status would you include that you would not normally include in an adult’s health status? o Immunizations o Safety measures used o Activities and exercise o Nutrition o Sleep

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What are the key topics to address when collecting psychosocial data for adolescents? (HEEADSSS screen tool) o Home environment o Education and employment o Eating o Activities o Drugs (substance abuse) o Sexuality o Suicidal thoughts o Safety, savagery (exposure to violence)

 Developmental Approach to the Examination  Briefly describe the specific approaches for each age group when performing a physical exam: Developmenta l Age Newborns & Infants under 6 months of age

Approach and Techniques to use when performing a physical exam:

Sequence of the exam

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Keep the parent present to provide comfort and security for the infant by feeding, using a pacifier, cuddling, or changing the diaper to keep the infant calm and quiet. Distraction such as rocking or clicking noises may help when the infant gets distressed. Portions of the exam that may disturb the infant, such as the exam of the hips, should be performed last. Often best to examine the infant and toddler on the parent’s lap and then held against the parent’s chest for some steps, such as the ear exam. Make sure the room is warm. Smile and talk soothingly to the infant. Use toys to distract the older infant. Use a pacifier or bottle to quite the child when necessary.

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Head-to-toe, but be flexible: take advantage of times when the infant is quiet or asleep to auscultate.

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Keep toddlers with parents, even on their lap, because of their stranger anxiety. For invasive assessments, parent can hold the child close to the chest with legs between parent’s legs. Demonstrate use of instruments on the parent or security object to reduce anxiety.

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Begin with the feed and hands before moving to the trunk because the infant may be fearful of strangers. Take advantage of opportunities to auscultate when infant is quiet or asleep. Begin exam by touching the feet and then move gradually toward the body and head. Use instruments to examine ears, eyes, and

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Infants over 6 months of age

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Toddlers

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NURS 342 Pediatric Nursing

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Preschoolers

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School-age

       

Adolescents

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 Avoid asking for permission to perform the exam. When a choice is possible, let the child have some control. Much of neurological and musculoskeletal exams can be performed by observing he child play and walk around the exam room. Assess the willingness of the child to be separated from the parent. Most children are willing to undress but leave the underpants on until conducting the genital exam. Allow child to touch and play with equipment. Give simple explanations about the assessment procedures and offer choice when possible. Use distraction to gain cooperation, such as asking the child to count, name colors, or talk about a favorite activity. Give positive feedback when the child cooperates. Willingly cooperate and want to be helpful, so have them sit on the exam table. Anticipate the development of modesty and offer patient own to cover the underwear. Let older school-age child determine if the exam will be conducted in privacy or with parent or siblings present. Demonstrate how the instrument are used and let he child handle them if they wish. During exam, explain what you are doing and why. Offer as many choices as possible to help the child feel empowered. The exam is a good time to teach the child about how the body works, such as letting the child listen to heart and breath sounds. Protect modesty by providing a private place to undress and put on the patient gown, and then during the exam by covering the part so the body not being assessed. Perform without parent or siblings unless the adolescent specifically requests parent’s presence but provide a chaperone (preferably the same genre as the client) when the parent or accompanying adult is not present.

mouth last as they often cause anxiety.

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Some prefer to have head, eyes, ears, and mouth examined first while others will prefer to postpone to the end.

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Head-to-toe sequence can be used.

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Head-to-toe sequence as used for adults.

Only a few questions regarding the actual physical assessment will be reviewed here. These questions will highlight assessments you will typically not perform on an adult. You can review information in the rest of the chapter on your own.

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Palpation of the Skull o When does the posterior fontanelle normally close? 2 to 3 months of age o When does the anterior fontanelle normally close? 12 to 18 months of age

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Hearing Assessment o What are the indicators of hearing loss in an infant?  No startle reaction to loud noises.  Does not turn toward sounds by 4 months of age.  Babbles as a young infant but does not keep babbling or develop speech sounds after 6 months of age.

NURS 342 Pediatric Nursing

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o What are the indicators of hearing loss in a toddler? No speech by 2 years of age. Inability to follow age-appropriate directions, such as “Bring me the block.” Speech sounds are not distinct at appropriate ages.

Infant Reflexes (utilize your ATI Review book: page 10) – For each infant reflex, describe the test, the expected findings, and the expected age in the table below:

Infant Reflex Sucking and Rooting reflexes

Palmar grasp

Reflex test and Expected Findings Test: Elicited by stroking an infant’s cheek or the edge of an infant’s mouth. . Expected Findings: The infant turns head toward the side that is touched and starts to suck Test: Elicited by placing an object in an infant’s palm.

Plantar grasp

Expected Findings: The infant grasps the object. Test: Elicited by touching the sole of an infant’s food.

Moro reflex

Startle reflex

Tonic neck reflex (Fencer position) Babinski reflex

Stepping

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Expected Findings: The infant’s toes curl downward. Test: Elicited by allowing the head and trunk of an infant in a semi-sitting position to fall backward to an angle of at least 30 0. Expected Findings: The infant’s arms and legs symmetrically extend, then abduct while fingers spread to from C shape. Test: Elicited by clapping hands or by a loud noise. Expected Findings: the newborn abducts arms at the elbows, and the hands remain clenched. Test: Elicited by turning an infant’s head to one side. Expected Findings: the infant extends the arm and leg on that side an flexes the arm and leg on the opposite side. Test: Elicited by stroking the outer edge of the sole of an infant’s foot up toward the toes. Expected Findings: The infant’s toes fan upward and out. Test: elicited by holding an infant upright with his feet touching a flat surface. Expected Findings: The infant makes stepping movements.

Expected Age Birth to 4 months

Birth to 3 months Birth to 8 months Birth to 4 months

Birth to 4 months Birth to 3 to 4 months Birth to 1 year

Birth to 4 weeks

Using your ATI reference book, pages 15-16, answer the following questions regarding normal Dentition for an infant: o When do the first teeth typically erupt? 6 to 10 months of age o How many teeth do they typically have at the end of 1 year? 6 to 8 o What can be used for teething pain?  Frozen teething rings  An ice cube wrapped in a wash cloth  OTC teething gels o What are the considerations for use of medications such as acetaminophen or ibuprofen for teething?  Appropriate if irritability interferes with sleeping and feeding.  Should not be used for more than 3 days.

NURS 342 Pediatric Nursing

o o

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o At what age is it considered safe to use ibuprofen? Over 6 months What is the proper way to clean infants’ teeth? Cool, wet washcloths Why should bottles not be given to infants when they are falling asleep? Prolonged exposure to milk or juice can cause early childhood dental carries.

Review the tables on page 841 and 844 of your Maternal & Child text for the Gross Motor and Fine Motor Milestones:

Average age (in months) 4 6 9 12 18 24 36

Gross Motor Milestones (Table 33.14)

Fine Motor Milestones (Table 33-18)

If prone, pushes up on elbows Rolls over in both directions

Reaches for a toy with one hand Transfers objects between hands, brings objects to mouth Thumb finger grasp to pick up small objects

Gets to sitting position and sits without support Creeps or crawls Pulls self to standing position Takes a few steps walking alone May walk up steps Climbs on furniture without help Rides tricycle

Bangs items together, releases toy without help Uses spoon to feed self Builds tower of four or more blocks

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Posture and Spinal Alignment o What is the assessment specifically for the school-age child and adolescent to assess spinal alignment? Assessment for scoliosis, a lateral spine curvature.  What you expect as normal findings and what are abnormal findings?  Normal: no curve should be present when the child bends forward at he waist with head and arms toward the floor. Ribs should stay flat bilaterally. The lumbar concave curve should flatten with forward flexion.  Abnormal: A lateral curve to the spine or a one-sided rib hump is an indication of scoliosis.

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Expected language Development (table 33-16): fill in the expected language milestones for each of ages in the table below: Age attained 4 - 6 months 12 months 1 - 2 years 2 - 3 years 3 – 4 years 4 - 5 years

Language Milestones Babbles speech like sounds, including p, b., and m Has 1-2 words like mama, dada, bye-bye Increases words each month; two-word combinations (e.g., “Where baby?” and “Want cookie”) Two- to three-word sentences to ask for things or talk about things; large vocabulary; speech understood by family members. Sentences may have four or more words; speech understood by most people. Says most sounds correctly except a few like l, s, r, v, z, ch, sh, th; tells stores and uses same grammar as rest of family.

 CHAPTER 39: Nursing Considerations for the Hospitalized Child

NURS 342 Pediatric Nursing

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o Effects of Hospitalization on Children and Their Families Identify the common stressors for each of the age groups for a hospitalized child and ways to minimize these stressors:

Developmental Age Infants

Common Stressors

Ways to Minimize effects of stressors

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*Separation from parents manifested by separation anxiety Painful procedures Immobilization of extremities Sleep deprivation, sensory overload

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Toddler

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*Separation from parents is the major stressor. Loss of self-control Immobilization Painful, invasive procedures Bodily injury or mutilation Fear of the dark

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Preschooler

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School-age

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Adolescent

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Separation anxiety and fear from abandonment Loss of control related to bodily functions Privacy issues Bodily injury or mutualization Painful, invasive procedures Fear of the dark and monsters Loss of control Loss of privacy and control over bodily functions Bodily injury Separation from family and friends Painful, invasive procedures Fear of death

Loss of control Fear of altered body image, disfigurement, disability, and death Separation from peer group Loss of privacy and identity

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Encourage parental presence Adhere to infant’s home routine as much as possible. Utilize topical anesthetics or preprocedural sedation as prescribed. Promote a quiet environment and reduce excess stimuli. Encourage parental presence. Allow parents to hold child in their lap for examinations and procedures when possible. Allow choices when possible. Utilize topical anesthetics or preprocedural sedation as prescribed. Explain all procedures using simple developmentally appropriate language. Provide a night-light. Encourage parental presence. Allow choices when possible. Utilize topical anesthetics or preprocedural sedation as prescribed. Explain all procedures. Provide a night-light or flashlight.

Encourage parental participation. Allow the child choices when possible. Explain all procedures and offer reassurance. Utilize topical anesthetics or preprocedural sedation as prescribed. Encourage peer interaction via internet, phone calls, and other methods of communication. Include the adolescent in the plan of care. Encourage discussion of fears and anxieties. Explain all procedures.

NURS 342 Pediatric Nursing

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Ask the adolescent about the desire for parental involvement. Encourage peer interaction.

(The following questions related to support before, during, and after a procedure are required on your worksheet that you will submit for a grade). This information begins on page 949 of the Maternal and Child text. 

Describe appropriate methods for preparing children for procedures. Identify techniques appropriate for each developmental level (page 951). o Infants:  Explain to parents the procedure, th reason for it, and their role.  Allow parents the option of being present for procedures.  Parents may be able to touch a foot, rub a cheek, and talk soothingly to the infant. o Toddler:  Give explanation just before the procedure, since toddler’s concept of time is limited.  Explain that the child di nothing wrong, and that the procedure is imply necessary. o Preschool child:  Give simple explanations of the procedure.  Basic drawings may be useful.  While providing supervision, allow the child to touch and play with equipment to be used, if possible.  Since any entry into the body is viewed as a threat, state that the child’s body will remain the same, and use adhesive bandages to reassure the child that the body Is intact and parts will not “fall out”. o School-age child:  Clear, thorough explanations are helpful.  Use drawing, pictures, books, and contact with equipment.  Teach stress-reduction techniques such as deep breathing and visualization.  Offer a choice of reward after the procedure is completed. o Adolescent:

  

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Give clear explanations orally and in writing. Teach stress-reduction techniques. Explore fear of certain procedures, such as staple removal or venipuncture.

Describe appropriate methods for supporting a child during a procedure. Identify techniques appropriate for ...