Peds chapter one review

a nurse who was interested in the welfare of children, and is credited with suggesting the establishment of a Federal Childrens Bureau. (est. 1912)

Lillian Wald

• 1912
• infant mortality
• maternal mortality
• birth registration in all states.

the development of hot lunch programs in many schools.

the depaartment of health, and human services.

a body of socially inhereted characteristics that one generation hands down to the next. ((consists of values, beliefs, and practices shared by members of the group))

a consious awareness of the cultural values, beliefs, and preseptions of one's self and others.

an understanding of and sensativity to cultural practices that differ from ones own.

a quality, attained by cultural awarness and sensativity, that enables health care providers to adapt practices to meet the  needs of patients from various cultures

what she considers normal practice

• 1 - how does the woman view her preganancy? (as an illness, a vulnerable time, or a healthy time )
• 2 - Does she view the birth process as dangerous?
• 3 - in what position does she expect to deliver? (squating, lothotomy, or some other position?)
• 4 - What type of help doed she need before, and after delivery?
• 5 - What role does her immediate, and extended family play in relation to the pregnancy, and birth?

F - strong

adaptation to the birth experience.

developed in 1963 The nursing process refers to the searies of steps describing the process nurses use to identify, prevent or treat actual or potential health problems.

• 1 - assessment: Collection of patient data, both subjective, and objective.
• 2 - Diagnosis: Analisis of data in terms of NANDA nursing diagnosis.
• 3 - Planning: Preperation of a plan of care designed to achieve stated outcomes
•    Outcomes identification: Identification of individualized expected patient outcomes.
• 4 - implamentation: Carrying out of interventions identified in the care plan.
• 5 - Evaluation: of outcome process and redesigning of the plan if nessisary.

developed as a result of the nursing process It is a written insturment of communication among staff members that focusses on individualized patient care

collabpritive guidelines that define multidissiplinary care in terms of outcomes within a timeline (Aka. Critical pathways, mare maps, or multidisiplinary action plans)

it identifies expected process within a set timelline, and benchmarks by which to recognize this progress.......Clinical Pathways improve the quality of care and reduce unnessisary hospitialization time.

when a daily goal for progress is not met, it is called a deviation or variance. these variances. if a goal is not achieved and time is lost it is known as a negative variance. negative varainces can delay discharge from hospitals.

purpodefull,goal-directed thinking based on scientific evedence rather than assumption or memorization. Critical thinking entails applying creativity, and ingenuity to solve a problem.

• 1 - Identify the problem
• 2 - Differentiate fact from assumption
• 3 - Check reliability and accuracy of data
• 4 - Determine relevent from irrevelant data
• 5 - Identify possible conclusions or outcomes
• 6 - Set prioritys and goals
• 7 - Evaluate response of patient

Nursing intervention classification specifies actions that nurses perform to help patients toward a specafied goal or outcome.

Nursing outcomes classification Develpoed to identify outcomed of nursing care that are directly influenced by nursing actions

• Trust/Mistrust
• Getting needs met
• Tolerating frustration in small doses
• Recognizing mother as distinct from others and self

• Sensorimotor Stage (birth to 2 years) –
• at birth, responses are limited to reflexes; begins to relate to outside
• events; concerned with sensations and actions that affect self directly

• Preconventional/premoral
• – cannot distinguish
• right from wrong

• Autonomy/Shame and doubt
• Trying
• out own powers of speech
• Beginning acceptance
• of reality versus pleasure

• Preoperational (2 to 7 years) –
• child is still egocentric; thinks everyone sees world as self does

• Punishment/obedience – performance based
• on fear of punishment

• Initiative/guilt Questioning
• Exploring
• own body and environment
• Differentiation of
• sexes

• Perceptual (4 to 7 years) –
• capable of some reasoning but can concentrate on only one aspect of a situation
• at a time

• Morality –
• rules are absolute; breaking rules results in punishment; behavior based on rewards

Conventional morality – rules are created for the benefit of all; adhering to rules is the right thing to do (7 to 11 years)

Concrete operations (7 to 11 years) – capable of some reasoning but can concentrate on only one aspect of a situation at a time

Industry/inferiority  Learning to win recognition by producing things Exploring, collection Learning to relate to own sex

• Identity/role diffusion
• Moving toward Heterosexuality. Selecting vocation. Beginning separation from family. Integrating personality

• Principled morality (autonomous stage)
• (12 years on) – acceptance of right or wrong on basis of own perceptions of world and personal conscience

• Formal Operations (11 to 16 years) –
• acquires ability to develop abstract concepts for self; oriented to problem solving

proceeds from head to toe. The infant is able to raise the head before being able to sit, and he or she gains control of the trunk before walking

 – proceeds from midline to the periphery. Development proceeds from the center of the body to the periphery. These patterns occur bilaterally.

• Height – refers to standing measurement, whereas length
• refers to measurement while the infant is in recumbent position.

50cm (20 inches).

The length of the infant usually increases about 2.5 cm (1inch) per month for the 6 months. By age 1 year, the birth length increases by 50%

The infant usually regains his or her birth weight by age 10 to 12 days.

Birth weight usually doubles by age 5 to 6 months and triples by age 1 year.

• After the first year, weight gain levels off to approximately
• 1.81 to 2.72 kg (4 to 6lbs) per year, until the pubertal growth spurt begins

• Growth is measured in dimensions such as height,
• weight, volume, and thickness of tissues. 
• A number of standards have been developed to make it possible to compare
• 1. The measurement of a child to others of the same age and sex, and
• 2. The child’s present measurements with the former rate of growth and pattern of progress.     
• Length refers to horizontal measurement; it is used before achild can stand, usually from birth to 2 years.
• Height is measured with the child standing, usually between 2 and 18 years.
• Some pointers in reading and interpreting growth charts are as follows:
• Children who are in good health tend to follow a consistent pattern of growth
• At any age there are wide individual differences in measured values

• Development of the 20 deciduous, or baby, teeth begins at about the first month of intrauterine life. The health and diet of the expectant mother affect their soundness. Primary teeth erupt during the first 2.5 years of life. It is a normal process and is generally accompanied by little or no discomfort. 1st tooth generally appears at about the sixth or seventh month. The 1 year old has about 6 teeth four about and two
• below.

• The 32 permanent teeth develop just before birth
• and during the first year of life. They do not erupt through the gums, however
• until the sixth year. Nutrition and general health during the first year of life affect the
• formation on permanent teeth. This process is completed until the wisdom teeth
• appear at about age 18 to 25 years.

age in minths - 6

• found in infants
• Provide visual stimuli for newborns; touch
• stimuli for infants, and toys involving manipulations for 1-year-olds

• occurs in 1 to 2 year olds
• Children play next to each other but with each
• other. Provide each child with toys that reflect activities of daily living

• Occures in 3 to 5 year olds
• Children play with each other, each taking a specific roll: You be the mommy and I’ll be the daddy.”
• A simple box can
• become a train to a 3-year-old

• Occures in 5 to 7 year olds
• Secret codes, “Knock-Knock” jokes, and rhymes
• are popular at the age

• Occurs in 7 to 10 year olds
• Children at this age start to accept competition
• with structured rules and highly interactive physical activity

occures in 10 to 13 year olds ------ internet should be supervised

• 13 to 18 year olds
• Leadership activities such as baby-sitting or tutoring are popular.
• Daydreaming occurs.
• Board games are popular.
• Interactive social activities
• in “cliques” occur at and after school

6 months is recommended because this is when the tongue extrusion reflex has completely disappeared and the gastrointestinal tract is mature enough to digest foods. Parents should be instructed to read the labels on the jars to obtain nutrition information

Offer only small amounts at first (1 teaspoonful). A small amount of food is placed on the back of the tongue

• Only one new food isoffered in a 4-day to 1-week period to determine tolerance.
• IF the infant refuses a certain food, it is temporarily omitted. Mealtime is kept pleasant
• New foods should not be introduced when the
• infant is ill because adverse responses may not be effectively assessed.
• Offer new foods BEFORE milk feedings

• Highly allergenic foods that may be delayed
• include orange juice, fish, nuts, strawberries, chocolate, and egg whites *honey should also be ommited for the first year -- not because of allergy issues but to prevent the development of botulism.

• (protrusion of the tongue), which pushes food out of the
• mouth to prevent intake of inappropriate food, disappears. after about the fourth month.

• 1 - the infant has gained 4 to 7 oz per week for the first 6 months
• 2 - the infant has at least six wet diapers per day.
• 3 - the infant sleeps peacfully for several hours after feedings.

bottle feedings 3 - 4 hour intervals, breast feeding, 2 - 3 hour intervals.

10 to 20 mL at birth, 200 mL by twelve months.

complex nutrients , allergens

infants should be positioned for sleep on their backs and on a firm mattress, both for their safety and to prevent sudden infant death syndrome (SIDS).....((((comforters, pillows, quilts, loose bedding, thick pillow like crib bumpers can endanger a child in a crib)))))

• 1 month  :Chin up
• 2 months :Chest up - Elevates self with arms
• 4 months :Rolls over at will
• 5 months :Sits alone, momentarily
• 6 months :Sits alone steadily with hands forward for support
• 8 months :Sits with  support. Pulls to standing positon
• 9 months :Creeps
• 10 months :Walks whenled
• 11 months :stands alone from standind position
• 12 months :Walks 3 steps
• 15 monthd :Can walk up stairs with support

18 to 24

waking up dry, maturity

potty-chair

• 1 - when the toddler stays dry for about 2 hours at
• a time
• 2 - when the parrent discover that the toddler has gone the entire night without wetting

age 4 years

parents should accept it matter-or-factly and merely change the clothes. Children benefit when adults show continuous affection to them and accept both bad and good days.

• including toilet training, self feeding, self
• dressing and speech development.

• 1 - One major parental responsibility is to maintain safety whileallowing the toddler the opportunity for social and physical independence.
• 2- Another major parental responsibility is to maintain a positive self-image andbody image in the child whose behavior is inconsistent and often frustrating.

• 1- Inadequate establishment of self - concept, leading to lack of confidence, even in unfamiliar environments
• 2 - Uses protest of seporation as a manulipitive control device.
• 3 - fear of being abandoned

• 1- prepare toddler for anticipated seporation
• 2 - refer to toime using concrete terms, like "I will be home after lunch" instead of " I will be home at one"
• 3 - Avoid radiating personal anxiety, at planned seporation
• 4 - Spend time with toddler in a new inviorment, or with a new caregiver before leaving.

• Has vocabulary of approximately 300 – 800 words.
• Uses plurals
• Forms three-word sentences
• Can repeat three numbers
• Understanding occurs
• before expressive ability

• Has vocabulary of 1500 words.
• Uses four to five word sentences
• Experiments with language and words
• May use offensive words without understanding the meaning

• Has vocabulary of 2000 words
• Can name four colors
• Uses six to eight
• word sentences with pronouns

• Kohlberg: beginning moral development.
• Identifies with same-sex parent.
• Develops understanding of good/bad.
• Explains different emotions in pretend play
• Starts to engage in group play
• Is highly imaginative

• Engages in rough and tumble play.
• Learns how much he or she can control.
• Demonstrates sibling rivalry

• Wants to play by rules but cannot accept losing
• Can copy sample shapes and print first name.
• Establishes preference for hand use

• 10yrs marks the beginnning of pre adolescence
• - girls are phisically more mature thatn boys
• - the child begins to show self direction, is curtious to adults, and thinks clearly about social problems and predijuces.
• - resents being told what to do, but is receptive to sudjestions
• - the ideas of the group are more imporntatnt than that of the individual.
• - interest in sex, and sexual curiosity continues
• - they can wright  fo rlong periods of time, mantaning a good writing speed, uses fractons and knows abstract numbers
• - begin to identify themselves with skills that pertain to their sex role.
• - intollerent of oppasit sex
• - take more interst in personal appearence

• - intense, obervant, all-knowing, energetic, meddlesome, and arguementative. a period of complete disorginization.
• - Before the end of this period, the hormones in the body start to influence physical growth.
• - 24 to 26 perminant teeth.
• - preoccupied, drop in grades
• - cant bear the though tof dependance yet cant quite stand alone.
• - boys and girls tend to "ignore the oppasit sex, but are verry much aware of them

Children who are left unsupervised after school because parents are away from home, or at work, an d extendes family is not avaliable to care for them. --Higher rate of accidents, and at high risk for feeling isolated and alone.

The stage in which the reproductive organs becomefunctional, and secondary sex charecteristics develop.

period of growth during adolescence whenthe final 20% of height occures

different body parts mature at different rates ...think gaingley

• - Imagionary audience they believe that everyone is lookong at them....which accounts for thir constant combing, and fixing of makeup seen among adolesence.
• - some young adolesence may try to hide their changing body, or may try to advertize it.
• - early adolesence try to be like their peers, late adolesences enjoy their individual skills.

• - Reflective Listening - i.e the restate
• - "i" message - communicating your feelings about adolesent behavior by telling hem how it effects you. " "when ..... I fell...."
• - Exploring alternatives - helping them solve problems on their own
• - Natural and logical consiquences - Permiting (within limits) the adolesent to decide how they will behave and allowing them to experience the cosiquences.

not to change homosexual behaviors, but to help the child cope with the reaction of others

increased, because of inadequate dental mantinence, and frequent snacking on candies.

12 to 18 years.

low self esteem

• Tantrums peak at age 2 years, decreasing in frequency and intensity until they rarely occur by about 4 years of age
• Tantrums usually occur in response to the frustrated desires of a child, such as wanting a toy that cannot be purchased.

• Used as a manipulative device to gain
• control of parental behavior.
• Insufficient positive interaction with adults, leading
• to use of tantrums to gain attention

• Use simple explanations of behavior
• expectations.
• Use “time-out” responses (1 minute per
• year of age)
• Maintain consistency of expectations
• from both parents

Reward good behavior

• Use simple explanations of behavior
• expectations.
• Use “time-out” responses (1 minute per
• year of age)
• Maintain consistency of expectations
• from both parents
• Reward good behavior

• Child has full physiological capacity
• for day control by age 3 years, night control by age 4 years.
• Daytime and nighttime “accidents” occur
• throughout early childhood, decreasing in frequency by age 4 years.
• Regression occurs with environmental or social
• changes, such as arrival of sibling, moving or divorce.

• Fears and anxiety in response to
• negative toilet training.
• Used as an attention-getting device if
• positive means of gaining attention are lacking
• May use constipation as a control
• mechanism
• Excessive fluid intake before bedtime

• Use positive rewards for successful
• toileting and ignore accidents.
• Recognize signals of need to use
• toilet.
• Restrict fluids before bedtime.
• Use clothing that toddler can easily remove for
• self-toileting.

• Ability to play cooperatively begins to
• emerge at 3-5 years.
• Before this age, the child is seldom
• able to share toys and often wants toys that another child has.
• There is a predominant use of physical hitting and
• shoving to express displeasure; verbal abilities begin to emerge

• Insufficient positive adult attention,
• leading to deliberate use of aggression to gain adult attention.
• May arise from actual or perceived adult preference
• for sibling or playmate

• Prepare toddler for the separation and
• change involved in the arrival of a new sibling.
• Provided for any changes involved 1-2
• months before arrival of sibling
• Provide toddler with doll to imitate parental
• behaviors. Provide for special individual time with toddler each day

• Child can separate easily by age 3
• years if surroundings are consistent, predictable and positive.
• Child continues to protest separation
• if environment changes or if confronted by total strangers.
• Child is shy in new and strange surroundings but
• relaxed and spontaneous in familiar surroundings

• Inadequate establishment of
• self-concept, leading to lack of confidence, even in familiar surroundings.
• Uses protest of separation as a
• manipulative control device
• Fear of being abandoned

• Prepare toddler for anticipated separation.
• Refer to time using concrete terms
• Avoid radiating parental anxiety at the
• planned separation.
• Spend time with toddler and in new environment or with
• new caregiver before leaving