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Main ped problems
- overweight/obesity
- tobacco/substance use
- safe sex
- mental health
- injury/violence
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leading cause of childhood mortality
- accidents
- violent deaths have increased too
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most common type of disease affecting children
- respiratory (50% of all acute illness)
- followed by GI
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what is the most related to a childs risk of injury
directly related to the developmental level of the child
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What accidental injuries are most likely to occur at each developmental stage
- infants: exposure through taste and touch (ie led, poisoning)
- toddlers: becoming increasingly mobile with heavy heads (falls)
- younch children: engrossed in play and can be easily distracted
- adolescents: risk taking behaviors
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factors affecting family dynamics
- parenting styles
- temperment of the child
- parent-child fit (do they mesh)
- sibling and extended family relationships
- home environment
- stressors
- family roles
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pediatric nursing requires an understanding and appreciation of
- the uniqueness of the family
- family dynamics and family centered care
- diversity of influences on the health and well-being of families
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types of children
- easy child
- slow to warm up child
- difficult child
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characteristics of the easy child
- even-tempered
- predictable
- positive reaction to new things
- open/adaptable to change
- overall positive- go with the flow
- they will be excited to see you and warm up right away
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characteristics of the difficult child
- highly active- may be irritable
- less predicatble
- irregular in habits
- negative withdrawal responses to new stimuli- may withdraw when you approach them.
- require a strucutured environment- dont do well in the hospital
- adapt slowly to new routines, ppl and situations, need mroe time
- moods typically intense and often negative
- prone to temper tantrum if frustrated
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characteristics of the slow to warm up child
- less active and moody
- need time to adapt, require a repeated approach
- only moderate irregularity in habits
- negative withdrawal responses to new stimuli with mild intensity
- adapt slowly with repetition
- respond with mild but passive resistance to change in routine
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how to promote acceptable behavior in children
- validate their feelings
- treat them as unique
- set limits and expectations depenidng on development level- they feel out of control without boundaries
- provide role model and positive reinforcement
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types of parenting styles
- authoritarian
- permissive
- authoritative
- neglectful
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authoritarian parenting
- parent is strict and demanding but not responsive
- my way or the highway
- little dialogue between parent and child
- use punishment- dont teach a lesson just say thats the way it is
- gives few choices/no compromising
- little emotional support
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what can authoritarian parenting lead to
- poor self-esteem
- fearfulness
- shyness
- acting out when child older
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Permissive parenting
- parents nurturing and responsive but no clear boundaries/expectation
- parent/child roles blurred- they try to be kids friend
- rules are inconsistant and parent doesnt follow through- lack of structure
- often passive to avoid conflict- theyd rather let the child run the show than argue
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results of permissive parenting
- child may grow up with little/no self discipline and self-control
- inadequate social skills
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authoritative parenting
- ideal parent
- high expectations for children, but temper them with understanding and support
- have rules and consequences
- healthy open communications
- not friends with children, but find the balance to know whats going on in their lives
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Neglectful parenting
- can be intentional or unintentional
- failing to inconsistantly meet childs physical/emotional needs
- lack of communication in childs life
- intervention is warrented and often parental education is effective
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risk factors for neglectful parenting
parental immaturity and inexperience
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consequences of neglectful parenting
child can have difficulties with relationships as they get older
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difference between growth and development
- growth: the physical anatomical processes, a quantitative change.
- development: a qualitative change. focuses ont he process of progressive continuous and predictable changes. but each child goes through things at a different place. includes cognition, language, motor skills
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what do the processes of growth and development depend on
endocrine, genetic, environmental and nutritional influences.
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when should developmental milestones be hit
- its a RANGE, not a set time.
- ie early talkers late walkers
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Patterns of growth and development
- directional trends: cephalocaudal (head to toe. ie a child cant sit up alone until they have control over their head), proximodistal, differentiation
- sequential trends
- developmental pace (milestones)
- sensitive periods
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what are sensitive periods
- Critical points in development
- ie: prenatally (avoiding exposure to teratogens)
- ie: trust vs mistrust in infancy
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how much does the infant grow (weight and height) in the first 6 months
- 1.25-1.5 lbs per month
- 1 inch per month
birth weight doubles by 6months and triples by 1 year
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growth of preschool/school age children
4-6 pounds per year
there are also marked growth spurts in puberty
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when do you see the most dramatic developmental changes
infancy: 1-12 months
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hardest group to assess
toddler: 1-3 years
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name the developmental age periods
- infant: 1-12 mo
- toddler: 1-3 years
- preschooler: 3-6 years
- school aged: 6-13 years
- adolescent: 12-18 years
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growth in adolescence
accelerated physical growth, but slower development than younger ages
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types of development
- physical development
- fine and gross motor skills
- cognitive development (Piaget)
- language development
- psychosocial development (Erikson)
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Piaget's stages of cognitive development
- sensorimotor: birth- 2years
- preoperational: 2-7 years
- concrete operations: 7-11 years
- formal operations: 11-15 years
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erickson's stages of psychosocial development
- trust vs mistrust: birth- 1year
- autonomy vs shame and doubt: 1-3 years
- initiative vs guilt: 3-6 years
- industry vs inferiority: 6-12 years
- identity vs role confusion 12-18 years
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content of play
- social-affective play
- sense-pleasure play
- skill play
- unoccupied behavior
- dramatic or pretend play (big in preschoolers)
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social types of play
- onlooker play: child intently watches play thats going on but does nto try to join in
- solitary play: plays alone (infants)
- parallel play: doing similar play next to eachother but not interacting with eachother (toddlers)
- associative play: playing together but not toward a common goal
- cooperative play: more structured. rules, rewards, leaders, followers etc (school aged)
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functions of play
- sensorimotor development
- intellectual development
- creativity and self expression
- self-awareness
- therapy
- morality development (expectations of peers, society, acceptable behavior, fairness etc)
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atraumatic care
- should be given to all kids
- serves to reduce psychological and physical distress to the child
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how to provide atraumatic care
- foster the parent-child relationship during their time in hospital
- preparing the child before an unfamiliar treatment or procedure
- control pain (esp non pharmacologically)
- give privacy
- provide play activities to express feelings
- offer choices
- respect culture
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risk factors for hospitalization stress
- impaired child-parent bonding
- temperment (ie the difficult child may not be able to stay in a room/bed all day)
- age (esp 6mo-5yrs)
- multiple and continuing stresses (ie frequent hospitlizations, unstable home)
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child reactions to hospitalization
- seperation anxiety to caregiver (greatest stressor, esp in those under 5)
- fear of bodily harm
- fear of loss of control
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phases of seperation anxiety
- protest phase
- despair phase
- detatchment phase (occurs with prolonged separation)
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protest phase of separation anxiety
- dramatic in toddlers
- they may sense that the caregiver is going to leabe and will claw at the parent and not let them go
- in infants: crying, desperately clinging to parent
- in toddlers: do that and may even attack the stranger and attempt to plead with and physically force the parent to stay
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despair phase in separation anxiety
- ceases crying
- withdrawn and depressed
- regressive behaviors
- refusal to eat/drink/sleep
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Detachment phase of separation anxiety
- usually only occurs in prolonged separation
- child resigns self to new situation, superficially interacts with new caregiver and appears adjusted but not content
- may even ignore/reject parent upon their return
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what can the nurse do to help the child
- avoid/minimize separation
- create a familiar environment for the child
- maintain presence if parent/caregiver needs to leave
- minimize unfamiliar/frightening stimuli
- family centered care
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parent reactions to child hospitalization
- helplesseness, powerlessness, fear
- questioning skills of staff
- dealing with fear
- coping with uncertainty
- seeking reassurance
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managing the stress of hospitalization
- prepare child ahead of time
- prevent/minimize parental seperation
- minimize loss of control- encourage freedom/independence. keep routine
- Atraumatic care
- child life specialist
- provide developmentally appropriate activities
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post-hospital behaviors in young children
- initial aloofness towards parents (few hours to a few days)
- dependency behaviors
- clingyness
- may act out when they get home
- nightmares, resistance to going to bed, attachement to blanket/toy, tantrums, regressive behavior
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post-hospitalization behavior in older children
rejection and outward anger towards parent or siblings
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