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NR 322-Exam 1: Review of Knowledge
Principles of Growth & Development
Growth and development follow a specific pattern:
1. Cephalocaudal: (head to tail) the process by which development proceeds from head downward through the body towards the feet 2. Proximodistal: (near to far) the process by which development proceeds from the center of the body outward to the extremities. **3. *Know your milestones
- Stages & age ranges** A. Newborn---------first 28 days of life B. Infant--------------birth-1year C. Toddler----------1-3 years D. Preschool-------3-6 years E. School-age-----6-12 years F. Adolescent----12-19 years
Newborn (First 28 days of life)
Trust vs. Mistrust Oral Stage ➢ Growth and Development
1. General appearance: newborn’s head is one-quarter of the body length; the child is top heavy with short lower extremities. 2. Weight: 6 to 8 lbs. gains to 7 oz. weekly for the first 6 months 3. Height: 20 in.; grows 1 in. monthly for the first 6 months 4. Head circumference: 33 to 35 cm; head circumference is greater than chest circumference; posterior fontanel closes in 2 to 3 months and anterior fontanel closes by 12 to 18 months ➢ **Reflexes (present at birth)
- Moro:** startle reflex elicited by loud noise or sudden change in position ( strongest during first 2 mos. but disappears after 3- mos.)
2. Tonic Neck: elicited when side infant lies supine and head is turned to one side the infant will assume a “fencing position” and legs are opposite direction ( disappears by age 3-4 mos. ) 3. Gag, cough, blink, pupillary: protective reflexes ( persist throughout life ) 4. Grasp: the infant’s hands and feet will grasp when the hand or foot is stimulated. ( Palmar grasp lessens after age 3 mos. And plantar grasp lessens by 8 mos. of age ) 5. Rooting: elicited when side of mouth is touched, causing the child to turn to that side ( disappear at about 3-4 mos. but may persist for up to 12 mos .) 6. Babinski: fanning of the toes when sole of foot is stroked upward (disappears after age 1 yr.) ➢ Gross Motor: 1. Head Lag if prone on pillow, but able to move mon ➢ Fine Motor: 1. Hand predominantly closed at 1 month ➢ Sensory Development: 1. Hearing and touch well developed at birth ➢ Nutrition: 1. Breast Milk- best option for infant nutrition up to 1 year of age, micronutrients that are bioavailable (nutrients are available in quantities and qualities which makes it easy to digest as a newborn. Breast milk has a variety of immunologic properties that is found exclusively in human milk. Human milk has been shown to be affect to protect the newborn against respiratory tract infections and decreasing the incidence of hospital admission for respiratory tract illness, GI infections caused by enterococci, Otis media, allergies, atopy and type 2 diabetes 2. Formula (iron-fortified) closely resembles the nutritional content of human milk, recommended for the first 1st^ 6 months. No additional fluid required for the 1 st^4 months of life after 6 month fluoridated water can be given especially of breast feeding ends. Honey should be avoided in the first 6 months because of risk of botulism ➢ Safety: 1. Infants up to 20 lbs. should be restrained in rear-facing car seat in the middle of the back seat of the car. 2. Keep side rails of crib 3. Never leave infant unattended on table, bed, bathtubs 4. Check temperature of bath water, formula, foods 5. Avoids giving bottles at naps or bedtime (may cause dental caries)
**9. What is abnormal for a newborn?
- Systems: cardiorespiratory, GI, Integumentary, GU, musculoskeletal**
Infant (birth to 1 year)
Trust vs. Mistrust Oral- Anal at 1 ½ ➢ Growth and Development
1. Weight: doubles birth weight in 6 months; triples birth weight in 1 year 2. Height: increase 50% by 1 year 3. Head growth rapid: brain increase in weight 2.5 times by 1 year ➢ Reflexes (appear during infancy) 1. Parachute: involves extension of arms when suspended in prone position and lowered suddenly 2. Landau: when the infant is suspended horizontally, the head is raised 3. Labyrinth righting: provides orientation of the head in the space
- Body righting: when you turn the hips to the side, the body follows ➢ Gross Motor 1. Gains head control by **4 months
- Rolls from back to side** by 4 months 3. Rolls from abdomen to back by 5 months 4. Rolls from back to abdomen by **6 months
- Sits alone without support** by **8 months
- Stands holding furniture** by **9 months
- Crawls** (may go backward initially) by **10 months
- Creeps with abdomen off floor** by **11 months
- Cruises** (walking upright while holding furniture) by 10 -12 months 10. Can sit down from upright position by **10-12 months
- Walks** well with one hand held by 12 months ➢ **Fine motor
- Desires to grasp** at **3 months
- Two-handed, voluntary grasp** at **5 months
- Hold bottle, grasp feet** at **6 months
- Transfers from hand to hand** by **7 months
- Pincer grasp established** by **10 months
- Neat pincer grasp (picks up raisin) with thumb and finger** by 12 months
➢ Sensory development
1. Smiles at 2 months 2. Usually searches and turns head to locate sounds by 2 months 3. Has taste preferences by **6 months
- Responds to own name** by 7 months 5. Able to follow moving objects, visual acuity 20/50 or better, amblyopia may develop by **12 months
- Can vocalize four words** by 1 year ➢ Nutrition 1. Human breast milk is the most complete and easily digested 2. Commercially prepared iron-fortified formulas used for bottle feeding closely resembling the nutrition content of human milk: recommended for first 12 months 3. Solids are introduced no sooner than 6 months to avoid exposure to potential to allergens. 4. Iron- fortified rice cereal is introduced first because of its low allergenic potential 5. Eruption of deciduous baby teeth by 5 to 6 months; lateral incisions erupt first; increase in drooling and saliva; ( **slightly elevated temperature may be associated with teething)
- Gradual weaning from breast to bottle to cup during second 6 months of infancy 7.** Juices may be introduced, diluted 1:1at 6 months; preferably given by a cup 8. Introduction of fruits, vegetables, and meats (one food each week is recommended to identify any allergy) 9. Junior foods or chopped table foods introduced by 12 months 10. No more than 32 oz. formula per 24 hours should be given to infants, to avoid iron-deficiency anemia. ➢ Safety 7. Infants up to 20 lbs. should be restrained in rear-facing car seat in the middle of the back seat of the car. 8. Keep side rails of crib 9. Never leave infant unattended on table, bed, bathtubs 10. Check temperature of bath water, formula, foods 11. Avoids giving bottles at naps or bedtime (may cause dental caries) 12. Teach injury prevention : g) Aspiration of foreign objects h) Suffocation (plastic bags, strangulation) i) Falls
A. Anticipatory guidance- pacifiers, feeding problems, communication, colic, temperament, B. Safety & injury prevention, including car seats: Rear facing until 20 lbs. C. Play D. Growth pattern (pg .139) E. Nutrition: solids? Food safety? Introducing foods? F. Immunizations G. Dental health: start mouth hygiene as soon as tooth erupts, but 1 st^ dentist appointment at 2 years old H. Temperament-stranger vs separation anxiety I. Colic- recommendations to prevent shaken baby syndrome J. Systems: cardiorespiratory, GI, Integumentary, GU, musculoskeletal- assessing for hip dislocation
Toddler (1 to 3 years)
Trust vs. Mistrust (18 mos.-3 yrs.) Anal (potty training) ➢ Growth and Development:
- Weight: growth rate slows considerably; weight is four times the birth rate by 2 ½ years
- Head circumference: 19 ½ to 20 inch by 2 years; increase only 3 cm in the year; achieves 90 percent of adult size brain by 2 years
- Anterior fontanel closes by 18 months ➢ Gross motor: still clumsy at this age
- Walks without help (usually 15 months)
- Jumps in place by 18 months
- Goes up stairs (with 2 feet on each step) by 24 month
- Runs fairly well (wide stance) by 24 months ➢ Fine Motor:
- Uses cup well by 15 months
- Builds a tower of two cubes by 15 months
- Holds crayon with fingers by 24 to 30 months
- Copies a circle by 3 years ➢ Sensory:
- Binocular vision well developed by 15 months
- Knows own name by 12 months: refers to self
- Follows simple directions by 2 years
- Identifies geometric forms by 18 months
- Uses short sentences by 18 months to 2 years
- Remembers and repeats 3 numbers by 3 years
- Able to speak 200-300 words by 2 -3 years
- Object permanence (knowledge that an object or person continues to exist when not seen , heard or felt
- Ritualistic behavior ( toddler needs to maintain sameness and reliability; provides sense of comfort ➢ Nutrition:
- Growth slows at age 12 to 18 months; thus appetite and need for intake decrease
- Toddlers are picky, ritualistic eaters
- Avoid more than 32 oz. formula/day to prevent iron-deficiency anemia
- Avoid large pieces of food such as hot dogs, grapes, cherries, peanuts
- Able to feed self completely by 3 years
- Deciduous teeth are present by 2 ½ to 3 years
- Teach good dental practices (brushing, fluoride) ➢ Safety
- Continue to use care seat properly; children greater than 20 pounds should be forward facing position in the back seat of car
- Supervise indoor play and outdoor activities
- Teach use of syrup of ipecac for accidental ingestion
- Teach injury prevention: A. Child proof the home environment: stairs ways, cupboards, medicine cabinets, outlets B. Suffocation C. Burns D. Fall E. Aspiration F. Poisoning G. Drowning ➢ Play (parallel)
- Begins as imaginative and make believe play
- Provides blocks, wheels toys, push toys, puzzles, crayons to develop motor and coordination abilities
- Toddlers enjoy repetitive stories and short songs with rhythm
- Gross & fine motor skills
➢ Rest & sleep ➢ Systems: cardiorespiratory, GI, Integumentary, GU, musculoskeletal School-aged Physical growth Developmental milestones ➢ Gross & fine motor skills ➢ Language and social development ➢ Cognitive development & play ➢ Nutrition ➢ Dental health ➢ Anticipatory guidance : school and homework, peers, self-concept, body image, bullying, stress, dishonesty, limit setting and discipline, sexuality & puberty changes ➢ Vocabulary ➢ Immunization ➢ Elimination ➢ Rest and sleep ➢ Activity & play ➢ Safety & injury prevention ➢ Rest & sleep ➢ Systems: cardiorespiratory, GI, Integumentary, GU, musculoskeletal 5 A. Parental anxiety/stress: Munchausen Biproxy Syndrome
Adolescent
Physical growth & development; Developmental milestones
- Gross & fine motor skills
- Language and social development
- Cognitive development & play
- Nutrition
- Dental health
- Anticipatory guidance : body image, nutritional issues, attachment & autonomy, caregiver-adolescent conflict, sibling relations, school, employment, peers & peer influence, dating, sexual activity, homosexuality, violence, suicide, drug abuse, alcohol abuse, television/media
- Vocabulary
- Immunization
- Elimination
- Rest and sleep
- Activity & play
- Safety & injury prevention ➢ Systems: cardiorespiratory, GI, Integumentary, GU, musculoskeletal (How to assess for scoliosis? What is the name of this test?) Ask yourself? What are nursing measures in any age group for a hospitalized child, especially for painful procedures? How do you assess pain for each age group? How do you communicate with each age group? How do you gain and maintain trust? Week 1 lab specifics Review notes taken during lab and videos/ Review your skills checklist Review your lab manual (you are responsible for all materials in this manual) Math: Can you safely & accurately calculate medication dosages for a child?
