growth and development. intra-uterine stages of fetal growth heart functions by 2-3 weeks placenta...
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Intra-UterineStages of fetal growth
Heart functions by 2-3 weeksPlacenta begins to function at 3 weeks and
fully functioning 4 monthsTransports nutrients, oxygen, and wastes
Amniotic Fluid and membranesMaintains temperature, provides cushioning, and
protects from infectionEmbryo to fetus at 8 weeks when all organs
are developedSex visible by week 12Vernix and lanugo at 20 weeksHearing ability by week 24 Lungs developed by week 28
Birth to One YearErikson
Trust vs Mistrust (needs attachment to a nurturing person)
Piaget (Birth to 2 years)Sensorimotor
Infant gains knowledge about the world through sensory and motor skills
Birth to One Year
BowlbyEmotional attachment (usually mom) to
an adult is necessary to survivalEmergence of basic emotions (joy,
anger, fear)Kolberg
PreconventionalInfant is not aware of right or wrong
Birth to One Year
A nurse is reinforcing instructions to a new mother regarding the psychosocial development of the infant. Using Erikson’s psychosocial development theory, the nurse would instruct the mother to:
1.Allow the infant to signal a need.2.Anticipate all of the needs of the infant.3.Avoid the infant during the first 10 minutes of
crying.4.Attend to the infant immediately when crying.
Birth to One Year
A nurse is reinforcing instructions to a new mother regarding the psychosocial development of the infant. Using Erikson’s psychosocial development theory, the nurse would instruct the mother to:
1.Allow the infant to signal a need.2.Anticipate all of the needs of the infant.3.Avoid the infant during the first 10 minutes of
crying.4.Attend to the infant immediately when crying.
Birth to One YearAt birth head circumference is larger
than chest circumferenceHeight increases ¾ inch per month (9
inches or more in a year)Double weight by 3-6 months, Triple by
one yearAnterior fontanel closes by 12-18
months, posterior fontanel closes by 3 months
First teeth appear by 6-8 months
Birth to One Year Milestones
2-3 monthsSmiles, turns head side to side, follows
objects, holds head midline4 months-6 months
Turns over by selfGrasps objects with palmEnjoys social interaction and shows
memoryAware of unfamiliar surroundings
Birth to One YearMilestones:
6 months- 7 monthsSits with supportImitates and waves good-byeFear of strangers, mood swings, holds arms out
Transfers objects from one hand to another (5 months)
Birth to One YearMilestones
8-9 monthsSits without supportCrawls and pulls to stand and can stand while
holding onPincer grasp
10-11 monthsChanges position from prone to sittingStands securely and walks while holding on to
furnitureEntertains self
12 monthsWalks with hand held and can take a few steps
without fallingDrinks from a cup
Birth to One YearReflexes (neurological)
Rooting, suckling, eye blinking and withdrawalSenses
Recognizes familiar odorsDifferentiates tastesFeels painHears pitches in the range of the human voicePrefers to look at patterned stimuli
Understand some speech, may speak in two-word sentences
Birth to One YearPlay
Solitary playColorful mobiles, musical toysTeething toysPlastic blocks, rattlesNon-breakable mirror (6-12 months)
SafetyRear facing car seat for 1 year
Longer if weighs less than 20 poundsBottle mouth caries syndrome
Birth to One YearHospitalization
Separation anxietyFear of injury and painLoss of control
Nursing InterventionsSwaddleUse FACE pain scalePacifierProvide stimulation, contrasting
colors/textures
One to Three YearsErikson
Autonomy vs Shame and DoubtPiaget
Preoperational (2-4 years)Relates to the world only through their own
perspective Bowlby
Complex emotions (guilt, embarrassment, pride)Kohlberg
Begins to know right from wrong by punishments and rewards
One to Three YearsPhysical
Anterior fontanel closes between 12-18 months
Myelin still being developedWalks unassisted by 15 months, but bodies
are top-heavy, crawls up stairsCan run and walk backwards by 2 yearsAt age 2, average weight is 27 pounds and
average height is 34 inchesLordosis (pot belly)Bowel control develops before bladder control
Good bowel and bladder control (during the day) by age 3
One to Three YearsPlay
Parallel play (1-2 years) Cooperative play (3 years)Short attention spanExplores body parts of self and othersPush-pull toys, blocks, sand, finger paints,
bubbles, balls, crayons, trucks and dolls, containers, play dough, toy telephones, cloth books, wooden puzzles
SafetyCurious about the world (dangling cords, stove
burners, windows, stairs, unlocked cars/containers, water, medicine/poisons
Forward facing car seat until 40 lbs
One to Three YearsRecognizes self in mirror by 15 monthsBy age 3, speaks up to 10 word
sentences, vocabulary up to 300 words“No” and “Why”Picky eaters, needs high protein
One to Three YearsHospitalization
Separation anxiety (try and get parents to stay)Temper tantrumsRefusal to comply with normal routines
RegressionFear of pain and injury
Nursing InterventionsDo not punish regressive behaviorExplain procedures in simple terms
Use puppets and dollsLeave special objects in the crib
Preschool (3-5 Years)
EriksonInitiative vs Guilt (try new things, handle failure)
PiagetPreoperational Thinking
Can’t see others’ perspectivesKohlberg
Preconventional (4-7 years old)Decisions based on desire to please others
and avoid punishment
Preschool 3-5 years
A mother of a 3-year-old tells the nurse that the child is constantly rebelling and having temper tantrums. The appropriate instruction to the mother is to:
1. Punish the child every time the child says “no,” to change the behavior
2. Allow the behavior, because this is normal at this age period
3. Set limits on the child’s behavior4. Ignore the child when this behavior occurs.
Preschool 3-5 years
A mother of a 3-year-old tells the nurse that the child is constantly rebelling and having temper tantrums. The appropriate instruction to the mother is to:
1.Punish the child every time the child says “no,” to change the behavior.
2.Allow the behavior, because this is normal at this age period.
3.Set limits on the child’s behavior.4.Ignore the child when this behavior occurs.
Preschool 3-5 yearsPhysical
Gains 5 lbs and 3 inches per yearAverage 43 inches and 32 lbs at age 5
12 hours of sleep/day (security object)Primary/deciduous teeth in- dental health important
Motor skills refined Age 3- rides tricycle, copies circleAge 4- Throws ball overhand, catches ball,
copies a squareAge 5- Jumps rope, balances on one foot, ties
shoes, uses scissors
Preschool Age 3-5Good bowel/bladder control- occasional
accidentsNutrition
1800 cal/dayVerbal
Age 3- 3-4 word sentences, Age 5- 6 word or longer sentences
Vocabulary 900 words at age 3, 2100 words at 5Play
Cooperative and associative- Not necessarily organized play. No gender preferenceUnderstands sharingFine motor- puzzles, crayons, paintsOutdoor activity, Dress-up
Preschool Age 3-5
SafetyMagical thinking: Cartoons real, flying
possibleAble to learn simple safety practices
Fire safety, 911, Name and addressStranger Danger
Booster seat until 8 years or 60 lbs
Preschool Age 3-5Hospitalization
Separation anxietyLess severe and less obvious, but when
stress increases anxiety will worsenMay displace feelings onto othersWithdrawn, imagines things worse, thinks it’s their fault
Loss of newly learned skills, regression, wants to keep routines
Uncooperative with meds, wants to do own ADL’s
Preschool, Age 3 to 5Nursing Interventions
Allow expression of fear, anger and accept regression
Allow mobility, encourage play (diversion) with others
Explain procedures simplyAllow underpants
Preschool, Age 3 to 5
Which of the following developmental tasks should be achieved during the preschool years?
1. Sitting up alone2. Dressing independently3. Following several directions at once4. Comprehending satire
Preschool, Age 3 to 5
Which of the following developmental tasks should be achieved during the preschool years?
1.Sitting up alone2.Dressing independently3.Following several directions at once4.Comprehending satire
School Age (6-12 years)Erikson
Industry vs InferiorityNeeds to master tasks and gain competence
PiagetConcrete Operations (7-11 years)
Inductive Reasoning- beginning logicTakes an incident and generalizes problem
solving
KohlbergConventional (7-11 years)
Increasing awareness of others feelingsConformity
School Age 6-12Physical
2 inches per year, 5 lbs per year (girls growing faster)Average height- 59 inches at age 12Average weight- 88 lbs at age 12
First secondary teeth around age 6 (dental important- soft bristles)
Sleeps 10-12 hours per nightFood pyramid- 1800-2200 cal/dayMotor skills refined- increasing strength and
endurance
School Age 6-12Play
Cooperative and competitiveRules and rituals importantSecret clubs, peer group activities
(scouts)Team sports
Drawing, collecting, dolls, pets, board games, radio/TV, reading, video/computer games
School Age 6-12Hospitalization
Better coping with separationConcerned about privacyShould be involved in plan of careFear of mutilation
Nursing InterventionsAccept regressionProtect privacyAllow socialization (talking on phone)Allow to make choicesExplain procedures- can understand
complexUse diagrams or outlines
School
School Age 6-12 Safety
Less fearTools, guns, bikes, skateboards, fire
Teach Traffic safetyStranger danger, drugs/alcohol, sexual
predatorsFire drills
Car lap belt, shoulder belt used if not crossing over face/neck
School Age 6-12
An 8 year old boy with a fractured femur is hospitalized in a two-bed room. With which of the following roommates should the boy share a room?
1. A 14 year old boy with colitis2. A 9 year old boy with an appendectomy3. A 10 year old girl with cancer4. A 6 year old girl with asthma
School Age 6-12
An 8 year old boy with a fractured femur is hospitalized in a two-bed room. With which of the following roommates should the boy share a room?
1.A 14 year old boy with colitis2.A 9 year old boy with an appendectomy3.A 10 year old girl with cancer4.A 6 year old girl with asthma
AdolescenceErikson: Identity vs Role confusion (12-
20)Develops sense of self apart from others
PiagetFormal Operations
Deductive reasoning- from generalizations to specificsConsiders alternative outcomesDeals with contradictions in the worldDraws logical conclusions
Adolescence
PhysicalWeight gain- 15-60lbsPubertySebaceous and sweat glands active2nd fastest growth period- growth spurtsNutrition- high calories- Calcium, zinc,
iron, folic acid, and protein importantBone formation complete at 17 for
female and 19-21 for male8 hours of sleep
AdolescencePlay
AthleticsCompetition and strict rulesSports, video/computer games, movies,
reading, parties, dancing, hobbies, experimenting (especially with body image)
Friends- IMPORTANTSafety
Risk takersDrugs, alcohol, smoking, seat belts, water
safety, STD’s, date rape
AdolescenceHospitalization
Coping mechanisms similar to adults- help identify positive ones
Seek help, then reject itBody image important- mutilationSeparation from peers and friends
Friends going on with their livesPsychosomatic complaints
Adolescence
Nursing InterventionsExplain procedures using body
diagramsRoom with peersPrivacy- especially during ADL’sTelephoneEncourage independence (wear own
clothes)- accept regressionAllow favorite foods
Adolescence Which of the following interventions are
appropriate for an adolescent male with a broken femur?
1. Suggest that his parents room in2. Provide a television and DVDs for him to
watch3. Restrict visitors4. Encourage him to get enough rest5. Allow him to perform his own morning
care
AdolescenceWhich of the following interventions are
appropriate for an adolescent male with a broken femur?
1.Suggest that his parents room in2.Provide a television and DVDs for him to
watch3.Restrict visitors4.Encourage him to get enough rest5.Allow him to perform his own morning
care
Young AdulthoodErikson (20-35)
Intimacy vs. IsolationEstablishing intimate bonds- love and
friendship
KohlbergFormal operations
Young AdulthoodGrowth completeIgnore physical symptoms- postpone
seeking health careSeparating from familyLearning to adapt to new situationsMaking life decisionsLifestyle habits
Developing modifiable risk factorsRisk for STD’s
Middle AdulthoodErikson (35-65 years)
Generativity vs. StagnationFulfilling life’s goals that involve
family, career and societyAbility to care for others Unsuccessful: self absorption
Middle Adulthood Mid 30’s to Mid 60’s
Reproductive changes Physiological changes have an impact on self concept and body image
Interested in learning new skillsChange in Career?
Psychosocial changesKids moving awayUnexpected death of friends/familyRelationship redefining after kids goneGrandparenting
Middle Adult (40 to 60 years)
When performing a psychosocial assessment, a nurse would expect a health middle adult to:
1. Develop an acceptance of diminished strength and increased dependence on others.
2. Feel frustrated that time is too short for attempting to start another life.
3. Accept one’s life a s creative and productive.4. Find someone with whom to share one’s life.
Middle Adult (40 to 60 years)
When performing a psychosocial assessment, a nurse would expect a health middle adult to:
1.Develop an acceptance of diminished strength and increased dependence on others.
2.Feel frustrated that time is too short for attempting to start another life.
3.Accept one’s life a s creative and productive.4.Find someone with whom to share one’s life.
Late AdulthoodErikson (65 years-death)
Integrity vs. despairLooking back at life and accepting its
meaningSense of integrity and fulfillmentUnsuccessful: Dissatisfaction with life
Late Adulthood Delirium, as opposed to dementia, is
typically:
1. Acute.2. Chronic.3. Progressive in nature.4. Caused by unknown factors.
Late AdulthoodDelirium, as opposed to dementia, is
typically:
1.Acute.2.Chronic.3.Progressive in nature.4.Caused by unknown factors.
Late Adulthood Presbyopia is common visual age
related change that results in a decline:
1. Far vision2. Near vision3. Central vision4. Peripheral vision
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