ball ch04 lecture

Principles of Pediatric Nursing

Copyright ©2012 by Pearson Education, Inc.All rights reserved.

Principles of Pediatric Nursing, Fifth EditionJane Ball • Ruth Bindler • Kay Cowen

CHAPTER

Fifth Edition

Caring for Children

Growth and Development

4



Directory

• Classroom Response System• Lecture Note Presentation



Classroom Response System



Question #1

A mother asks the pediatric nurse about what she should begin to feed her 6-month-old infant. The correct response is:



Question #1 Choices

1. Egg whites are the least allergenic food to be introduced into the baby’s diet.

2. Rice cereal is the first solid introduced that is least allergenic of the cereals.

3. Formula is the only source of nutrition given for the first year.

4. Fruits and vegetables are good sources of iron.



Question #1 Answer

1. Egg whites are the least allergenic food to be introduced into the baby’s diet.

2. Rice cereal is the first solid introduced that is least allergenic of the cereals.

3. Formula is the only source of nutrition given for the first year.

4. Fruits and vegetables are good sources of iron.



Question #1 Rationale

Introduction of solid food is recommended at age 4 to 6 months, when the gastrointestinal system has matured sufficiently to handle complex nutrients. The suck reflex and tongue-thrust reflex diminish at 4 months of age. Rice cereal is the first solid food because it is a rich source of iron and rarely induces allergic reactions.




Fruits and vegetables, good sources of vitamins and fiber, are introduced after cereal, one at a time to determine allergic reactions. Egg whites are highly allergenic.

Application level



Question #2

A 1-year-old male child is scheduled for a routine exam at the pediatric clinic. The child’s birth weight was 8 lbs. 2 oz. The child now weighs 18 pounds, 4 oz. The nurse knows that this weight is:



Question #2 Choices

1. Below the expected weight.

2. Appropriate for the child’s age.

3. Above the expected weight.

4. Individualized and thus unpredictable.



Question #2 Answer

1. Below the expected weight.

2. Appropriate for the child’s age.

3. Above the expected weight.

4. Individualized and thus unpredictable.




The first year of life is one of rapid growth. The birth weight usually doubles by 5 months and triples by the end of the first year. The other choices are incorrect.

Analysis level



Question #3

A school nurse prepares a lecture on puberty for 5th- and 6th-grade girls. She asks the group, “What is the first sign of puberty?” A student correctly replies:



Question #3 Choices

• “The appearance of breast buds.”• “An increase in energy and appetite.”• “The occurrence of the first menarche.”• “Appearance of body odor.”



Question #3 Answer

• “The appearance of breast buds.”• “An increase in energy and appetite.”• “The occurrence of the first menarche.”• “Appearance of body odor.”




Puberty is a process that brings about the development of secondary sex characteristics, which begin, with the appearance of breast buds at 9 to 11 years followed by the growth of pubic hair. Menarche follows approximately 1 year later. Body odor may result later because of an increase in secretions from the apocrine glands.



Question #4

A 4-year-old scores two failures on the Denver II. Which of the following statements is most accurate?



Question #4 Choices

1. The child is not as intelligent as expected for age and should be referred to a learning specialist.

2. The child has a speech problem and should be referred to a speech therapist.

3. The child is at risk for school problems and should be retested.

4. The failures are to be expected in preschoolers who may not be cooperative with testing.



Question #4 Answer

1. The child is not as intelligent as expected for age and should be referred to a learning specialist.

2. The child has a speech problem and should be referred to a speech therapist.

3. The child is at risk for school problems and should be retested.

4. The failures are to be expected in preschoolers who may not be cooperative with testing.




The Denver II is a screening test, not a diagnostic test; therefore children who score a failure should be retested. The child is considered at-risk until other diagnostic indicators can determine a specific problem.

Analysis level



Question #5

Whenever the parents of a 10-month-old leave their hospitalized child for short periods, he begins to cry and scream. The nurse explains that this behavior demonstrates that the child:



Question #5 Choices

• Needs to remain with his parents at all times.

• Is experiencing separation anxiety.• Is experiencing discomfort.• Is extremely spoiled.



Question #5 Answer

• Needs to remain with his parents at all times.

• Is experiencing separation anxiety.• Is experiencing discomfort.• Is extremely spoiled.




Infants and toddlers between the ages of 6 months and 30 months experience separation anxiety. There are three stages of separation anxiety. The child who demonstrates crying and rejecting anyone other than the parent is in protest, the first stage of separation anxiety. This behavior does not exhibit spoiling or any indication of discomfort. The second is despair.




The child expresses hopelessness, appears quiet, and is withdrawn. The third stage is detachment. The child becomes interested in the environment, especially the caregivers. If the parents return, the child ignores them.

Analysis level



Question #6

A teenager refuses to wear the clothes his mother bought for him. He states he wants to look like the other kids at school and wear clothes like they wear. The nurse explains this behavior is an example of teenage rebellion related to internal conflicts of:



Question #6 Choices

• Autonomy vs. shame and doubt.• Trust vs. mistrust.• Identity vs. role confusion.• Initiative vs. inferiority.



Question #6 Answer

• Autonomy vs. shame and doubt.• Trust vs. mistrust.• Identity vs. role confusion.• Initiative vs. inferiority.




Erikson’s theory of psychosocial development states that the child is faced with conflicts that need to be resolved. Erikson identifies stages of personality development. Identity vs. role confusion (12 to 19 years) is a period when adolescents search for answers regarding their future.




During this time, the child rejects the identity presented by his parents and attempts to create his own identity. Identity is often based on peers. Positive outcomes result in optimism and confidence. Negative outcomes result in sense of purposelessness or deviance.

Application level



Question #7

The nurse conducts Denver II screenings at a community center for infants and young children. The nurse explains that the purpose of these screenings is to:



Question #7 Choices

1. Reverse degenerative processes that have occurred.

2. Recognize early infection in order to prevent spread to individuals in close contact with the child.

3. Recognize a disorder early so strategies can be developed to promote optimum development.

4. Measure intelligence and readiness for school.



Question #7 Answer

1. Reverse degenerative processes that have occurred.

2. Recognize early infection in order to prevent spread to individuals in close contact with the child.

3. Recognize a disorder early so strategies can be developed to promote optimum development.

4. Measure intelligence and readiness for school.




The Denver II is a developmental screening test. The primary reason for doing developmental screenings to find children who might be at risk and refer them for further assessment so that possible delays can be identified and appropriate early intervention initiated. The Denver II is not a measure of intelligence. It has nothing to do with infection control nor is it an intervention to correct degenerative processes.

Application level



Question #8

A mother of a 4-year-old tells the nurse that her son is a “picky eater.” The nurse should inform the mother that she should:



Question #8 Choices

1. Increase the amount of carbohydrates in the daily menu plan.

2. Administer vitamins twice a day to her child.

3. Be more concerned with the quantity of food than the quality of food.

4. Recognize this is common for preschoolers as their caloric requirements have decreased slightly.



Question #8 Answer

1. Increase the amount of carbohydrates in the daily menu plan.

2. Administer vitamins twice a day to her child.

3. Be more concerned with the quantity of food than the quality of food.

4. Recognize this is common for preschoolers as their caloric requirements have decreased slightly.




The preschooler will be influenced by others’ eating habits and demonstrate their likes and dislikes for food preferences. The caloric requirement decreases slightly, to 90 kcal/kg/day. Quality, not quantity, is important. It is not necessary to give vitamins after infancy unless the child is at nutritional risk.

Application level



Question #9

A father brings his 5-year-old to the doctor’s office for a well-child visit. The father is embarrassed by his child’s behavior during the visit. The father states that every time the child comes for an immunization she begins to cry and scream. An appropriate response to this father is:



Question #9 Choices

1. “All children have a major fear of needles; preschoolers often believe pain is a punishment.”

2. “Your child most likely had a traumatic experience at an early age.”

3. “Next time the mother should accompany the child for an immunization.”

4. “It is best to ignore this type of behavior as the child is seeking attention.”



Question #9 Answer

1. “All children have a major fear of needles; preschoolers often believe pain is a punishment.”

2. “Your child most likely had a traumatic experience at an early age.”

3. “Next time the mother should accompany the child for an immunization.”

4. “It is best to ignore this type of behavior as the child is seeking attention.”




Preschoolers relate pain to an injury; they fear injections and do not believe an injection takes away pain. This is a normal response to cry and scream, kick and protest. Any supportive caretaker should accompany the child. This behavior does not necessarily indicate the child has experienced a previous traumatic injection.

Analysis level



Question #10

A mother of a 15-month-old brings her son to the clinic. While doing a nursing assessment, the mother makes the following comments. Which comment merits further investigation by the nurse?



Question #10 Choices

• “My son cries sometimes when I leave him at his grandparent’s house.”

• “My son always takes his blanket with him.”

• “My son is not crawling yet.”• “My son likes to eat mashed potatoes.”



Question #10 Answer

• “My son cries sometimes when I leave him at his grandparent’s house.”

• “My son always takes his blanket with him.”

• “My son is not crawling yet.”• “My son likes to eat mashed potatoes.”




The child crawls or pulls their body along the floor by their arms by 8-10 months. This is a Growth and Developmental milestone during infancy. If the 15-month-old child displays inability to crawl this is an abnormal finding and it should be referred to the pediatrician for follow up. It is a normal response for the infant to cry when left with others.




Infants often become attached to security items, such as a blanket. Toddlers begin to display food preferences.

Analysis level



Question #11

The mother of a 12-month-old infant who is hospitalized is upset that she must leave her baby to go home for a short time. What should the nurse suggest to this concerned parent?




1. Return as soon as possible to attend to her daughter’s needs.

2. Leave a personal article with the child and reassure her that she will return.

3. Call a family relative to stay at all times with the child when the mother leaves.

4. Ask a nurse to sit at the child’s bedside in her absence.



Question #11 Answer

1. Return as soon as possible to attend to her daughter’s needs.

2. Leave a personal article with the child and reassure her that she will return.

3. Call a family relative to stay at all times with the child when the mother leaves.

4. Ask a nurse to sit at the child’s bedside in her absence.




The goal is to preserve the child’s trust. Strategies such as leaving a personal article, picture, or favorite toy help minimize the anxiety of separation. The parent may need to leave for short periods. It is unrealistic to expect the nurse to be at the child’s bedside at all times.

Application level



Question #12

An inexperienced mother is playing with her 8-month-old in the playroom. The nurse has taught the mother about toys that are developmentally appropriate for the child. The nurse will know the teaching has been successful when the mother selects:




1. Blocks.

2. Tricycle.

3. Puzzles.

4. Rattles.



Question #12 Answer

1. Blocks.

2. Tricycle.

3. Puzzles.

4. Rattles.




Objects that can be grasped and banged together, such as blocks, are most appropriate for an 8-month-old child. Such play with blocks develops the skill of manipulation. Pleasure is experienced from the feel and sounds of these activities. Tricycles and puzzles are recommended for toddlers, rattles are recommended for infants (1-6 months).

Application level



Question #13

The nurse is discussing STDs with a 17-year-old student. To correctly plan the teaching lesson, the nurse utilizes Piaget’s theory to determine the adolescent’s cognitive abilities. The educational plan should be based on the:




1. Sensorimotor reactions.

2. Limited cause and effect understanding.

3. Concrete thinking.

4. Mature abstract thinking.



Question #13 Answer

1. Sensorimotor reactions.

2. Limited cause and effect understanding.

3. Concrete thinking.

4. Mature abstract thinking.




The adolescent is in the formal operational stage and is capable of mature, abstract thought. The nurse should give clear and complete information, mature thought leads to greater understanding. The other options indicate sensorimotor stage (birth to 2 years), preoperational stage (2 to 7 years), and concrete operational stage (7 to 11 years).

Analysis level



Lecture Note Presentation



Learning Outcomes

1. Describe Major Developmental Theories

2. Plan Theory-Based Interventions

3. Explain Contemporary Approaches

4. Recognize Major Developmental Milestones

5. Synthesize Approaches in Planning Assessments of Growth and Development



Learning Outcomes (cont’d)

6. Describe the Role of Play

7. Use Collected Data Plan Activities That Promote Growth and Development



Growth and Development Principles

• Growth Equals Increased Size• Development Equals Increased

Capabilities– Cephalocaudal (head-to-tail direction)– Proximodistal (center to outside)



Box 4-1 Developmental Age Groups



Major Developmental Theories

• Freud– Psychosexual stages

• Erikson– Developmental tasks

• Piaget– Cognitive stages



Table 4-2 Common Defense Mechanisms Used by Children



Major Developmental Theories (cont’d)

• Kohlberg– Moral development

• Bandura– Social learning theory

• John Watson– Behaviorism



Nursing Application of Theories

• Freud– Awareness of body concerns

• Erikson– Task achievement promotes psychosocial

health

• Piaget– Cognitive skills guide client, teaching content

and method



Nursing Application of Theories (cont’d)

• Kohlberg– Child’s decision-making skills

• Bandura– Parent and nurse as role models

• Watson– Reward desirable behaviors



Contemporary Approaches

• Ecologic– Nature plus nurture

• Temperament– Personality characteristics

• Resiliency– Nature plus nurture plus adaptive skills



Table 4-4 Assessment of Ecologic Systems in Childhood—Bronfenbrenner



Nursing Application of Theories

• Ecologic Theory– Use child/family strengths to optimize

environment

• Temperament Theory– Adjust care relative to child’s temperament

• Resiliency Theory– Identify risks; plan interventions based on

child/family skills



Table 4-4 Assessment of Ecologic Systems in Childhood—Bronfenbrenner



Table 4-6 Components of Resiliency Model



Influences on Development

• Genetic Inheritance• Prenatal Influences• Environmental Influences• Family• Culture



Pediatric Stages of Life

• Newborn: Birth to 1 month• Infant: 1 month to 1 year• Toddler: 1 to 3 years• Preschool: 3 to 6 years• School-Age: 6 to 12 years• Adolescent: 12 to 18 years



Developmental Milestones

• Physical Growth and Development• Cognitive Development• Psychosocial Development

– Play– Personality and temperament– Communication



Assessment Planning

• Newborn– Cue to infant’s alertness– Observe attachment behavior

• Infant– Fine/gross motor skills– Receptive communication more than

expressive communication– Personality characteristics



Assessment Planning (cont’d)

• Toddler– Increases gross motor activity– Seeks autonomy– Increases expressive behavior, both verbal

and nonverbal– Engages in imitative behavior, parallel play




• Preschooler– Shows greater independence– Has interest in body, hygiene– Need for concrete language– Able to engage in associative play




• School-Age– Seeks achievement– Understands idiom– Engages in cooperative play– Shows interest in sexual issues




• Adolescent– Seeks identity– Has abstract-reasoning ability– Establishes close ties with peers– Achieves sexual maturity



Play

• Occurs at All Stages• Affects Physical, Cognitive, Psychosocial

Development• Nursing Role: Facilitate Play

– Necessary in health and illness– Can be part of teaching or therapy



Promoting Development

• Newborn– Multisensory stimulation

• Infant– Multisensory stimulation– Hearing spoken language– Fine/gross motor activities



Promoting Development (cont’d)

• Toddler– Fine/gross motor play– Reading aloud, naming objects– Parallel play

• Preschooler– Dramatic play, puppets– Reading together– Associative play



Promoting Development (cont’d)

• School-Age– Sports– Puzzles, reading, games– Cooperative play

• Adolescent– Sports, school activities– Games, reading, music



Summary

• Nurses use Theories to Assess, Plan, and Implement Care

• Nursing Role: Promote Growth and Development



Resources

• Child Trends www.childtrends.org This group conducts research, gathers data on indicators of children’s health, analyzes trends, and provides a wealth of articles and publications on their website.



Resources (cont’d)

• The Annie E. Casey Foundation www.aecf.org A national organization serving and advocating for vulnerable children and families. The national Kids Count, a database of state-by-state indicators of child health and welfare, can be found at this site.




• Morbidity and Mortality Weekly Report http://www.cdc.gov/mmwr/ Provides current information and recommendations on issues such as food safety and vaccinations.

• National Center for Health Statistics http://www.cdc.gov/nchs/ This site provides a wealth of information about health, health status, and use of the health care system.




• The Brazelton Institute www.brazelton-institute.com Promotes the healthy development of young children and their families through education and research.




• American Academy of Pediatrics www.aap.org This professional site offers news, fact sheets, research, and policy guidelines. The “You and Your Family” section provides information to families, some of which is available in Spanish.




• Zero to Three www.zerotothree.org Supported by the National Center for Infants, Toddlers, and Families, this site provides information for consumers and professionals about children ages zero to three.




• U. S. Food and Drug Administration www.fda.gov The FDA’s site provides a wealth of information for both consumers and professionals on topics such as food safety, new drug approvals, cosmetics, and tobacco use.




• Bright Futures http://www.brightfutures.org/ A national health initiative whose website offers downloadable information on prenatal care, health care for children of all ages, guidelines for physical examinations, and related information.




• Children’s Safety Network http://www.childrenssafetynetwork.org/ A national resource center for the prevention of children’s injuries and violence which provides a clearinghouse of useful information for childhood injury prevention professionals.




• Emergency Medical Services for Children http://www.childrensnational.org/EMSC/ A national initiative that works to prevent child disability and/or death due to injury. Research and family teaching and other educational materials can be found here.




• Office of Minority Health http://minorityhealth.hhs.gov/ Here you’ll find publications and data related to ethnic disparities in health care delivery and the office’s work to eliminate them.




• Safety Belt Safe USA http://www.carseat.org/ This organization promotes child passenger safety. Find out here how to select a car seat and which car seats have been recalled. Free publications in English and Spanish available for download.




• National Highway Transportation Safety Administration http://www.nhtsa.gov Information on all aspects of transportation safety, some tailored for health care professionals.




• The National Safe Kids Campaign http://www.safekids.org/ A nonprofit agency dedicated to eliminating preventable injuries in children. Information on state laws, common hazards, etc.

• OutProud http://www.scarleteen.com The National Coalition for Gay, Lesbian, Bisexual, and Transgender Youth, this site offers resources for youth and educators.




• PFLAG http://community.pflag.org/Page.aspx?pid=194&srcid=-2 Parents, Families, and Friends of Lesbians and Gays – Promotes the health and well-being of lesbians, gays, bisexual, and transgendered persons through advocacy and education.

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