The term “Growth” and “Development” are occasionally used interchangeably but are different.
GROWTH is generally used to denote an increase in physical size or quantitative change.
DEVELOPMENT is used to denote an increase in skills or ability to function.
COGNITIVE DEV’T is the ability to learn or understand from experience, to retain knowledge and to solve problems (Intelligence).
Factors affecting Growth and Development
1. Genetic Influences 6. Environment
2. Gender 7. Nutrition
3. Race and Nationality 8. Socio-Economic Level
4. Intelligence 9. Parent-Child Relationship
5. Health 10. Ordinal Position (Family)
Developmental Screening for Newborn – done by Pediatrician
1.Denver II Developmental Screening Test
– divide streams of Development into gross motor, Fine motor, language and personal-social.
2. Clinical Adaptive Test
– rates problem solving and visual motor ability.
Criteria for Suitability of Toys
1. Is it safe? 2. Is it Useful? 3. Is it compatible?
|
Infancy |
Solitary |
– stack toys, blocks, pots- drums to bang- push and pull toys |
|
Toddler |
Parallel |
– rocking horse, swing- finger paints, puzzle |
|
Pre-school |
Associative |
– Trucks, dollhouse- Doctor and nurse kits- Sandbox, outdoor gym |
|
Schooler |
Cooperative |
– Games and Sports- Board games, books and TV |
PLAY medium form expression, communication and growth in children
Functions of Play
- Educational
- Recreational
- Physical Dev’t
- Social and Emotional Adjustment
- Therapeutic
Growth and Development Throughout Lifespan
Infancy (0-1)
Nutrition
– Vit. C, D and Iron is not found in milk
– Solid food introduce at 4 to 6 months
Psychosocial Dev’t
– mother should not expect too much from infant
Health Maintainace
Toddler (1-3)
– Autonomy / Independence
– Recognize that they are separate individual
> negativistic
> Difficult to manage
Socialization
– imitates what she/ he sees
– differentiate boy from girl
Toilet Training
– stays dry for 2 hours with regular bowel mov’t
– Can sit, walk and squat
– Can verbalize the desire to void or defecate
Negativism
– undergo extreme negativism, hates to do anything
– reply to every request is definite NO!
Temper tantrums
Pre-school (4-5)
Oedipus and Electral Complexes
– aware of sexuality, sexual roles and organs
Phallic Stage
– Aware of body’s anatomy and sexual identity (Male and Female)
– Sexual identity is important to preschool in play (Boys-toy guns / Girls-dolls)
– Penis envy or castration fear
– Deal with masturbation in non-judgmental manner
Oedipus and Electral Complexes
– aware of sexuality, sexual roles and organs
Phallic Stage
– Aware of body’s anatomy and sexual identity (Male and Female)
– Sexual identity is important to preschool in play (Boys-toy guns / Girls-dolls)
– Penis envy or castration fear
– Deal with masturbation in non-judgmental manner
School Age (6-12)
Strives for Achievements of:
1. Gross motor competency (Sports)
2. Fine motor dexterity (crafts/arts)
3. Cognitive proficiency (reading, math)
4. Social mastery (friends, peer groups)
Psychosocial Development
– master skills that will help them fxn in the adult world
– Stealing is a common school-age problem
Ways to assist a school-age child develop psychosocially
- Recognizing success and providing praise for achievements.
- Guiding children to perform task in w/c they are likely to succeed.
- Guiding the child to complete task
- Teaching the child to get along with peers
- Teaching the child to get along with adut
Play
– collecting age begins (Cards, posters, marbles etc.)
Cognitive Dev’t
– develop logical reasoning, cause and effect
Moral and Spiritual Dev’t
– God is good and always present to help
– Hygiene and Nutrition
Adolescent (12-18)
– Period during w/c the person becomes physically and psychologically mature and acquires personal identity.
Puberty – first stage of adolescent in w/c sexual organ begins to grow and mature.
girls – 10 to 14
boys – 12 to 16
Menarche – occurs in girls
Ejaculation – occurs in boys
Physical Dev’t
– adolescent growth Spurt
– Glandular changes – sweat, acne
Cognitive Dev’t
– ability to use scientific thought – plan their future
Psychosocial Dev’t
– task is to establish identity and self-concept
– Adolescent are sexually active and may engage in masturbation or heterosexual activity.
– Dating helps prepare them for marriage by teaching them how to act with members of opposite sex.
Promoting Healthy Family Functioning
– It is not easy to be with teenagers, it is equally difficult to be teenagers
– Teenagers need good adult role models so that they can see that adult roles are not frightening but desirable.
Sex Education
Common Health Problems
– Obesity
– Acne
– Adolescent Pregnancy
– STD
– Drug / Alcoholism
– Suicide
– Motor Vehicular Accident
Physiologic Status of Newborn
CIRCULATORY STATUS
- UMBILICAL VEIN and DUCTUS VENOSUS constrict after cord is clamped.
- DUCTUS ARTERIOSUS constricts w/ establishment of respiratory function.
- FORAMEN OVALE closes functionally as respirations are established, but anatomic or permanent closure may take several months.
- HEART RATE averages 140 bmn
- BP 73/55 mmHg
- PERIPHERAL CIRCULATION acrocyanosis w/n 24H
Renal System
- Urine present in the bladder at birth, but NB may not void for 1st 12-24 hours.
- Later pattern is 6-10 voidings/day – indicative of sufficient fluid intake.
- Urine is pale and straw colored.
– initial voidings may leave brick-red spots on diaperd/t passage of uric acid crystals in urine
- Infant unable to concentrate urine for the 1st 3 mos
DIGESTIVE SYSTEM
- Hard palate should be intact, small raised white areas on the palate are normal. EPSTEIN’S PEARLS
- Newborn can’t move food from lips to pharynx.
- capable of digesting simple CHO and simple CHON but fats
- Stomach capacity caries= 50-60 ml
- Feeding patterns
- FIRST STOOL is MECONIUM.
– black, tarry residue from lower intestine.
– usually passed within 12- 24 hours after birth.
After 3 days MILK STOOLS are usually passed.
a. MILK STOOLS for BF-INFANT
– Loose and golden yellow
b. MILK STOOLS for FORMULA-FED
– Formed and pale yellow
TEMPERATURE
- HEAT PRODUCTION – Metabolism of “BROWN FAT”
- Axillary temperature: 96. 8 to 99ºF
- NB’s body temp drops quickly after birth. – cold stress occurs easily.
- Body stabilizes temp in 8-10 hours if unstressed.
- Cold stress increases O2 consumption. – may lead to metabolic acidosis and respi distress.
WEIGHT
- normal= 2500 – 4300 g (5.5 to 9.5 lbs) at term.
- Initial loss of 5-10% of body weight
– normal for the first few days
– this should be regained in 1-2 weeks
LENGTH
- Average 45.7-55.9 cm (18-22 in)
CHEST CIRCUMFERENCE
- 30-33 cm (12-13 inches)
- should be equal to or 2-3 cm < head circumference
HEAD
25% of the body length; circumference 33-37cm
- Bones of the skull are not fused
- Palpable sutures
- Fontanels
- Molding ,Caput Succedaneum,Cephalohematoma
SKIN
- Pigmentation increases after birth
- Skin may be dry.
- ACROCYANOSIS
- Small amounts of lanugo and vernix caseosa still seen
- May develop “NEONATAL RASH
- HARLEQUIN SIGN
INITIAL CARE OF THE NEWBORN
- Observe and assist with initiation of respirations
- Assess Apgar score
- Note characteristics of cry
- Monitor for nasal flaring, grunting, retractions and abnormal respirations
- Obtain vital signs
- Observe NB for signs of hypothermia or hyperthermia.
NURSING INTERVENTION
- Suction mouth, then nares with bulb syringe.
- Dry baby and stimulate crying by rubbing.
- Maintain temperature stability.
- Keep newborn with mother to facilitate bonding.
- Place newborn at mother’s breast if breastfeeding is planned or place on mother’s abdomen.
- Place newborn in a warmer.
- Position newborn on the side or abdomen or in modified Trendelenburg position to facilitate drainage of mucus.
- Ensure proper NB ID
- Footprint NB & fingerprint mother on ID sheet/ agency’s policies & procedures
- Place matching ID bracelets on mother & NB
APGAR SCORING SYSTEM
- Perform and record Apgar score at 1 min & at 5 mins.
- If the score is less than 7 at 5 mins., the Apgar score shld be perform at 10 mins.
- A score of 7-10 indicates a healthy newborn.
- A score of 3-6 is considered moderately depressed.
- A score of 0-2 is severely depressed.
Pediatric Neuro Disorders
Hydrocephalus – accumulation of CSF more than normal volume
Types:
- Comunicating
- Non-comunicating
Dx Test: Myelogram
Dyes:
- Oil – FOB 6- 8 hrs.
- Water – head elevation 6 hrs.
- Air – trendelenburg
Mgt: Shunting
Spina Bifida – baby born without fusion of backbone
Cause: folic acid deficiency
Types:
- Oculta – dimple
- Cystica – sac protrusion
Meningocoele – sac contains CSF
Myeloeningocoele – sac contains CSF and Spinal cord
Mgt :
Surgery within 24 hrs after birth
Crede’s maneouver
Reye’s Syndrome – degeneration of aftes in the liver
Cause: aspirin toxicity
Mani : Decorticate and Decerebrate posture
Mgt: Oxygenation (No ore than 4L/min – Retrolental Fibroplasia)
Tumor – space occupying lesion
Medulloblastoma – fatal type -death within hours to days
Mgt: surgery
RESPIRATORY DISORDERS
BRONCHIOLITIS
Mani:
Rhinorrhea & ß fever
Lethargy
Poor feeding
Irritablity
Tachypnea
Dyspnea
Nasal flaring
Wheezing
Diminished breath sounds
Mgt: Ribavirin (Virazole)
PNEUMONIA
Types:
Viral : Whitish sputum
Bacterial: non productive hacking cough
Primary Atypical: Non productive – productive- blood streak sputum
NURSING CARE
- Administer O2, Mist tent
- Suction PRN
- Chest physiotherapy
- Bed rest
- Lie on the affected side
- Isolation precaution
- Anti-tussives, antimicrobial therapy, antipyretics
- Thoracenthesis
ASTHMA
ü Wheezing
ü Dyspnea
ü Chest tightness
ü Exacerbations
– air is trapped behind occluded or narrow airways
and hypoxemia can occur
STATUS ASTHMATICUS
– child displays respiratory distress despite vigorous
treatment
– may result in respiratory failure & death if untreated
HOME CARE MEASURES
– Allergens control
– Avoid extremes of temperature
– Avoid exposure to viral respiratory infection
– Recognize early symptoms
– Instruct the child in the administration of medications as Rx
– Adequate rest, sleep, and a well-balanced diet
– Adequate fluid intake
– Exercise as tolerated
SUDDEN INFANT ‘s DEATH SYNDROME
MATERNAL RISK FACTORS
Maternal smoking
Substance abuse
Younger mothers
APPEARANCE WHEN FOUND
Apneic & blue
Frothy blood-tinged fluid in the nose & mouth
Typically found in a disheveled bed, with blankets over the head,
Diaper is wet & full of stool
GUT
Cryptorchidism
- Whether or not to treat is still controversial.
– If the testes remains in the abdomen, damage to the testes (sterility) is possible because of increased body temperature.
- If not descended by age 8-9 mos, chorionic gonadotropin can be given.
Orchipexy
– surgical procedure to retrieve and secure testes placement
– preformed between ages 1-3 years
NURSING CARE
- Advise parents of absence of testes and provide nformation about treatment options.
- Support parents if surgery is to performed.
Post-op
- Avoid disturbing the tension mechanism.
– will be in place for about 1 week.
- Avoid contamination of incision.
GIT DISORDERS
Celiac’s dse aka Gluten Enteropathy
– Increase in amino acid glutamine
Monitor gluten free diet
Provide supplement fat-soluble vitamins
Provide client teaching and discharge planning concerning:
a. Gluten-free diet
b. avoidance of infection.
c. importance of adhering to diet
d. importance of long term ff-up management.
IMPERFORATED ANUS
- Surgery to reconstruct the anus and perform a colon pull-through or sigmoid colostomy with anastomosis and pull-through 1 year later
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