Pediatric Nursing

PEDIATRIC NURSING Alejandro S. Mendoza RN, MD

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GENERAL PRINCIPLES Definition of Terms A. Growth: increase in size of a structure. Human growth is orderl and !redicta"le, "ut not e#en$ it follows a c clical !attern. B. Development: Development: maturation of !h siologic and !s chosocial s stems to more com!le% state. C. Cephalocau al: head&to&toe !rogression of growth and de#elo!ment GENERAL PRINCIPLES Definition of Terms D. Pro!"mo "#tal: trun'&to&!eri!her (fingers and toes) !rogression of growth and de#elo!ment E. Ph$lo%en$: de#elo!ment or e#olution of a s!ecies or grou!$ grou!$ a !attern of de#elo!ment for a s!ecies &. 'nto%en$: de#elo!ment of an indi#idual within a s!ecies Rate# o( Development

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A. *etal !eriod and infanc : the head and neurologic tissue grow faster than other tissues. +. ,nfanc and adolescence: adolescence: fast growth !eriods -. Toddler through school&age: school&age: slow growth !eriods D. Toddler and !reschool !eriods: !eriods: the trunk grows more ra!idl than other tissue. .. The lim"s grow most during school&age !eriod. *. The trun' grows faster than other tissue during adolescence. adolescence.

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NE'NATAL ASSESS)ENT ,nitial assessment /ngoing assessment 0h sical assessment Sensor assessment +eha#ioral assessment

In"t"al A##e##ment Airwa  suctioning and /1 if needed +od tem!erature 0ositioning  head lower than the trun' A!gar scoring -ord clam!  "leeding, A2A 2oiding and meconium *oot!rints and finger!rints

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,dentification "ands Mother infant "onding APGAR SC'RING Heart rate Res!irator effort Muscle tone Refle% irrita"ilit S'in color 3 minute  initial ada!tation to e%trauterine life 4 minutes  o#erall status APGAR SC'RING INTERPRETATI'N 5 to 36  7ood condition 8 to 9  *air condition 6 to :  ,n danger  resuscitation 'n%o"n% Ph$#"cal A##e##ment 2ital Signs 2ital statistics 7estational age assessment Administer medications 0erform la"orator tests

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'n%o"n% Ph$#"cal A##e##ment *"tal #"%n#: RR :6 to 96 "!m A!ical 0ulse

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336  slee!ing 316 ; 396  awa'e 3<6  cr ing Tem!erature :9  :9.< +lood 0ressure <6=89 mmHg *"tal Stat"#t"c#: >eight 1,466 ; 8,666 g ?ength 3< ; 13 inches Head -ircumference 3: ; 38 inches -hest -ircumference 31 ; 3: inches

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'n%o"n% Ph$#"cal A##e##ment 7estational Age 0reterm Term 0ostterm ?a"orator Test Mother  Rh neg or "lood t !e / +lood t !e +iliru"in le#el Direct coom"@s test Reticuloc te count Hct Administer Medications 2it A (ABuame!h ton) .4 to 3 mg ,M 0re#ent transient deficienc of coagulation factors .r throm cin ointment .4C

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3 to 1 cm Neisseria gonorrhea, chlam dia P+,SICAL ASSESS)ENT S'in Head . es .ars Nose Mouth and throat Nec' -hest 7enitalia .%tremities +EAD

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. es Normal -olor  gra A"sence of tears Searching n stagmus A"normal Dellow sclera +lue e es 0urulent discharge -ongenital cataracts .ars Normal 0inna  to! is horizontal line with outer cantus of the e e, fle%i"le, cartilage !resent A"normal ?ow !lacement of ears A"sent of startle refle% in res!onse to loud noise

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)'UT+ AND T+R'AT .!stein !earl Refle%es Suc'ing 7ag .%trusion -andidiasis (thrush) ,na"ilit to !ass N7T High !itch cr or a"sent Nec' Normal Short, thic', usuall surrounded " s'in folds Tonic nec' refle% A"normal Resistance to fle%ion *ractured cla#icle No tonic nec' refle% -hest Normal A0D E TD Slight sternal retractions e#ident during ins!iration A"normal As mmetr of the chest De!ressed sternum GENITALIA MA?. Normal Frethral o!ening at ti! of glans !enis 0al!a"le tetes A"normal H !os!adias

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.!is!adias *.MA?. Normal ?a"ia and clitoris usuall edematous Frethral meatus "ehind clitoris 0seudomenstruation A"normal *used la"ia Meconium in the #aginal area A"sence of #aginal o!ening E-TRE)ITIES N/RMA? Ten fingers and toes *ull range of motion Nail "eds are !in', with transient c anosis immediatel after "irth .Bual "rachial !ulses Sole usuall flat A+N/RMA? 0ol dact l S ndact l  fused or we""ed digits Dellowing of nail "eds FneBual gluteal folds Sole co#ered with creases SENS'R, ASSESS)ENT Tactile +eha#iors Sensation to touch, !ain and !ressure /lfactor "eha#iors 2ision +eha#iors -an see  5 to 31 inches Auditor +eha#iors Taste +eha#iors BE+A*I'RAL ASSESS)ENT 0eriod of Reacti#it :6 minutes after "irth

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Awa'e and acti#e 2S are increased Mother infant "onding  "reastfeeding Resting 0eriod 1 to 8 hours 2S returning to "aseline 3 G slee! and difficult to "e aroused Second 0eriod of Reacti#it 8 to 9 hours

NUTRITI'N

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7.N.RA? ,N*/RMAT,/N ?oses 4 to 36C and regain within 36 da s 7ain of 1<g =da  3st 9 months 7ain of 38g=da  1nd 9 months >eight gain 1%  9 months :%  3 ear 8%  1 G ear DA,?D NFTR,/NA? R.HF,R.M.NTS -alories  366 to 166 'cal='g *luid  346 to 3<6ml='g -H/N  1.1g=Ag  3.9g=Ag *at  :6 to 96C of dail calories +IG+ RIS. IN&ANTS According to size ?+>  I 1466g .?+>  I 3666g M?+>  I 3466g S7A +irth weight falls "elow 36th !ercentile on intrauterine growth cur#e ?7A  a"o#e J6th C According to age 0remature *ull term 0ostmature

DE*EL'P)ENTAL T+E'RIES P#$cho#e!ual mo el /&reu 0 1. 'ral a. 6&3< months ". 0leasure and gratification through mouth c. +eha#iors: +eha#iors: de!endenc , eating, eating, cr ing, ing, "iting d. Distinguishes "etween self and mother e. De#elo!s "od image, aggressi#e dri#es P#$cho#e!ual mo el /&reu 0 2. Anal a. 3< months & : ears ". 0leasure through elimination or retention of feces c. +eha#iors: +eha#iors: control of holding on or letting go d. De#elo!s conce!t of !ower, !ower, !unishment, am"i#alence, concern with cleanliness or "eing dirt P#$cho#e!ual mo el /&reu 0 3. Phall"c4'e "pal a. : & 9 ears ". 0leasure through genitals c. +eha#iors: +eha#iors: touching of genitals, genitals, erotic attachment to !arent of o!!osite se% d. De#elo!s fear of !unishment " !arent of same se%, se%, guilt, guilt, se%ual identit P#$cho#e!ual mo el /&reu 0 5. Latenc$ a. 9 & 31 ears ". .nerg used to gain new s'ills in social relationshi!s and 'nowledge c. +eha#iors: +eha#iors: sense of industr and master d. ?earns control o#er aggressi#e, destructi#e im!ulses e AcBuires friends P#$cho#e!ual mo el /&reu 0 6. Gen"tal a. 31 & 16 ears ". Se%ual !leasure through genitals c. +eha#iors: +eha#iors: "ecomes inde!endent of !arents, !arents, res!onsi"le for self d. De#elo!s se%ual identit , a"ilit to lo#e and wor' P#$cho#oc"al )o el /Er"7#on0 1. Tru#t v# m"#tru#t a. 6 & 3< months ". Significant relations: mother c. 0s chosocial #irtues: ho!e, ho!e, faith d. Malada!tations K malignancies: sensor distortion& withdrawal P#$cho#oc"al )o el /Er"7#on0 2. Autonom$ v# #hame an ou8t a. 3< months & : ears ". Significant relations: !arents c. 0s chosocial #irtues: will, determination d. Malada!tations K malignancies: im!ulsi#it && com!ulsion

P#$cho#oc"al )o el /Er"7#on0 3. In"t"at"ve v# %u"lt a. : & 4 ears ". Significant relations: famil c. 0s chosocial #irtues: !ur!ose, courage d. Malada!tations K malignancies: ruthlessness && inhi"ition P#$cho#oc"al )o el /Er"7#on0 5. In u#tr$ v# "n(er"or"t$ a. 9 & 31 ears ". Significant relations: neigh"orhood and school c. 0s chosocial #irtues: com!etence d. Malada!tations K malignancies: narrow #irtuosit && inertia P#$cho#oc"al )o el /Er"7#on0 6. I ent"t$ v# role con(u#"on a. 31 & 16 ears ". Significant relations: !eer grou!s, grou!s, role models c. 0s chosocial #irtues: fidelit , lo alt d. Malada!tations K malignancies: fanaticism && re!udiation P#$cho#oc"al )o el /Er"7#on0 9. Int"mac$ v# "#olat"on a. 16 & 14 ears ". Significant relations: !artners, !artners, friends c. 0s chosocial #irtues: lo#e d. Malada!tations K malignancies: !romiscuit && e%clusi#it P#$cho#oc"al )o el /Er"7#on0 :. Generat"v"t$ v# #ta%nat"on a. 14 & 84 ears ". Significant relations: household, wor'mates c. 0s chosocial #irtues: care d. Malada!tations K malignancies: o#ere%tension && rejecti#it P#$cho#oc"al )o el /Er"7#on0 ;. Inte%r"t$ v# e#pa"r a. 84 ears to end of life ". Significant relations: man'ind or Lm 'indM c. 0s chosocial #irtues: wisdom d. Malada!tations K malignancies: !resum!tion && des!air 1. In(anc$ a. 6 & 3< months ". /thers will satisf needs 2. Ch"l hoo a. 3< months & 9 ears Interper#onal )o el /Sull"van0

". ?earn to dela need gratification 3. <uven"le a. 9 & J ears ". ?earn to relate to !eers Interper#onal )o el /Sull"van0 5. Prea ole#cence a. J&31 ears ". ?earn to relate to friends of same se% 6. Earl$ a ole#cence a. 31&38 ears ". ?earn inde!endence and how to relate to o!!osite se% 9. Late a ole#cence a. 38&13 ears ". De#elo! intimate relationshi! with !erson of o!!osite se% A. = > 2 $ear#: #en#or"motor &refle%es, refle%es, re!etition of acts Co%n"t"ve Theor$ /P"a%et0

B. 2 > 5 $ear#: preoperat"onal &no cause and effect reasoning$ egocentrism$ use of s m"ols$ m"ols$ magical thin'ing C. 5 > : $ear#: "ntu"t"ve &"eginning of causation Co%n"t"ve Theor$ /P"a%et0 D. : > 11 $ear#: concrete operat"on# > uses memor to learn - aware of re#ersi"ilit E. 11 > 16 $ear#: (ormal operat"on# &realit , a"stract thought &can deal with the !ast, !resent and future .'+LBERG?S STAGES '& )'RAL DE*EL'P)ENT

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PREC'N*ENTI'NAL LE*EL Sta%e 1 De#cr"pt"on: 0unishment or o"edience (heteronomous moralit ) A child does the right things "ecause a !arent tells him or her to a#oid !unishment PREC'N*ENTI'NAL LE*EL Sta%e 2 De#cr"pt"on: ,ndi#idualism, ,nstrumentalism, and .%change Age : 8&5 Age: 1&:

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-hild carries out actions to satisf own needs rather than societ @s. The child does something for another if that !erson does something for him in return

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C'N*ENTI'NAL LE*EL level 2 Sta%e 3 De#cr"pt"on: N7ood "o =girlN /rientation to inter!ersonal relations of mutualit Age : 5&36

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A child follows rules "ecause of a need to "e a good !erson in own e es and in the e es of others C'N*ENTI'NAL LE*EL level 2

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Sta%e 5 De#cr"pt"on: ?aw and /rder

Age : 36&31

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Maintenance of social order, fi%ed rules and authorit -hild follows rules of authorit figures as well as !arents to 'ee! the s stem wor'ing P'STC'N*ENTI'NAL LE*EL level 3 Sta%e 6 Age :older :older than 31 De#cr"pt"on: social contract, utilitarian law ma'ing !ers!ecti#e child follows standards of societ for the good of all !eo!le P'STC'N*ENTI'NAL LE*EL level 3 Sta%e 9 Age :older :older than 31 De#cr"pt"on#: 0rinci!led -onscience un"ver#al eth"cal pr"nc"ple or"entat"on child follows internalized standards of conduct NE'NATAL RE&LE-ES

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Refle%: Refle%: S mmetric tonic nec' Stimulus: Stimulus: nec' fle%ion, nec' e%tension Res!onse:arm Res!onse:arm fle%ion, leg e%tension, arm e%tension, leg fle%ion /nset: /nset: "irth&3month Su!!ression: Su!!ression: 8 mos

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NE'NATAL RE&LE-ES Refle%: !ositi#e su!!orting

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Stimulus: tactile contact and weight "earing on sole Res!onse:leg e%tension for su!!orting !artial "od weight /nset: 1 months Su!!ression: :&5 mos, re!laced " #olitional standing NE'NATAL RE&LE-ES Refle%: rooting Stimulus: stro'ing the corner of the mouth,u!!er or lower li! Res!onse:mo#ing the tongue, mouth and head towards the site of stimulus /nset: "irth Su!!ression: 8 mos NE'NATAL RE&LE-ES Refle%: !almar gras! Stimulus: !ressure or touch on the !alm, stretch of finger fle%ors Res!onse:fle%ion of fingers /nset: "irth Su!!ression: 8&9 mos NE'NATAL RE&LE-ES Refle%: 0lantar gras! Stimulus: !ressure on the sole just distal to the metatarsal heads Res!onse:fle%ion of toes /nset: "irth Su!!ression: 31&3< mos NE'NATAL RE&LE-ES Refle%: Automatic neonatal wal'ing Stimulus: contact of the sole in #ertical !osition tilting the "od forward and from side to Res!onse: automatic alternating ste!s /nset: "irth Su!!ression: :&8 mos RE&LE-ES +lin'ing or corneal refle% 0u!illar refle% Doll@s e e  fi%ation de#elo!s

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Sneeze refle% Suc'ing refle% 7ag refle% Rooting refle%  : to 8 months RE&LE-ES .%trusion refle%  8 months -ough refle% +a"ins'i refle% Moro refle%  : to 8 months Dance or ste! refle%  : to 8 wee's NE'NATAL SENSES H.AR,N7: a"le to hear in the utero within hrs after "irth, hearing in N+ "ecomes acute 2,S,/N: focus on "lac' and white o"jects distance of J&31 inches !u!illar refle% !resent at "irth NE'NATAL SENSES TAST.: de#elo!ed "efore "irth T/F-H: well de#elo!ed at "irth react to !ainful stimuli SM.??: !resent as soon as the nose is cleared of mucus a"ilit to res!ond to odors can "e used to document alertness In(ant A. 0h sical tas's

3. Neonate (+irth to 3 month) a. >eight: >eight: 9 & < l" (1546 & :91J g)$ gains 4 & 5 oz (381 & 3J< g) wee'l for first 9 months ". ?ength: ?ength: 16 inches (46 cm)$ grows 3 inch (1.4 cm) monthl for first 9 months In(ant A. 0h sical tas's

3. Neonate (+irth to 3 month)

c. Head growth 3) head circumference :: & :4.4 cm (3: & 38 inches) 1) head circumference eBual to or slightl larger than chest :) increases " 3=1 inch (3.14 cm) monthl for first 9 months In(ant A. 0h sical tas's

3. Neonate (+irth to 3 month) d. 2ital signs 3) !ulse: 336 & 396 and irregular$ count for a full minute a!icall 1) res!irations: :1 & 96 and irregular$ neonates are a"dominal "reathers, "reathers, o"ligate nose "reathers :) "lood !ressure: 54=8J mm Hg In(ant A. 0h sical tas's

1. Neonate /B"rth to 1 month0 e. Motor de#elo!ment 3) "eha#ior is refle% controlled 1) fle%ed e%tremities

1. Neonate /B"rth to 1 month0 f. Sensor de#elo!ment 3) hearing and touch well de#elo!ed at "irth 1) sight not full de#elo!ed until 9 ears a) differentiates light and dar' at "irth ") ra!idl de#elo!s clarit of #ision within 3 foot c) fi%ates on mo#ing o"jects d) stra"ismus due to lac' of "inocular #ision

In(ant A. 0h sical tas's

2. 1 > 5 month# a. Head growth: growth: !osterior fontanel closes ". Motor de#elo!ment 3) refle%es "egin to fade (e.g., Moro, tonic nec') 1) gains head control$ control$ "alances head in sitting !osition :) rolls from "ac' to side 8) "egins #oluntar hand&to&mouth acti#it In(ant A. Ph$#"cal ta#7# 2. 1 > 5 month# c. Sensor de#elo!ment 3) "egins to "e a"le to coordinate stimuli from #arious sense organs 1) hearing: locates sounds " turning head and #isuall searching :) #ision: follows o"jects 3<6O 3<6O In(ant A. Ph$#"cal ta#7#

In(ant A. Ph$#"cal ta#7#

3. 6 > 9 month# a. >eight: >eight: "irth weight dou"les$ dou"les$ gains :&4 oz (<8&386 g) wee'l for ne%t 9 months ". ?ength: ?ength: gains 3=1 inch (3.14 cm) for ne%t 9 months

3. 6 > 9 month# c. .ru!tion of teeth "egins 3) lower incisors first 1) causes increased sali#a and drooling :) enz me released with teething causes mild diarrhea, diarrhea, facial s'in irritation 8) slight fe#er ma "e associated with teething, "ut not a high fe#er or seizures In(ant A. Ph$#"cal ta#7#

In(ant A. Ph$#"cal ta#7#

3. 6 > 9 month# d. Motor de#elo!ment 3) su!!orts weight on arms 1) sits with su!!ort

3. 6 > 9 month# e. Sensor de#elo!ment 3) hearing: can localize sounds a"o#e and "elow ear 1) #ision: smiles at own mirror image and res!onds to facial e%!ressions of others :) taste: suc'ing needs ha#e decreased and cu! weaning can "egin$ chewing, chewing, "iting, "iting, and taste !references "egin to de#elo! In(ant A. Ph$#"cal ta#7# 5. : > @ month# a. Teething continues 3) 5 months: u!!er central incisors 1) J months: u!!er lateral incisors ". Motor de#elo!ment 3) crawls$ crawls$ ma go "ac'wards initiall 1) !ulls self to standing !osition :) de#elo!s finger&thum" o!!osition (!incer (!incer gras!) In(ant A. Ph$#"cal ta#7#

In(ant A. Ph$#"cal ta#7#

6. 1=>12 month# a. >eight: >eight: "irth weight tri!led ". ?ength: ?ength: 46C increase o#er "irth length c. Head and chest circumference eBual d. Teething 3) lower lateral incisors eru!t 1) a#erage of eight deciduous teeth 6. 1=>12 month# e. Motor de#elo!ment 3) wal's with hel! or cruises 1) ma attem!t to stand alone 3. Neonatal !eriod a. -ries to e%!ress dis!leasure

In(ant A. Ph$#"cal ta#7#

In(ant B. P#$cho#oc"al ta#7#

". Smiles indiscriminatel c. Recei#es gratification through suc'ing d. Ma'es throat sounds In(ant B. P#$cho#oc"al ta#7#

2. 1 > 5 month# a. -r ing "ecomes differentiated at 3 month 3) decreases during awa'e !eriods 1) ceases when !arent in #iew ". 2ocalization distinct from cr ing at 3 month 3) coos, coos, "a""les, "a""les, laughs$ laughs$ #ocalizes when smiling

2. 1 > 5 month# c. Socialization 3) stares at !arents@ !arents@ faces when tal'ing at 3 month 1) smiles sociall at 1 months :) shows e%citement when ha!! at 8 months 8) demands attention, enjo s social interaction with !eo!le at 8 months In(ant B. P#$cho#oc"al ta#7#

In(ant B. P#$cho#oc"al ta#7#

3. 6 > 9 month# a. 2ocalization: "egins to imitate sounds ". Socialization: recognizes !arents, stranger an%iet "egins to de#elo!$ comfort ha"its "egin In(ant B. P#$cho#oc"al ta#7#

5. : > @ month# a. 2ocalization: #er"alizes all #owels and most consonants ". Socialization 3) shows increased stranger an%iet and an%iet o#er se!aration from !arent 1) e%hi"its aggressi#eness " "iting at times :) understands the word Lno M LnoM In(ant B. P#$cho#oc"al ta#7#

6. 1= > 12 month# a. 2ocalization: imitates animal sounds, can sa onl 8 & 4 words "ut understands man more (ma, da) ". Socialization 3) "egins to e%!lore surroundings 1) !la s games such as !at&a&ca'e, !at&a&ca'e, !ee'&a&"oo :) shows emotions such as jealous , affection, anger, fear (es!eciall in new situations) In(ant C. Co%n"t"ve ta#7# 1. Neonatal per"o : refle%i#e "eha#ior onl 2. 1 > 5 month# a. Recognizes familiar faces ". ,s interested in surroundings c. Disco#ers own "od !arts In(ant

C. Co%n"t"ve ta#7# 3. 6 > 9 month# a. +egins to imitate ". -an find !artiall hidden o"jects 8. 5 & J months a. +egins to understand o"ject !ermanence$ !ermanence$ searches for dro!!ed o"jects ". Reacts to adult anger$ cries when scolded c. ,mitates sim!le acts and noises d. Res!onds to sim!le commands In(ant C. Co%n"t"ve ta#7#

6. 1=>12 month# a. Recognizes o"jects " name ". ?oo's at and follow !ictures in "oo' c. Shows more goal&directed actions

1. B"rth to 9 month# a. +reast mil' is a com!lete and healthful diet$ su!!lementation ma include 6.14 mg fluoride, 866 ,F #itamin D, and iron after 8 months. months. ". -ommercial iron&fortified formula is acce!ta"le alternati#e$ su!!lementation ma include 6.14 mg fluoride if water su!!l is not fluoridated. c. Puices ma "e introduced at 4&9 months, diluted 3:3 and !refera"l gi#en " cu!. In(ant D. Nutr"t"on

In(ant D. Nutr"t"on

1. 9 & 31 months a. +reast mil' or formula continues to "e !rimar source of nutrition. ". ,ntroduction of solid foods starts with cereal (usuall rice cereal), which is continued until 3< months. In(ant D. Nutr"t"on

2. 9 > 12 month# c. ,ntroduction of other food is ar"itrar $ most common seBuence is fruits, #egeta"les, meats. 3) introduce one new food a wee'. wee'. 1) decrease amount of formula to a"out :6 oz. as foods are added. d. ,ron su!!lementation can "e sto!!ed. In(ant D. Nutr"t"on

2. 9 > 12 month# e. *inger foods such as cheese, meat, carrots can "e started around 36 months. months. f. -ho!!ed ta"le food or junior food can "e introduced " 31 months g. >eaning from "reast or "ottle to cu! should "e gradual during second 9 months. months. In(ant .. 0la (Solitar )

1. B"rth to 5 month# a. 0ro#ide #ariet of "rightl colored o"jects, different sizes and te%tures. ". Hang mo"iles within <&36 inches of infant@s face. In(ant

.. 0la (Solitar ) 2. 6 > : month# a. 0ro#ide "rightl colored to s to hold and sBueeze. sBueeze. ". Allow infant to s!lash in "ath. c. 0ro#ide cri" mirror. 3. ; > 12 month# a. 0ro#ide to s with mo#a"le !arts and noisema'ers$ noisema'ers$ stac' to s, "loc's$ !ots, !ans, drums to "ang on$ wal'er and !ush&!ull to s. s. ". 0la s games: hide and see', see', !at&a&ca'e. !at&a&ca'e. In(ant &. &ear#

1. Separat"on (rom parent# a. Searches for !arents with e es. ". Shows !reference for !arents. c. De#elo!s stranger an%iet around 9 months (!ea's at < months). 2. Pa"n To ler /12 month# to 3 $ear#0 A. Ph$#"cal ta#7#: th"# "# a per"o o( #low %rowth 3. >eight: >eight: gain of a!!ro%imatel 33 l" (4 'g) during this time$ "irth weight Buadru!led " 1 3=1 ears 1. Height: Height: grows 16.: cm (< inches)$ :. Head circumference: circumference: 3JG & 16 inches (8J & 46 cm) " 1 ears$ anterior fontanel closes " 3< months To ler /12 month# to 3 $ear#0 A. Ph$#"cal ta#7#: th"# "# a per"o o( #low %rowth 8. 0ulse 336$ res!irations 19$ "lood !ressure JJ=98 4. 0rimar dentition (16 (16 teeth) teeth) com!leted " 1 3=1 ears 9. De#elo!s s!hincter control necessar for "owel and "ladder control To ler /12 month# to 3 $ear#0 B. P#$cho#oc"al ta#7# 3. ,ncreases inde!endence$ inde!endence$ "etter a"le to tolerate se!aration from !rimar caregi#er. 1. ?ess li'el to fear strangers. strangers. :. A"le to hel! with dressing=undressing at 3< months$ dresses self at 18 months. months. 8. Has sustained attention s!an. 4. Ma ha#e tem!er tantrums during this !eriod$ should decrease " 1 3=1 ears. 9. 2oca"ular increases from a"out 36 & 16 words to o#er J66 words " : ears. To ler /12 month# to 3 $ear#0 B. P#$cho#oc"al ta#7# 5. Has "eginning awareness of ownershi! (m , mine) at 3< months$ shows !ro!er use of !ronouns (,, me, ou) " : ears. <. Mo#es from hoarding and !ossessi#eness at 3< months to sharing with !eers " : ears. J. Toilet training usuall com!leted " : ears. a. 3< months: "owel control ". 1 & : ears: da time "ladder control c. : & 8 ears: nighttime "ladder control

To

ler /12 month# to 3 $ear#0

C. Co%n"t"ve ta#7# 3. *ollows sim!le directions " 1 ears. 1. +egins to use short sentences at 3< months to 1 ears. :. -an remem"er and re!eat : num"ers " : ears. 8. Anows own name " 31 months$ refers to self, gi#es first name " 18 months$ gi#es full name " : ears. 4. A"le to identif geometric forms " 3< months. To ler /12 month# to 3 $ear#0 C. Co%n"t"ve ta#7# 9. Achie#es o"ject !ermanence$ !ermanence$ is aware that o"jects e%ist e#en if not in #iew. 5. Fses LmagicalM LmagicalM thin'ing$ thin'ing$ "elie#es own feelings affect e#ents (e.g., anger causes rain). <. Fses ritualistic "eha#ior$ "eha#ior$ re!eats s'ills to master them and to decrease an%iet . J. Ma de#elo! de!endenc on Ltransitional o"jectM such as "lan'et or stuffed animal. To ler /12 month# to 3 $ear#0 D. Nutr"t"on 3. -aloric reBuirement is a!!ro%imatel 366 calories='g=da . 1. ,ncreased need for calcium, iron, and !hos!horus. :. Needs 39 & 18 oz mil'=da . 8. A!!etite decreases. 4. A"le to feed self. 9. Negati#ism ma interfere with eating. 5. ,nitial dental e%amination at : ears. To ler /12 month# to 3 $ear#0 E. Pla$ 3. 0redominantl & L!arallel L!arallel !la M !eriod. 1. 0ro#ide to s a!!ro!riate for increased locomoti#e s'ills: !ush to s, s, roc'ing horse, horse, riding to s or tric cles$ cles$ swings and slide. :. 7i#e to s to !ro#ide outlet for aggressi#e feelings: feelings: wor' "ench, to hammer and nails, drums, !ots, !ans. 8. 0ro#ide to s to hel! de#elo! fine motor s'ills, s'ills, !ro"lem&sol#ing a"ilities: !uzzles, !uzzles, "loc's$ "loc's$ finger !aints, cra ons. ons. To ler /12 month# to 3 $ear#0 G. &ear#: #eparat"on an!"et$ 3. ?earning to tolerate and master "rief !eriods of se!aration is im!ortant de#elo!mental tas'. 1. ,ncreasing understanding of o"ject !ermanence hel!s toddler o#ercome this fear. To ler /12 month# to 3 $ear#0 G. &ear#: #eparat"on an!"et$ :. 0otential !atterns of res!onse to se!aration a. 0rotest: 0rotest: screams and cries when mother lea#es$ attem!ts to call her "ac'. ". Des!air: Des!air: whim!ers, clutches transitional o"ject, curls u! in "ed, decreased acti#it , roc'ing. c. Denial: Denial: resumes normal acti#it "ut does not form !s chosocial relationshi!s$ when mother returns, child ignores her Pre#chooler /3 to 6 $ear#0 A. Ph$#"cal ta#7# 3. Slower growth rate continues a. >eight: increases 8 & 9 l" (3.< & 1.5 'g) a ear ". Height: increases 1 3=1 inches (4&9.14 cm) a ear c. +irth length dou"led " 8 ears 1. 2ital signs decrease slightl

a. 0ulse: J6&366 ". Res!irations: 18&14=minute c. +lood !ressure: s stolic <4&366 mm Hg diastolic 96&J6 mm Hg Pre#chooler /3 to 6 $ear#0 A. Ph$#"cal ta#7# :. 0ermanent teeth ma a!!ear late in !reschool !eriod$ first !ermanent teeth are molars, molars, "ehind last tem!orar teeth. 8. 7ross motor de#elo!ment a. >al's u! stairs using alternate feet " : ears. ". >al's down stairs using alternate feet " 8 ears. c. Rides tric cle " : ears. d. Stands on 3 foot " : ears.

Pre#chooler /3 to 6 $ear#0 A. Ph$#"cal ta#7# 8. 7ross motor de#elo!ment e. Ho!s on 3 foot " 8 ears. f. S'i!s and ho!s on alternate feet " 4 ears. g. +alances on 3 foot with e es closed " 4 ears. h. Throws and catches "all " 4 ears. i. Pum!s off 3 ste! " : ears. j. Pum!s ro!e " 4 ears. Pre#chooler /3 to 6 $ear#0 A. Ph$#"cal ta#7# 4. *ine motor de#elo!ment a. Hand dominance is esta"lished " 4 ears. ". +uilds a tower of "loc's " : ears. c. Ties shoes " 4 ears. d. A"ilit to draw changes o#er this time 3) co!ies circles, circles, ma add facial features " : ears. 1) co!ies a sBuare, sBuare, traces a diamond " 8 ears. Pre#chooler /3 to 6 $ear#0 B. P#$cho#oc"al ta#7# 3. +ecomes inde!endent a. *eeds self com!letel . ". Dresses self. c. Ta'es increased res!onsi"ilit for actions. 1. Aggressi#eness and im!atience !ea' at 8 ears then a"ate. :. 7ender&s!ecific "eha#ior is e#ident " 4 ears. ears. 8. .gocentricit changes to awareness of others$ rules "ecome im!ortant$ im!ortant$ understands sharing. Pre#chooler /3 to 6 $ear#0 C. Co%n"t"ve evelopment 3. *ocuses on one idea at a time$ time$ cannot loo' at entire !ers!ecti#e. 1. Awareness of racial and se%ual differences "egins. a. 0rejudice ma de#elo! "ased on #alues of !arents. ". Manifests se%ual curiosit . c. Se%ual education "egins. d. +eginning "od awareness. awareness.

Pre#chooler /3 to 6 $ear#0 C. Co%n"t"ve evelopment :. Has "eginning conce!t of causalit . 5. Un er#tan "n% o( t"me evelop# ur"n% this !eriod. a. ?earns seBuence of dail e#ents. e#ents. ". ,s a"le to understand meaning of some time&oriented words (da of wee', month, etc.) " 4 ears. 4. Has 1666&word #oca"ular " 4 ears. 9. -an name 8 or more colors " 4 ears. 5. ,s #er inBuisiti#e (wh Q, wh Q wh Q). Q). Pre#chooler /3 to 6 $ear#0 D. Nutr"t"on 3. -aloric reBuirement is a!!ro%imatel J6 calories='g=da . 1. Ma demonstrate strong taste !references. !references. :. More li'el to taste new foods if child can assist in the !re!aration. Pre#chooler /3 to 6 $ear#0 &. Pla$ 3.0redominantl associati#e !la 1. .njo s imitati#e and dramatic !la . a. ,mitates same&se% role functions in !la . ". .njo s dressing u!, dollhouses, truc's, cars, tele!hones, doctor and nurse 'its. :. 0ro#ide to s to hel! de#elo! gross motor s'ills: tric cles, cles, wagons, wagons, outdoor g m$ m$ sand"o%, wading !ool. Pre#chooler /3 to 6 $ear#0 &. Pla$ 8. 0ro#ide to s to encourage fine motor s'ills, s'ills, self&e%!ression, and cogniti#e de#elo!ment: construction sets, "loc's, car!entr tools$ flash cards, illustrated "oo's, !uzzles$ !uzzles$ !aints, !aints, cra ons, ons, cla , sim!le sewing sets. 4. Tele#ision, Tele#ision, when su!er#ised, can !ro#ide a Buiet acti#it $ some !rograms ha#e educational content. Pre#chooler /3 to 6 $ear#0 G. &ear# 3. 7reatest num"er of imagined and real fears of childhood during this !eriod. 1. *ears concerning "od integrit are common. a. Magical and animistic thin'ing allows children to de#elo! man illogical fears (fear of inanimate o"jects, o"jects, the dar', dar', ghosts). ghosts). School>a%e /9 to 12 $ear#0 A. Ph$#"cal ta#7# 3. Slow growth continues. a. Height: 1 inches (4 cm) !er ear ". >eight: dou"les o#er this !eriod c. At age J, J, "oth se%es same size$ size$ age 31, 31, girls "igger than "o s 1. Dentition a. ?oses first !rimar teeth at a"out 9 ears. ". + 31 ears, has all !ermanent teeth e%ce!t final molars. School>a%e /9 to 12 $ear#0

A. Ph$#"cal ta#7#

:. +one growth faster than muscle and ligament de#elo!ment$ #er lim"er "ut susce!ti"le to "one fractures during this time. 8. 2ision is com!letel mature$ mature$ hand&e e coordination de#elo!s com!letel . 4. 7ross motor s'ills: !redominantl in#ol#ing large muscles$ children are #er energetic, energetic, de#elo! greater strength, strength, coordination, and stamina. 9. De#elo!s smoothness and s!eed in fine motor control. School>a%e /9 to 12 $ear#0 B. P#$cho#oc"al ta#7# 3. School occu!ies half of wa'ing hours$ hours$ has cogniti#e and social im!act. a. Readiness includes emotional (attention s!an), !h sical (hearing and #ision), and intellectual com!onents. ". Teacher ma "e !arent su"stitute, su"stitute, causing !arents to lose some authorit . School>a%e /9 to 12 $ear#0 B. P#$cho#oc"al ta#7# 1. Moralit de#elo!s a. +efore age J moral realism !redominates: strict su!erego, su!erego, rule dominance$ things are "lac' or white, right or wrong. wrong. ". After age J autonomous moralit de#elo!s: recognizes differing !oints of #iew, sees Lgra M areas.

School>a%e /9 to 12 $ear#0 B. P#$cho#oc"al ta#7# :. 0eer relationshi!s a. -hild ma'es first real friends during this !eriod. ". ,s a"le to understand conce!ts of coo!eration and com!romise (assist in acBuiring attitudes and #alues)$ learns fair !la #s com!etition. com!etition. c. Hel! child de#elo! self&conce!t. d. 0ro#ide feeling of "elonging. School>a%e /9 to 12 $ear#0 B. P#$cho#oc"al ta#7# 8. .njo s famil acti#ities. 4. Has some a"ilit to e#aluate own strengths and wea'nesses. 9. Has increased self&direction. self&direction. 5. ,s aware of own "od $ com!ares self to others$ others$ modest de#elo!s. School>a%e /9 to 12 $ear#0 C. Co%n"t"ve evelopment 3. 0eriod of industr a. ,s interested in e%!loration and ad#enture. ad#enture. ". ?i'es to accom!lish or !roduce. !roduce. c. De#elo!s confidence. School>a%e /9 to 12 $ear#0 C. Co%n"t"ve evelopment 1. -once!t of time and s!ace de#elo!s. a. Fnderstands causalit . ". Masters conce!t of conser#ation: !ermanence of mass and #olume$ conce!t of re#ersi"ilit .

c. De#elo!s classification s'ills: understands relational terms$ ma collect things. d. Masters arithmetic and reading. School>a%e /9 to 12 $ear#0 D. Nutr"t"on 3. -aloric needs diminish in relation to "od size: <4 'cal='g. 1. LPun'M LPun'M food ma "ecome a !ro"lem$ e%cess sugar, starches, fat. :. /"esit is a ris' in this age grou!. 8. Nutrition education should "e integrated into school !rogram.

School>a%e /9 to 12 $ear#0 E. Pla$ 3. Rules and ritual dominate !la $ indi#idualit not tolerated " !eers$ 'nowing rules !ro#ides sense of "elonging$ Lcoo!erati#e Lcoo!erati#e !la .M 1. Team !la : games or s!orts a. Hel! learn #alue of indi#idual s'ills and team accom!lishments. ". Hel! learn nature of com!etition. com!etition. :. Huiet games and acti#ities: "oard games, collections, "oo's, tele#ision, !ainting 8. Athletic acti#ities: swimming, hi'ing, "ic cling, s'ating School>a%e /9 to 12 $ear#0 G. &ear#: more realistic fears than ounger children$ include death, death, disease or "odil injur , !unishment$ !unishment$ school !ho"ia ma de#elo!, resulting in !s chosomatic illness. A ole#cent /12 to 1@ $ear#0 A. Ph$#"cal ta#7# a. 7irls: 7irls: height increases a!!ro%imatel : inches= ear$ slows at menarche$ sto!s around age 39. ". +o s: s: growth s!urt starts around age 3:$ height increases 8 inches= ear$ slows in late teens. c. +o s dou"le weight "etween 31 and 3<, related to increased muscle mass. A ole#cent /12 to 1@ $ear#0 A. Ph$#"cal ta#7# d. +od sha!e changes 3) "o s "ecome leaner with "roader chest. 1) girls ha#e fat de!osited in thighs, hi!s, and "reasts$ !el#is "roadens. e. A!ocrine glands cause increased "od odor. odor. f. ,ncreased !roduction of se"um and !lugging of se"aceous ducts causes acne. acne. A ole#cent /12 to 1@ $ear#0 A. Ph$#"cal ta#7# 8. Se%ual de#elo!ment: girls c. De#elo!ment of secondar se% characteristics and se%ual functioning under hormonal control d. +reast de#elo!ment is first sign of !u"ert . 3) "ud stage: areola around ni!!le is !rotu"erant. 1) "reast de#elo!ment is com!lete around the time of first menses. A ole#cent /12 to 1@ $ear#0

A. Ph$#"cal ta#7# 4. Se%ual de#elo!ment: "o s

a. De#elo!ment of secondar se% characteristics, characteristics, se% organs and function under hormonal control. ". .nlargement of testes is first sign of se%ual maturation$ occurs at a!!ro%imatel age 3:, a"out 3 ear "efore growth s!urt. c. Scrotum and !enis increase in size until age 3<. d. Reaches re!roducti#e maturit a"out age 35, with #ia"le s!erm. A ole#cent /12 to 1@ $ear#0 A. Ph$#"cal ta#7# 4. Se%ual de#elo!ment: "o s e. Nocturnal emission: emission: a !h siologic refle% to ejaculate "uildu! of semen$ natural and normal$ occurs during slee! (child should not "e made to feel guilt $ needs to understand that this is not enuresis). f. Mastur"ation increases (also a normal wa to release semen). g. 0u"ic hair continues to grow and s!read until mid 16s. h. *acial hair$ hair$ a!!ears first on u!!er li!. A ole#cent /12 to 1@ $ear#0 A. Ph$#"cal ta#7# 4. Se%ual de#elo!ment: "o s i. 2oice changes due to growth of lar ngeal, cartilage. j. 7 necomastia: necomastia: slight h !ertro!h of "reasts due to estrogen !roduction$ will !ass within months "ut causes em"arrassment. A ole#cent /12 to 1@ $ear#0 B. P#$cho#oc"al ta#7# 3. .arl adolescence: adolescence: ages 31&38 ears a. Starts with !u"ert . ". 0h sical "od changes result in an altered self&conce!t. c. Tends to com!are own "od to others. d. .arl and late de#elo!ers ha#e an%iet regarding fear of rejection. e. *antas life, da dreams, dreams, crushes are all normal, hel! in role !la of #ar ing social situations. f. ,s !rone to mood swings. swings. g. Needs limits and consistent disci!line. A ole#cent /12 to 1@ $ear#0 B. P#$cho#oc"al ta#7# 1. Middle adolescence: adolescence: ages 34&39 ears a. ,s se!arate from !arents (e%ce!t financiall ). ". -an identif own #alues. c. -an define self (self&conce!t, strengths and wea'nesses). d. 0arta'es in !eer grou!$ conforms to #alues=fads. e. Has increased heterose%ual interest$ interest$ communicates with o!!osite se%$ ma form Llo#eM relationshi!. A ole#cent /12 to 1@ $ear#0 B. P#$cho#oc"al ta#7# :. ?ate adolescence: adolescence: ages, 35&3J ears a. Achie#es greater inde!endence. inde!endence. ". -hooses a #ocation. #ocation. c. 0artici!ates in societ . d. *inds an identit . e. *inds a mate. mate. f. De#elo!s own moralit .

g. -om!letes !h sical and emotional maturit . A ole#cent /12 to 1@ $ear#0 C. Co%n"t"ve evelopment 3. De#elo!s a"stract thin'ing a"ilities. 1. ,s often unrealistic. :. ,s ca!a"le of scientific reasoning and formal logic. logic. 8. .njo s intellectual a"ilities. 4. ,s a"le to #iew !ro"lems com!rehensi#el . A ole#cent /12 to 1@ $ear#0 D. Nutr"t"on 3. Nutritional reBuirements !ea' during ears of ma%imum growth: age 36&31 in girls, 1 ears later in "o s 1. A!!etite increases. increases. :. ,nadeBuate diet can retard growth and dela se%ual maturation. 8. *ood inta'e needs to "e "alanced with energ e%!enditure. 4. ,ncreased needs include calcium for s'eletal growth$ iron for increased muscle mass and "lood cell de#elo!ment$ zinc for de#elo!ment of s'eletal and muscle tissue and se%ual maturation. A ole#cent /12 to 1@ $ear#0 &. Act"v"t"e#: grou! acti#ities !redominate (s!orts are im!ortant)$ acti#ities in#ol#ing o!!osite se% " middle adolescence. G. &ear# 3. Threats to "od image: image: acne, o"esit 1. ,njur or death :. The un'nown Ch"l ?# Re#pon#e to Death 1. to ler# & ma insist on seeing a significant other long after that !erson@s death. 2. Pre#chooler# & See death as tem!orar $ a t !e of slee! or se!aration. 3. School>a%e ; See death as a !eriod of immo"ilit . & *eel death is !unishment. !unishment. 5. A ole#cent# & Ha#e an accurate understanding of death. AD2ANTA7. BREAST &EEDING

       • • • •

Readil a#aila"le .conomical 0romotes facial muscles, jaw and teeth Mother infant "onding Reduced incidence of allergies Reduced incidence of maternal "reast cancer Transfer of maternal anti"odies ,g A ?actoferrin ? soz me ?eu'oc tes

•      • •

Macro!hages

D,SAD2ANTA7. 0re#ents other from feeding the infant ?imits !aternal role in feeding -om!els the mother to monitor her diet carefull Ma "e difficult to a wor'ing mother Digest Buic'l  more feeding

AD.HFAT. QQQ >ets 9 to < dia!ers a da 7aining weight B'TTLE &EEDING

AD2ANTA7.

          • – • • • – • • • •

0ermits the father to feed Mother  medications *ewer feedings

*eeding  !u"lic  em"arrassment D,SAD2ANTA7. -ost 7reater !re!aration and effort Hands  clean ReBuires refrigeration and storage No transfer of maternal anti"odies Doesn@t "enefit mother !h siologicall I))UNIAATI'N +-7 ,nfants .64 ml ,ntradermal Right deltoid School .ntrants .3ml ,ntradermal ?eft deltoid D0T

– – – – • – – – – • – – – • – – – – • – – – – • • • • • •

9, 36 and 38 wee's .4ml ,ntramuscular F!!er outer !ortion of the thigh I))UNIAATI'N He!atitis 9, 36, and 38 wee's .4ml ,ntramuscular F!!er outer !ortion of the thigh /02 9, 36 and 38 wee's 1 dro!s Mouth I))UNIAATI'N Measles J months .4ml Su"cutaneous ?eft outer !art of the u!!er arm 2itamin A -ontraindication: *e#er -om!romise ,mmune s stem Seizure disorder must "e controlled Ne#er gi#e gluteal IN&ANC, /= to 1 $r0 , ; ron su!!lement (8 to 9 months), immunization N ; o cho'ing hazard * ; ear of stranger !ea's at < months A ; llow to use a !acifier if N0/ N ; ote the weight changes T ; rust 2.S. mistrust

• • • • • • • • • • • • • •

S ; olitar !la T'DDLER /1 to 3$r0 T ; al' to the child at sim!le terms / ; ffer choices to the child to !ro#ide some control D ; on@t lea#e alone near the "athtu" or swimming !ool D ; ou"t and shame 2.S. Autonom ? ; earns a"out death R age : . ; limination !attern R ; rituals and routines T'DDLER 0 ; ush&!ull to s (mo"ile), !arallel !la (forget sharing) R ; rituals and routines (e es and consistenc ), regression A ; utnom 2S shame and dou"t, accidents (death) , ; n#ol#e !arents S ; e!aration an%iet . ; limination and e%!lore C'))'N ACCIDENTS

0 ; re#ent further a"sor!tion / ; ff, shower or wash off , & dentif S & u!!ort / ; ngoing safet education N ; otif local !oison control center

• • • • • • •

PRESC+''L /3 to 9 $r0 0 ; la is associati#e=coo!erati#e R ; gression is common . ; %!lain !rocedures S ; ame age grou! for room assignment - & urious H ; ighl imaginati#e / ; "ser#e for initiati#e 2S guilt

• • • • • • • • • • • • • • • • • • • • • • • •

/ ; ff limits to the 'itchen (ris' for !oisoning and "urn) ? ; oss of "od !art is a common fear PRESC+''L M & utilation A ; associate !la , a"andonment 7 & uilt , ; nitiati#e, imaginar !la mate, imagination - ; urious  LDM SC+''L AGE / 9 to 12 $r0 S ; ame se% stage - ; om!etiti#e !la H ; eroworshi! / ; "ser#e for industr 2S inferiorit / ; ff limits to #ehicles ? ; oss of control is a common fear . ; %!lain !rocedurse R ; egression is common SC+''L AGE D ; eath ("oge man), honest  funerals and "urials , ; ndustr 2S inferiorit (collections) M ; odest (!ri#ac ) 0 ; eers (own se%) ? ; oss of control  hos!italization, encourage decision ma'ing . & %!laination of !rocedures AD'LESCENT /12 to 1; $r0 0 ; eer grou!  acti#ities, !eer !ressure A ; ltered "od image  don@t want to "e seen different , ; dentit ; image  college or career

• • • • • • • • • • • •

R ; ole diffusion S ; e!aration from !eers SA)PLE BUESTI'NS Two month old Aristin is "rought to the health clinic for his first immunization against D0T. >hat route should the nurse use to administer the #accineQ /ral ,ntramuscular ,ntradermal Su"cutaneous

The nurse should teach Aristin@s mother a"out the normal reaction an infant can e%!erience a!!ro%imatel 31 to 18 hours after D0T. /ne of these reactions could "e: ?etharg Mild fe#er Diarrhea Nasal congestion

Mrs. /rtega "rings her 8&month&old child 0aula, to the clinic. She sa s, LThe soft s!ot near the front of the 0aula@s head is still "ig. >hen will it closeQM The nurse@s res!onse should "e guided " 'nowledge that most often the anterior fontanel closes when the infant@s age is "etween a"outQ

• • • • • • • • • • •

1 to 8 months 8 to < months < to 31 months 31 to 3< months

Mrs. /rtigas "rings her 8&month&old infant, Timm , to the clinic. He a!!ears well. Mrs. /rtigas as's the nurse when she should wean Timm from "reast&feeding and ha#e him use a cu!. The nurse should e%!lain that Timm will show readiness to "e weaned when he is: Ta'ing solid foods well Slee!ing through the night Shortening his nursing time .ating on a regular schedule

,n counseling a teenage mother on the first&solid food to introduce to her 4&month&old child, least allergenic foods are gi#en. >hich of the following should "e recommended in the usual order in introducing solid foodsQ

• • • • • • • • • • • • • • •

.ggs 0ureed chic'en +ananas Rice cereal

A nurse is o"ser#ing all of the following "a"ies in the clinic. >hich "a" ma "e e%!eriencing a de#elo!mental dela Q A 3&month&old who does not coo A :&month&old who does not crawl An <&month&old who does not wal' A 36&month&old who does not sit

A first&time mother is concerned that her 9&month&old infant is not gaining enough weight. The "est res!onse for the nurse to ma'e is which of the followingQ L+irth weight dou"les " 9 months of age.@ L+irth weight dou"les " : months of age.M LThe "a" will eat what he needs.M LDou need to ma'e sure the "a" finishes each "ottle.M

The nurse discusses ?uc @s motor s'ill de#elo!ment with her mother. The nurse e%!lains to ?uc @s mother that at a"out 5 months of age, ?uc will most li'el to "e a"le to

– – – –

>al' with su!!ort *eed herself with a s!oon Stand holding onto furniture Sit alone using her hand with su!!ort

• • • • • • •

A mother of an infant as's the nurse when she can e%!ect her "a" to sit u!. The nurse informs the mother that an infant can generall sit u! without su!!ort at: 8 months 9 months < months 36 months

A mother of a 36&month&old "a" as's a clinic nurse a"out a!!ro!riate and safe to s for the "a" . The nurse tells the mother that the most a!!ro!riate to s for a 36&month&old is which of the followingQ cradle g m

• • • •

Tedd "ears ?ow roc'ing horses +loc's >hich is the "est wa to deal with a toddler who is ha#ing a tem!er tantrumQ

– – – –

Reason with the child Threaten the child S!an' the child ,gnore the child@s out"urst

• • • • • • • • • • •

The nurse o"ser#es a grou! of 1& ear&old children at !la in the "each. The nurse would e%!ect to see: *our children !la ing soft "all Three children !la ing tag Two children !la ing sand"o% "uilding castles side " side /ne child digging a hole

>hen assessing a 1& ear&old child "rought " his mother to the clinic for a routine chec'& u!. The nurse would e%!ect the child is a"le to do which of the followingQ Ride a tric cle Tie his shoelaces Aic' a "all forward Fse "lunt scissors

Mrs. Sara tells the nurse that her 8& ear&old son, -harles does not seem to 'now the difference "etween right and wrong. She e%!lains that he 'nows he should not !ush other children, "ut the onl reason for not !ushing them is that he a#oids trou"le. Mrs. Sara is descri"ing t !ical "eha#ior of a child who has reached with le#el of moral de#elo!ment as descri"ed " Aohl"ergQ

• • • • • • •

Autonomous -on#entional 0recon#entional 0rinci!les

A mother "rings her 4& ear&old son to the !ediatrician@s office for a com!lete health a!!raisal "efore he enters 'indergarten ne%t moth. The nurse should focus !art of the assessment on the child@s achie#ement of !s chosocial tas's. At this age, he should "e tr ing to accom!lish a sense of Autonom ,dentit

• • • • • • •

Master ,nitiati#e

The mother of a 36& ear&old student is concerned a"out her daughter@s com!ulsion for collecting things. The nurse e%!lains that this "eha#ior is related to the cogniti#e a"ilit to !erform: -oncrete o!erations *ormal o!erations -oordination of secondar schemas Tertiar circular reactions