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NURS 207: Promoting Pediatric Wellness in the Family & Community Allan J. V. Cresencia, MSN, CPN, RN Samson Yigezu, PhD, RN Christine Limann, BS, CPN,

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Presentation on theme: "NURS 207: Promoting Pediatric Wellness in the Family & Community Allan J. V. Cresencia, MSN, CPN, RN Samson Yigezu, PhD, RN Christine Limann, BS, CPN,"— Presentation transcript:

1 NURS 207: Promoting Pediatric Wellness in the Family & Community Allan J. V. Cresencia, MSN, CPN, RN Samson Yigezu, PhD, RN Christine Limann, BS, CPN, RN West Coast University - Los Angeles

2 Theories of Development Personality Development Freud - Psychosexual Erickson - Psychosocial Mental Development Piaget - Cognitive Kohlberg - Moral

3 Erikson Stages of Psychosocial Development 1. Infancy : Birth to 18 Months Ego Development Outcome: Trust vs. Mistrust Basic strength: Drive and Hope 2. Toddler : 18 Months to 3 Years Ego Development Outcome: Autonomy vs. Shame Basic Strengths: Self-control, Courage, and Will 3. Preschooler : 3 to 5 Years Ego Development Outcome: Initiative vs. Guilt Basic Strength: Purpose

4 Erikson Stages of Psychosocial Development 4. School Age : 6 to 12 Years Ego Development Outcome: Industry vs. Inferiority Basic Strengths: Method and Competence 5. Adolescence : 12 to 18 Years Ego Development Outcome: Identity vs. Role Confusion Basic Strengths: Devotion and Fidelity

5 Theories of Development Piaget – Mental Sensorimotor – birth to 2 years Preoperational – 2 to 7 years Concrete operations – 7 to 11 years Formal operations – 11 to 15 years Kohlberg – Moral Preconventional level – good/bad or right/wrong Conventional level – approval by being “nice” Postconventional, autonomous, or principled level – formal operations

6 Piaget Stages of Cognitive Development Sensorimotor period Years 0-2  In this stage, infants construct an understanding of the world by coordinating sensory experiences (such as seeing and hearing) with physical, motoric actions.  Infants gain knowledge of the world from the physical actions they perform on it.  An infant progresses from reflexive, instinctual action at birth to the beginning of symbolic thought toward the end of the stage.  Object permanence is key word.

7 Infant Stimulation Newborn prefers human face for stimulation Visual benefit of black-and- white objects for stimulation Stimulation of human voice Importance of tactile stimulation

8 Focus on Visual Objects

9 Fine Motor Development Grasps object, age 2 to 3 months Transfers object between hands, age 7 months Pincer grasp, age 10 months Removes objects from container, age 11 months Builds tower of two blocks, age 12 months

10 Crude Pincer Grasp

11 Neat Pincer Grasp

12 Gross Motor Development Head control Rolls over, age 5 to 6 months Sits alone, age 7 months Moves from prone to sitting position, age 10 months

13 Head Control

14 Locomotion Cephalocaudal direction of development Crawling, age 6 to 7 months Creeping, age 9 months Walk with assist, age 11 months Walk alone, age 12 months

15 Psychosocial Development Erikson’s phase I: developing a sense of trust Trust vs. mistrust Importance of caregiver-child relationship “Delayed gratification” Importance of consistency of care

16 Finding Hidden Object

17 Development of Body Image Concept of object permanence By end of first year, recognize that they are distinct from parents

18 Viewing Own Image

19 Development of Sexual Identity Hormonal influences Infant Parental influences on development of sexuality

20 Social Development Attachment Reactive attachment disorder (RAD) Separation anxiety Stranger anxiety Play as major socializing agent

21 Stranger Fear

22 Language Development Crying is first verbal communication Vocalizations Three to five words with meaning by age 1 year

23 Infant’s Health Promotion Promoting Infant Safety Aspirations Falls Car (MVA) Siblings Bathing and Swimming Childproofing

24 Infant’s Health Promotion Nutritional Health Recommended dietary reference intakes Introduction of solid foods Loss of extrusion reflex Techniques for feeding solid foods Nutritional Health Quantities and types of food Cereal Vegetables and fruit Meat and eggs Table food Chart on next slide.

25 Infant’s Health Promotion Nutritional Health Establishment of healthy eating patterns Weaning Self-feeding Adequate intake with a vegetarian diet Development in Daily Activities Bathing Diaper-area care Use of pacifiers Care of teeth Dressing Sleep patterns Exercises

26 Infant’s Health Promotion Parental Concerns and Problems Diaper dermatitis – skin condition Miliaria – sebaceous glands Baby-bottle syndrome – dental carries Obesity – no comment!

27 Baby-bottle syndrome – dental carries

28 Health Problems During Infancy Chapter 13

29 Protein and Energy Malnutrition Kwashiorkor Severe protein malnutrition, especially in children after weaning, marked by lethargy, growth retardation, anemia, edema, potbelly, Marasmus A progressive wasting of the body, occurring chiefly in young children and associated with insufficient intake or malabsorption of food

30 Food Sensitivity Cow’s milk allergy Lactose intolerance

31 Feeding Difficulties Regurgitation and “spitting up” Reflux/GERD Colic (paroxysmal abdominal pain) Failure to thrive Organic FTT Nonorganic FTT

32 The “Colic Carry”

33 A Consistent Nurse in Nonorganic FTT

34 SKIN DISORDERS Diaper Dermatitis Principal factors in development Therapeutic management Nursing considerations

35 Seborrheic Dermatitis Chronic, recurrent, inflammatory reaction of the skin Scalp: cradle cap Eyelids: blepharitis External ear: otitis externa Cause unknown Nursing considerations Head & Shoulders to wash hair 1-2 times

36 Atopic Dermatitis Also called eczema Is a category of dermatologic diseases and not a specific etiology Pruritic Usually associated with allergy Hereditary tendency

37 Therapeutic Management Hydrate the skin Relieve pruritus Reduce inflammation Prevent and control secondary infection Nursing considerations Atopic Dermatitis-

38 Disorders of Unknown Etiology Sudden infant death syndrome (SIDS) Apparent life-threatening events (ALTEs) “Back to Sleep” campaign Increased incidence of positional plagiocephaly

39 Infants at Risk for SIDS Unknown Etiology Infants with one or more severe Apparent life-threatening events (ALTEs) requiring CPR or vigorous stimulation Preterm infants experiencing apnea at time of discharge from hospital Sibling of two or more SIDS victims History of central hypoventilation

40 Health Promotion of the Toddler and Family

41 Biologic Development Weight gain slows to 4 to 6 pounds per year Birth weight should be quadrupled by 2½ years of age Height increases about 3 inches per year Growth is “steplike” rather than “linear”

42 Maturation of Systems Most physiologic systems relatively mature by the end of toddlerhood Upper respiratory infections, otitis media, and tonsillitis are common among toddlers Voluntary control of elimination Sphincter control age 18 to 24 months

43 Gross and Fine Motor Development Locomotion Improved coordination between ages 2 and 3 Fine motor development Improved manual dexterity ages 12 to 15 months Throw ball by age 18 months

44 Typical Toddling Gait

45 Psychosocial Development Erikson: developing autonomy “Autonomy” vs. “shame and doubt” “Negativism” “Ritualization” provides sense of comfort Id, ego, superego/conscience

46 Promoting Optimum Growth and Development “The terrible 2s” Ages 12 to 36 months Intense period of exploration Temper tantrums, obstinacy occur frequently Developing independence vs. parental control

47 Piaget Stages of Cognitive Development Preoperational period (years 2 to 6)  Learn spatial relationships  Awareness of causal relationships between two events  the child learns to use and to represent objects by images, words, and drawings  The child is able to form stable concepts as well as mental reasoning and magical beliefs  Thinking is still egocentric: The child has difficulty taking the viewpoint of other

48 Moral Development Kohlberg: preconventional or premoral level Punishment and obedience orientation “Time out” is useful at this age -1 minutes per year of age

49 Development of Body Image Refer to body parts by name Avoid negative labels about physical appearance Recognize sexual differences by age 2

50 Development of Sexuality Exploration of genitalia is common Gender roles understood by toddler Playing “house” or “pirates”

51 Social Development Differentiation of self from mother and from significant others Separation Individualization

52 Language Increasing level of complexity Increasing ability to understand

53 Personal Social Behavior Toddlers develop skills of independence Skills for independence may result in tyrannical, strong-willed, volatile behaviors Skills include feeding, playing, and dressing and undressing self

54 Playing Dress-Up

55 Transitional Objects Provide Security

56 Play Magnifies physical and psychosocial development Parallel play Imitation Locomotive skills Tactile play

57 Coping with Concerns Related to Normal Growth and Development Toilet training Sibling rivalry Temper tantrums Negativism Regressive behavior

58 Toilet Training

59 Assessing Readiness for Toilet Training Voluntary sphincter control Able to stay dry for 2 hours Fine motor skills to remove clothing Willingness to please parents Curiosity about adult’s or sibling’s toilet habits Impatient with wet or soiled diapers

60 Promoting Optimum Health During Toddlerhood Nutrition Phenomenon of “physiologic anorexia” Sleep and activity Dental health Regular dental exams Removal of plaque Fluoride Low-cariogenic diet

61 Toothbrushing

62 Injury Prevention Motor vehicle injuries: car seat safety Drowning Burns Poisoning Falls Aspiration and suffocation Bodily damage

63 Forward-Facing Convertible Seat

64 Matches Are a Potentially Deadly Hazard

65 Plastic Caps for Electrical Sockets

66 Storage of Cleaning Agents

67 Health Promotion of the Preschooler and Family

68 PROMOTING OPTIMUM GROWTH AND DEVELOPMENT Preschool period 3 to 5 years of age Refining tasks mastered in toddlerhood

69 Biologic Development Physical growth rate slows and stabilizes during preschool years Physical proportions change Slender but sturdy Graceful, agile Posture erect Males and females similar in size and proportion

70 Gross Motor Behavior By 36 months: Walking, running, climbing, jumping By age 4 years: Skips and hops on one foot Catches ball By age 5 years: Skips on alternate feet, jumps rope, learns to skate and swim

71 4-Year-Old Hops on One Foot

72 Psychosocial Development: Erikson Developing a sense of initiative Initiative vs. guilt Development of superego (conscience) (Freud)

73 Cognitive Development: Piaget  Preoperational phase—ages 2 to 7  Preconceptual phase: ages 2 to 4  Intuitive thought: ages 4 to 7 * Causality *Time *Magical thinking *Logical thinking

74 Moral Development: Kohlberg Preconventional (premoral) Punishment and obedience orientation: ages 2 to 4 Naïve instrumental orientation: ages 4 to 7

75 Preschoolers Enjoy Friends

76 Spiritual Development Parental influences Concrete representation of spiritual beings Development of conscience related to spiritual development

77 Development of Body Image Increasing awareness of self and others Poorly defined body boundaries Poor understanding of internal anatomy

78 Development of Sexuality Sexual identity Sexual beliefs Sex typing Gender behaviors Sexual exploration of children is main health concern

79 Social Development Individuation-separation process Effects of prolonged separation (such as hospitalization)

80 Language Ages 4 to 5: four- and five-word sentences Age 6: understand all parts of speech; identify opposites

81 Preschooler Dressing Himself

82 Personal-Social Behavior Self-assertion is a major theme Independent in dressing, eating, toileting by ages 4 to 5 Desire to please Internalized values--conscience & morals More secure with new sibling arrival at this age

83 Play Associative play Make up rules as they go along Imitation Imaginary playmates Mutual play with parents

84 Preschoolers Enjoy a Sense of Accomplishment

85 Preschoolers Enjoy Imaginative and Imitative Play

86 Coping with Concerns Related to Normal Growth and Development

87 Preschool and Kindergarten Experience Learning group cooperation Peer group experiences Readiness for academics Preparing the child

88 Sex Education Find out what the child knows and thinks Be honest with responses Understanding the broader concept of sexuality Resources: Sexuality Information and Education Council of the United States (SIECUS) American Academy of Pediatrics (AAP)

89 Aggression Definition: behavior to hurt person or destroy property Frustration Modeling Reinforcement Professional help for parenting

90 Fears Night terrors Animism: ascribing lifelike characteristics to inanimate objects Techniques to overcome fears


92 Nutrition Nutritional requirement approximately 90 kcal/kg Fluid requirement approximately 100 ml/kg daily MyPyramid application to preschoolers Concerns about childhood obesity

93 Choosing Healthy Foods

94 Assist in Food Preparation

95 Sleep and Activity Sleep average is 12 hours per night for preschool Sleep problems Sleep rituals help establish routine & consistency

96 Dental Health Eruption of primary teeth is complete in preschoolers Need assistance with toothbrushing Routine prophylaxis including fluoride supplements

97 Injury Prevention Poisoning Drowning Pedestrian motor vehicle injuries Seat belts Bicycle helmets Emphasis on protection and education for safety

98 Health Problems of Early Childhood

99 Infectious Disorders Communicable diseases Incidence has declined with increase of immunizations Further decreased with use of antibiotics and antitoxins

100 Nursing Assessment in Identification of Infection Recent exposure to infectious agents Prodromal symptoms Immunization history History of having the disease

101 Prevent Spread of Disease Primary prevention of the disease Immunization Control spread of disease to others Reduce risk of cross-transmission of organisms Infection control policies Hand washing

102 Caution for Compromised Children Children with immunodeficiency  Receiving steroid therapy Other immunosuppressive therapies Generalized malignancies Immunologic disorder Risk for complications from communicable diseases, especially varicella (chickenpox) and erythema infectiosum (EI) Risk for viremia from varicella zoster virus

103 Chickenpox Agent: varicella zoster virus VZG also causes herpes zoster (shingles) VZIG treatment for children at risk Transmission: direct contact, droplet, and contaminated objects Incubation: 2 to 3 weeks Communicability: 1 day before eruption until all lesions crusted

104 Erythema Infectiosum (Fifth Disease) Agent: human parvovirus Rash in three stages: “Slapped face” appearance disappears in 1 to 4 days Maculopapular rash on extremities; lasts 7 days or more Rash subsides but reappears if skin irritated or traumatized by heat, cold, friction, etc.

105 Roseola Agent: human herpesvirus type 6 Incubation: 5 to 15 days Persistent high fever for 3 to 4 days; otherwise appears well After fever subsides, rash appears Rash first on trunk, then face and extremities

106 Rubeola (Measles) Agent: virus Transmission: secretions, droplets Incubation: 10 to 20 days; communicability from 4 days before to 5 days after appearance of rash Koplik spots appear 2 days before rash

107 Mumps Agent: paramyxovirus Transmission: via droplet or direct contact Incubation: 14 to 21 days Fever, headache, malaise, followed by parotitis May cause orchitis and meningoencephalitis

108 Pertussis (Whooping Cough) Agent: Bordetella pertussis Transmission: droplet or direct contact Incubation: 6 to 20 days Cough: short rapid coughs followed by crowing or “whoop” sound Complications: pneumonia (usual cause of death)

109 Rubella (German Measles) Agent: rubella virus Transmission: direct contact or indirect contact with article freshly contaminated with nasopharyngeal secretions, blood, stool, or urine Incubation: 14 to 21 days Complications: rare; greatest danger is teratogenic effect on fetus

110 Scarlet Fever Agent: group A hemolytic streptococci Transmission: droplet or direct contact Incubation: 1 to 7 days Complications: carditis, peritonsillar abscess, glomerulonephritis

111 Scarlet Fever (Cont.)

112 Conjunctivitis Newborns: chlamydia, gonorrhea or herpes simplex virus Infants: may be sign of tear duct obstruction Children: causes are bacterial (most common), viral, allergic, or foreign body

113 Intestinal Parasitic Diseases Ascariasis (common roundworm) Hookworm Strongyloidiasis (threadworm) Giardiasis—caused by a protozoon

114 Ingestion of Injurious Agents Cosmetics and personal care products Cleaning products Plants Foreign bodies, toys, and miscellaneous substances Hydrocarbons (gasoline)

115 Principles of Emergency Treatment Poison control center Call first, before initiating any interventions Assessment Gastric decontamination Induce vomiting, absorb toxin, or perform gastric lavage depending upon agent ingested Prevent recurrence

116 Heavy Metal Poisoning Mercury toxicity (less frequently) * Air & water pollutant from coal plants, etc Most common is lead ingestion *Most common by peeling lead-based paint *Micro particles of lead contaminate bare soil *Can be inhaled or ingested *Affects renal, hematologic, and neurologic systems developing brain and nervous are especially vulnerable

117 Effects of Lead on Body Systems

118 Lead Poison Diagnosis Rarely symptomatic Venous blood sample of 10 mcg/dl Screening for lead poisoning at ages 1 and 2 years Chelation therapy with calcium disodium edetate (EDTA) and succimer (DMSA) Prognosis

119 Child Maltreatment Intentional physical abuse (22%) or neglect (54%) Emotional abuse (4%) or neglect Sexual abuse of children (8%)

120 Types of Neglect Physical neglect Deprivation of food, clothing, shelter, supervision, medical care, and education Emotional neglect Lack of affection, attention, and emotional nurturance Emotional abuse—destroy or impair child’s self-esteem

121 Munchausen’s Syndrome by Proxy Caregiver fabricates signs and symptoms of illness in child (the proxy) to gain attention from medical staff Child may undergo needless and painful procedures and treatments—10% of cases may be fatal to the child

122 Factors Predisposing to Physical Abuse Parental characteristics Social isolation, poor support systems Parental low self-esteem and less adequate maternal functioning

123 Child Characteristics Predisposing to Physical Abuse Compatibility between child’s and parent’s temperament and parent’s ability to deal with behavioral style Removing the child victim from the home may place other siblings at risk for abuse

124 Environmental Characteristics Chronic stress Divorce, poverty, unemployment, poor housing, substance abuse, frequent relocation, crowded living conditions Child abuse can occur in any socioeconomic population

125 Sexual Abuse Defined as: “the use, persuasion, or coercion of any child to engage in sexually explicit conduct or simulation of such conduct for producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children”

126 Characteristics of Abusers and Victims Typical abuser is a male the victim knows but may be ANYONE All socioeconomic backgrounds

127 Nursing Care of the Maltreated Child Identify abusive situations as early as possible History pertaining to the incident Evidence of maltreatment Pattern or combination of indicators that arouse suspicion and further investigation Protect child from further abuse

128 References Hockenberry, M. J. (2005). Wong’s Essentials of Pediatric Nursing 8 th ed. St. Louis, Missouri: Elsevier Mosby. Jordan, D. N.(2005). Nursing 202 Lecture #1 Power Points. Los Angeles, CA. Pillitteri, A. (2007). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family 5 th ed. Philadelphia, PA: Lippincott Williams & Wilkins.

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