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Growth and developmental assessment of the child

Growth and developmental assessment of the child

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Growth and developmental assessment of the child

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  1. Growth and developmental assessment of the child Principles of growth & development P25 Major theories of development &nursing application P26~P36 Influences on developmentP36 各年齡層兒童的生長與發展 P39~P66 評估

  2. Principles of growth & developmentP25 • The exact age at which skill emerge differs, but the sequence or order of skill performance is uniform among children. 第2段第2行 • Cephalocaudal development • Proximodistal development • Physical size, motor skills, cognitive ability, language, sensory ability, and psychosocial patterns. • These assessments can guide the nurse in planning interventionsfor the child and family.

  3. Major theories of development &nursing application P26~P36 • Simon Freud-psychosexual • Erik Erikson-psychosocial • Jean Piaget-cognitive development • Chess &Thomas -Temperament theory

  4. 心理社會發展 • Simon Freud • Psychosexual • id 、ego (defense mechanism P27)、superego • oral、anal、phallic、latency、genital P27

  5. 心理社會發展 P27, 29, 30 • Erik Erikson • Psychosocial • Trust v.s. mistrust (birth to 1 year) • Autonomy v.s. shame and doubt (|1 to 3 years) • Initiative v.s. guilt (3 to 6 years) • Industry v.s. inferiority (6 to 12 years) • Identity v.s. role confusion (12 to 18 years) • Two possible outcomes P27倒數第四行最後 • Healthy&moves on to future stages • Unhealthy outcome&will influence future social relationships.

  6. Jean Piaget P30~32 • Cognitive development • Accommodation(適應) • Assimilation(同化)&change • Sensorimotor (birth to 2 years) • Preoperational (2 to 7 year) • Concrete operation (7 to 11 years) • Formal operation (11 years to adulthood)

  7. Chess &Thomas P34~36 • Temperament theory 先天就決定的對內在或外在刺激的反應模式 • Nine parameters of response to daily events (Table 2-5) P35 • Three major personality types (Table 2-6) P35 • Nursing Application

  8. Influences on developmentP36 • Genetics • Prenatal influences • Cultural influences • Others influences • Nutrition、Family structure、School、Stress、Socioeconomic influences、Community、Media

  9. 各年齡層兒童的生長與發展 P39 • Physical growth and development • Cognitive development • Injury prevention • Personality and Temperament • Play and communication • Sexuality

  10. Infant • Physical growth and development P40-42 • The first year of life is one of rapid change for the infant. P40第1段 • The birth weight usually doubles by about 5 months and triples by the end of the first year(Figure 2-7*). • Height increases by approximately l foot during this year. • Teeth begin to erupt at about 6 months, and by the end of the first year the infant has six to eight deciduous teeth (see Chapter 4). • Kidney and liver maturation helps infant excrete drugs or other toxic substances. P40第2段 • Maturation of the nervous system is demonstrated by increased control over body movements, enabling the infant to sit, stand, and walk. • Sensory function also increases as the infant begins to discriminate visual images, sounds, and tastes. • 參考Table 2-11

  11. Infant • Cognitive development P42-43 • The newborn's eyes widen an response to sound. • Turns to the sound and recognizes its significance. • The 2-month-old cries and coos • 1/y says few words and understands many more. • The 6-week-old grasps a rattle . • The l-year-old reaches for toys and self-feeds. • The infant receives stimulation through sight, sound, and feeling, which the maturing brain interprets. This input from the environment interacts with internal cognitive abilities to enhance cognitive functioning.

  12. Infant • Injury prevention P44 • Major cause of death in childhood. • Increasing mobility

  13. Infant • Personality and Temperament P45 • They may display varying degrees of regularity in activities of eating and sleeping, and manifest a capacity for concentrating on tasks for different amounts of time . • The parents can appreciate more fully the uniqueness of their infant and design experiences to meet the infant's needs. Parents can learn to modify the environment to promote adaptation. • Although the infant's temperament is unchanged, the ability to fit with the environment is enhanced.

  14. Toddler • First adolescence. • Displaying independence and negativism . • Physical growth and development P47 • Growth slows • By age 2 years, the birth weight has usually quadrupled and the child is about one half of the adult height. • Body proportions begin to change, with legs longer and head smaller in proportion to body size than during infancy (see Figure 2-7). • The toddler has a pot-bellied appearance and stands with feet apart to provide a wide base of support. • By approximately 33 months, eruption of deciduous teeth is complete, with 20 teeth present. • 粗及精細動作發展圖P48, P49Table 2-16 Toilet Training

  15. Toddler P47 • Cognitive development • Preoperational stage • Object permanence is well developed. • About 2 years of age, increasing use of words . • Rudimentary problem solving, creative thought, and an understanding of cause-and-effect relationships are now possible.

  16. Toddler • Injury prevention P49 • Family want to know P50 • Table 2-18 Injury Prevention in Toddlerhood P51

  17. Toddler • Personality and Temperament P50 • The toddler retains most of the temperamental characteristics identified during infancy, but may demonstrate some changes. • Increasing independence characteristic of this age is shown by the toddler's use of the word no.

  18. P52 Preschool child • A time of new initiative and independence. • Most children are in a child care center or school for part of the day and learn a great deal from this social contact. • Language skills are well developed, and the child is able to understand and speak clearly. • The world of busy preschoolers.

  19. Preschool child P52-54 • Physical growth and development • Grow slowly and steadily, with most growth taking place in long bones of the arms and legs.. • Runs with ease, holds a bat, and throws balls of various types. • Writing ability increases, enjoys drawing and learning to write a few letters. • Begin to brush their own teeth, and schedule the first dental visit so the child can become accustomed to the routine of periodic dental care. • Table 2-20.

  20. P54 Preschool child • Cognitive development • Preoperational thought. • Symbols or words • Still has some limitations in thought (Table 2-22).

  21. Preschool child P55 • Injury prevention • Increasing independence. • At high risk of injury from fire, drowning, and motor vehicle and pedestrian accidents.

  22. Preschool child P55 • Personality and Temperament • Characteristics of personality tend to persist over time. • The preschooler may need assistance as these characteristics are expressed in the new situations of preschool or nursery school • To identify the child's personality or temperament characteristics and to find the best environment for growth..

  23. School-age child • Physical growth and development P58 • Long bones continue to grow, leg length increases. • Fat gives way to muscle, and the child appears leaner. • tooth • the first deciduous tooth is lost at 6 years and permanent teeth begin to erupt. • Closely monitored to ensure that brushing and flossing are adequate. • Loose teeth are identified before surgery or other events that may lead to loss of a tooth. • Body organs and the immune system mature. • Medications are less likely to cause serious side effects. • The urinary system can adjust to changes in fluid status. • Rapid increases in size commonly occur during school age. • Physical skills are also refined . (Table 2-25).

  24. School-age child P59 • Cognitive development • Concrete operational thought at about 7 years. • Consider alternative solutions and solve problems. • Rely on concrete experiences and materials to form their thought content. • Learns the concept of conservation.

  25. School-age child • Injury prevention Play in unsupervised settings for longer periods . P61

  26. School-age child P62 • Personality and Temperament • The enduring aspects of temperament continue to be manifested during the school years. • Creative efforts and alternative methods of learning should be valued. • Encourage parents to see their children as individuals who may not all learn in the same way.

  27. School-age child P62 • Sexuality • Although children become aware of sexual differences between genders during preschool years, they deal much more consciously with sexuality during school age. • Need information about their bodily changes . • Become interested in sexual issues .

  28. Adolescent child P62 A period of identity formation. • Physical growth and development • The physical changes ending in puberty, or sexual maturity, begin near the end of the school-age period. • The prepubescent period : growth spurt. • The increase in height and weight is generally remarkable. • Girls :breast size , pubic hair & menstruation occurs. • Boys: penis and testes size  , pubic hair, deepening of the voice and growth of facial hair occur later. • Take adult doses of medications. • Table 2-28

  29. Adolescent child • Cognitive development P63 • Formal operational thought. • The ability to reason abstractly. • The ability to think and act independently leads many adolescents to rebel against parental authority. Through these actions, adolescents seek to establish their own identity and values.

  30. Adolescent child P63-65 • Injury prevention • They often believe they are immune from harm. This encourages adolescents to put themselves at high risk from dangerous behaviors . P63倒數第3行 • Motor vehicle crashes, suicides, and homicides cause 75% of adolescent deaths . P63此段第1行 • Suicide among adolescents has increased by 300% over the past four decades and is the second leading cause of death from l5 to l9 years(MMWR, 1995; Hayden & Leuer, 2000) . P64第2行 • The high rate of stress experienced, harmful substances and firearms promotes death by suicide. P64倒數第4行 • Violence is an increasingly important factor in adolescent injury. P65 第2段第1行

  31. Adolescent child P65 • Personality and Temperament • Characteristics of temperament manifested during childhood usually remain stable in the teenage years. • It is also common for an adolescent who was an easy child to become more difficult because of the psychologic changes of adolescence and the need to assert independence.

  32. Adolescent child • Sexuality • Achieves sexual maturity • Interactions with members of the opposite sex. • The forces of society and family • Identity formation. P66

  33. 評估 • 兒童完整健康史 • 身體檢查與評估 • 身心發展評估工具

  34. 兒童完整健康史 • 個人:病史、營養史、發展史 • 家庭評估:家族史、家庭內/外在結構、家庭互動 • 營養評估:體重及生長發育的情形、血比容及血紅素、皮膚及皮下脂肪、排泄睡眠精力)(飲食習慣、進食的量與質、對食物的喜好以及吸收的狀況 • 熱量需要量 • 奶量的計算 • 副食品添加(嬰幼兒每天飲食建議量) • Physiologic anorexia

  35. 熱量需要量 • 0-6M 115 Cal/Kg • 6-12 105 Cal/Kg  <1y/o 110-120 Cal/Kg • 1y/o左右 1300 Cal/day • > 1y/o 每增1歲增加100 Cal

  36. 奶量的計算 • 全奶 14% 30 ml = 20Cal

  37. 嬰幼兒每天飲食建議量 • 1~3個月大 • 牛奶占100% • 4~6個月大 • 牛奶占80~90% • 副食品:果汁、青菜湯、麥糊或米糊 • 7~12 個月大 • 牛奶占50%~70 % • 副食品:稀飯、麵條、蛋 • 1~2歲 • 牛奶占30%

  38. 身體檢查與評估 • 技巧--視、聽、叩、觸診 • 生長測量 • 身高、體重、頭圍之生長曲線圖、成長曲線圖 • 生理測量 • 體溫、脈搏、呼吸、血壓 • 器官或系統的檢查與評估

  39. 兒童生長可能有問題的情況 • 身高與體重的百分位相距太大 • 無法達到預期的生長速度(尤其是嬰幼兒及青少年期) • 成長突然增快或遞減

  40. 身心發展評估工具 P197 Table 6-2, P198 Table 6-3 • DDST(Denver Developmental Screening Test) • 社會適應、精細動作、粗動作、語言發展 • BSID(Bayley Scales of infant Development) • 心智、動作、行為量表 • PDMA(Peabody Developmental Motor Scales and Activity Cards) • 氣質評估量表 活動量、規律性、注意力分散度、趨避性、堅持性、反映閥、適應性、反應強度以及情緒本質。

  41. 氣質量表 • 嬰兒氣質評估量表 • 學步期幼兒氣質量表 • 兒童氣質量表 • 青少年氣質量表 徐澄清, “小時了了”