NURS 207: Promoting Pediatric Wellness in the Family & Community

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

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

5. 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 Theories of Development

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. 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. Infant’s Health Promotion

25. 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 Infant’s Health Promotion

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

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”