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NURS 207: Promoting Pediatric Wellness in the Family

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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, RN – PowerPoint PPT presentation

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Title: NURS 207: Promoting Pediatric Wellness in the Family


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
  • Eriksons 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
Infants Health Promotion
  • Promoting Infant Safety
  • Aspirations
  • Falls
  • Car (MVA)
  • Siblings
  • Bathing and Swimming
  • Childproofing

24
Infants 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
Infants Health Promotion
  • Development in Daily Activities
  • Bathing
  • Diaper-area care
  • Use of pacifiers
  • Care of teeth
  • Dressing
  • Sleep patterns
  • Exercises
  • Nutritional Health
  • Establishment of healthy eating patterns
  • Weaning
  • Self-feeding
  • Adequate intake with a vegetarian diet

26
Infants 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
  • Cows 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
Atopic Dermatitis-
  • 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

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 adults or siblings 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 phaseages 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
andDevelopment
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

91
PROMOTING OPTIMUM HEALTH DURING THE PRESCHOOL
YEARS
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)
  • Giardiasiscaused 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 abusedestroy or impair childs
    self-esteem

121
Munchausens 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 treatments10 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 childs and parents
    temperament and parents 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 theMaltreated 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). Wongs Essentials of
    Pediatric Nursing 8th 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 5th ed. Philadelphia, PA Lippincott
    Williams Wilkins.
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