Study Guide for Chapters 28,29, 31, 32
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Chapter 28: Developmental and Genetic Influences on Child Health Promotion
Foundations of Growth and Development
Growth:
 An increase in number and size of cells as they divide and synthesize new
proteins; results in increased size and weight of whole or any of its parts
Development:
 A gradual change and expansion; advancement from lower to more advanced
stage of complexity; increased capacity through growth, maturation, and learning
Maturation:
 An increase in competence and adaptability, usually described as a qualitative
change to function at higher level
Differentiation:
 The processes by which early cells and structures are systematically modified
and altered
Stages of development
Patterns of growth and development
 Directional trends
 Sequential trends
 Developmental pace
 Sensitive periods
 Individual differences
Biologic Growth and Physical Development
 External proportions
 Biologic determinants of growth and development
 Skeletal growth and maturation
 Neurologic maturation
 Lymphoid tissue
 Development of organ systems
Physiologic Changes
Metabolism
 Basal metabolic rate
Temperature
 Thermoregulation
Sleep and rest
 Protective function
Nutrition
 Single most important influence on growth
 Appetites fluctuate related to growth periods
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Temperament
 Manner of thinking, behaving, or reacting that is characteristic of an individual
 Easy child
 Difficult child
 Slow-to-warm-up child
Significance of temperament
Development of Personality and Cognitive Function
 Theoretical foundations
 Psychosexual development (Freud)
 Oral stage (birth to 1 year)
 Anal stage (1 to 3 years)
 Phallic stage (3 to 6 years)
 Latency period (6 to 12 years)
 Genital stage (≥ 12 years)
Theoretic Foundations of Personality Development
 Psychosocial development (Erikson)
 Trust versus mistrust (birth to 1 year)
 Autonomy versus shame and doubt (1 to 3 years)
 Initiative versus guilt (3 to 6 years)
 Industry versus inferiority (6 to 12 years)
 Identity versus role confusion (12 to 18 years)
Theoretic Foundations of Cognitive Development
 Cognitive development (Piaget)
 Sensorimotor (birth to 2 years)
 Preoperational (2 to 7 years)
 Concrete operations (7 to 11 years)
 Formal operations (11 to 15 years)
Language development
 Born with the mechanism and capacity to develop speech and language skills
 Environmental means
 Intact physiologic structure and function
 Intelligence
 A need to communicate
 Stimulation
Moral development (Kohlberg)
 Preconventional level
 Conventional level
 Postconventional, autonomous, or principled level
Development of Self-Concept
Body image
Self-esteem
 Competence
 Sense of control
 Moral worth
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 Worthiness of love and acceptance
Role of Play in Development
Classification of play
Content of play
 Social-affective play
 Sense-pleasure play
 Skill play
 Unoccupied behavior
 Dramatic or pretend play
 Games
Social character of play
 Onlooker play
 Solitary play
 Parallel play
 Associative play
 Cooperative play
Functions of play
 Sensorimotor development
 Intellectual development
 Socialization
 Creativity
 Self-awareness
 Therapeutic value
 Morality
Toys
 Can support and enhance children’s development
 Offer an opportunity to bring children and parents together
 Pushing, pulling, rolling, and manipulating help develop muscles
Developmental Assessment
 Screening procedures
 Objective measurements
 Assessment of child with disabilities
 Ages and stages
Genetic Factors that Influence Development
Genes, genetics, and genomics
Congenital anomalies
Disorders of the intrauterine environment
Genetic disorders
Role of the nurse in genetics
 Nursing assessment
 Identification and referral
 Education
 Question
A father tells the nurse that his child is “filling up the house with collections” such as
seashells, bottle caps, baseball cards, and pennies. The nurse should recognize that the
child is developing:
A. object permanence.
B. preoperational thinking.
C. concrete operational thinking.
D. ability to use abstract symbols.
ANS: C
Feedback
A Incorrect: Object permanence is the realization that items that leave the visual field still
exist. This is a task of infancy and does not contribute to collections.
B Incorrect: Preoperational thinking is concrete and tangible. Children in this age group
cannot reason beyond the observable, and they lack the ability to make deductions or
generalizations. Collections are not typical for this developmental level.
C Correct: During concrete operations children develop logical thought processes. They are
able to classify, sort, order, and otherwise organize facts about the world. This ability fosters
the child’s ability to create collections.
D Incorrect: The ability to use abstract symbols is a characteristic of formal operations,
which develops during adolescence. These children can develop and test hypotheses.
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
Chapters 29
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Guidelines for Communication and Interviewing:
Establishing a setting
Appropriate introduction-introduce self, proper name
Assurance of privacy and confidentiality
Computer privacy and applications in nursing
Telephone triage and counseling-screening questions, referral to 911 or same day
appointments
Communicating With Families:
Communicating with parents
➢ Encouraging the parents to talk
➢ Using silence-sort out thoughts
➢ Being empathetic
➢ Providing anticipatory guidance-deal with it before it becomes a problem
➢ Avoiding blocks to communication-judgements
➢ Communicating through an interpreter
Cont:
Communicating with children
Communication related to development of thought processes
➢ Infancy-non verbal communication (behaviors and vocalization)
➢ Early childhood-egocentric, focus communication on them
➢ School years-explanations and reasons
➢ Adolescence-interview alone or with parents, talk with parents
before adolescent, confidentiality, listen
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History Taking:
Performing a health history
➢ Identifying information
○ Informant, most likely the parent-person who furnishes the
information, health records
➢ Chief complaint-specific reason for visit
➢ Present illness
○ Analyzing a symptom or symptoms- onset and progression
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Cont:
➢ Birth history-prenatal influences
➢ Dietary history
➢ Previous illness, injuries, and operations
➢ Allergies-hayfever, reactions to foods/meds
➢ Current medications-vitamins, supplements
➢ Immunizations-school records, HCP records
➢ Growth and development-patterns of growth, milestones
Habits-concerns about child
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Cont:
➢ Reproductive health history-essential to adolescent
➢ Family health history-genetic or chronic illness
➢ Geographic location
➢ Family structure-quality of functional relationship
➢ Psychosocial history-habits, coping, school adjustment
➢ Review of systems-review of each body system through physical exam
Nutritional Assessment
➢ Dietary intake-difficult, under reporting
➢ Clinical examination of nutrition
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Hair, skin, mouth, eyes-reflect present nutritional status (weight,
skin fold thickness, arm circumference)
➢ Evaluation of nutritional assessment-food diary
○ Malnourished
○ At risk
○ Well nourished
○ Overweight or obese
Preferred diets that incorporate more fruits and vegetables compared to protein,
grain, and dairy.
Goals of Pediatric Assessment:
➢ Minimize stress and anxiety associated with assessment of various body
parts
➢ Foster trusting nurse-child-parent relationships
➢ Allow for maximum preparation of child
➢ Preserve security of parent-child relationship
➢ Maximize accuracy of assessment findings
➢ Head to toe sequence
➢ Cooperation usually enhanced with parent’s presence
➢ Age-appropriate techniques
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Physical Examination:
Growth measurements
➢ Growth charts-monitors for appropriate growth
➢ Length
➢ Height
➢ Weight
➢ Skin full thickness and arm circumference-measurement of body fat
(triceps, subscapular, abdomen, upper thigh)
➢ Head circumference-reflects brain growth
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Physiologic Measurements:
➢ Physical states of vital function
➢ Temperature
○ Electronic intermittent thermometer
○ Infrared thermometer
○ Electronic continuous thermometer
➢ Pulse
○ Radial
○ Apical
➢ Respiration
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Cont:
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➢ Pediatric blood pressure (BP)
➢ Measurement devices
➢ Selection of cuff
➢ Cuff placement
➢ BP measurement and interpretation
➢ Orthostatic hypotension
Physical Assessment
➢ General appearance-observations
➢ Skin-color, texture, temperature, rashes
➢ Accessory structures-hair, scalp, nailbeds, palmar creases
➢ Lymph nodes-size, mobility, tenderness (swollen, painful, warm may
indicate infection)
➢ Head and neck-symmetry, function
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Cont:
➢ Eyes
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External structures-placement, PERRLA (pupils equal, round, reactive to
light and accommodation)
Internal structures
■ Preparing the child-show child ophthalmoscope
■ Funduscopic examination-red reflex (absence may indicate
obstruction)
Vision testing
■ Ocular alignment
■ Visual acuity in children
■ Visual acuity in infants and difficult to test children
■ Peripheral vision
■ Color vision
Cont:
➢ Ears
➢ External structures-alignment, inspection
➢ Internal stuctures
○ Positioning the child-parents lap, introduce instrument
○ Otoscopic examination-tilt head, pinna-infant, child
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○ Auditory testing
➢ Nose
○ External structures-placement
○ Internal structures-inspection of mucous membranes
Cont:
➢ Mouth and throat
○ Internal structures-tounge blade
➢ Chest-size, shape, symmetry, movement, breast development
➢ Lungs
○ Auscultation-deep breaths
➢ Heart
➢ Auscultation-semi fowlers position
○ Origin of heart sounds-opening and closing of valves (S1 and S2) closing
of tricuspid and mitral valves
○ Differentiating normal heart sounds-quality
○ Heart murmurs
Cont:
➢ Abdomen
○ Inspection-movements, evidence of abnormalities
○ Auscultation-peristalsis (5 min for absence)
○ Palpation-masses (deep palpation) tenderness, muscle tone (superficial)
➢ Genitalia
○ Male genitalia-appearance
○ Female genitalia-examination and palpation of external structure
➢ Anus-placement, patency, gluteal folds
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Cont:
➢ Back and extremities
○ Spine-curvature
○ Extremities-symemetry, length and size
○ Joints –range of motion
○ Muscles-tone, quality, development, strength
➢ Neurologic assessment
○ Cerebellar function-balance and coordination
○ Reflexes-identifies cerebral insult
Chapters 31
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Promoting Optimal Growth and Development:
➢ Biologic development-dramatic physical and developmental achievements
➢ Proportional changes-rapid growth
○ 5- to 7-ounces weight gain per week
○ Doubling of birth weight by age 6 months
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○ Tripling of birth weight by age 1 year
○ Height increases by 1 inch per month x 6 months
○ Growth in “spurts” rather than gradual pattern
Fine Motor Development:
➢ Grasping object: Ages 2 to 3 months-starts as reflex, then voluntary
➢ Transferring object between hands: Age 7 months
➢ Pincer grasp: Age 10 months (finger foods)
➢ Removing objects from container: Age 11 months
➢ Building tower of two blocks: Age 1 year
Gross Motor Development:
➢ Head control- 3 months of age
➢ Rolling over
○ Age 5 months: Abdomen to back
○ Age 6 months: Back to abdomen
➢ Sitting: Age 7 months
Cont:
➢ Locomotion
○ Cephalocaudal direction of development
○ Crawling: Ages 6 to 7 months
○ Creeping: Age 9 months
○ Walking with assistance: Age 11 months
○ Walking alone: Age 1 year
Psychosocial Development
➢ Developing a sense of trust (Erikson)
➢ Infants trust that their comfort needs will be met-foundation for all succeeding
phases
○ Feeding
○ Stimulation-quality of interpersonal relationship
➢ Mistrust
○ Occurs when gratification of needs is delayed
➢ Social modifications-successful resolution strengthens mother-child relationship
○ Grasping
○ Biting
Cognitive Development:
➢ Sensorimotor phase (Piaget)
○ Birth to age 1 month: Use of reflexes
○ Ages 1 to 4 months: Primary circular reactions-replacement of voluntary
actions in places of reflex
○ Ages 4 to 8 months: Secondary circular reactions-prolonged and
repeated (grasping becomes shaking or banging)
○ Imitation-sounds, gestures
○ Play-taking pleasure in performing act after mastery
○ Affect-outward manifestation of emotion (sense of permeance)
Social Development:
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Cont:
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Attachment-discriminate mother from others, achievement of object permanence)
Separation anxiety-awareness of self and mother
Stranger fear-ability to distinguish between familiar and unfamiliar
Language development-crying, vocalization, exposure to expressive speech
Play-revolves around their own bodies
Temperament
○ Infants’ behavioral style
➢ Strong biologic component
○ May be modified by the environment and family-family involvement
➢ Revised infant temperament questionnaire
○ Difficult-avoid
○ Intense-acceptable descriptor
○ Less predictable-acceptable
Coping With Concerns Related to Normal Growth and Development:
➢ Separation and stranger fear-parents may have guilt
➢ Alternative child care arrangements-safe and competent facilities
➢ Limit setting and discipline-early discipline
➢ Thumb-sucking and use of a pacifier-investigate parents’ feelings, guidance
➢ Teething-physiologic process
Promoting Optimum Health During Infancy
➢ Nutrition
○ First 6 months of life: Human milk
○ Second 6 months
■ Selection and preparation of solid foods-grain, vegetable, fruit,
protein
■ Introduction of solid foods-one food every 5-7 days
■ Weaning from breast or bottle-gradual process
Cont:
➢ Sleep and activity
○ Sleep patterns vary among infants (range 10-20 hours)
○ By ages 3 to 4 months, nocturnal sleep lasts 9 to 11 hours
○ Breastfed infants awakened more often
○ Napping
○ Infants are naturally active
○ Walkers, swings, and playpens are not necessary
Cont:
➢ Dental health
○ Cleaning: Begins when primary teeth erupt
○ Fluoride at 6 months
➢ Prevention of dental caries
➢ No bottle propping
➢ No milk in bed
➢ No fruit juices
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Immunizations-recommendations
Schedule for immunizations-begins at birth, recommended schedule available at CDC
website
Recommendations for routine immunization:
➢ Hepatitis A
➢ Hepatitis B
➢ Diphtheria
➢ Tetanus
➢ Pertussis
➢ Polio
Cont:
Routine immunizations (Cont.)
➢ Measles, mumps, rubella
➢ Pneumococcal infections
➢ Haemophilus influenzae B
➢ Varicella (chickenpox)
➢ Influenza
➢ Meningococcal infections
Cont:
Recommendations for selected immunizations
➢ Selected groups of children
➢ Rotavirus (infants and young children) and human papillomavirus
(adolescents)
Reactions
➢ Vaccine Adverse Event Reporting System (VAERS)-reactions to
preservative rather than vaccine
Contraindications (conditions in individual that increase risk for adverse reaction) and
precautions
Administration
➢ Vaccine Information Statements (VIS) patient teaching, product
information
Cont:
➢ Safety promotion and injury prevention
○ Motor vehicle safety
➢ Nurse’s role in injury prevention
○ Ensuring safety in the home
○ Teaching infant CPR
➢ Anticipatory Guidance—care of families
Special Health Problems
➢ Colic (paroxysmal abdominal pain)
○ 15% to 40% of all infants
○ Therapeutic management-possible causes, supportive measures
○ Care management-diet, time of day for crying, relationship to feeding
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➢ Failure to thrive (growth failure)
○ Diagnostic evaluation-height, weight, food intake
○ Therapeutic management-reversing the cause of growth failure
○ Prognosis-risk for shorter heights, delayed development
○ Interprofessional care of FTT-physician, nurse, dietician, social worker,
mental health professional
○ Care management-nurse assessment, attachment problems (correct
nutritional deficiencies, educate parents, provide adequate calories,
restore optimal body composition
Cont:
➢ Sudden infant death syndrome (SIDS)
○ Etiology-sudden death in infants under one year, cause remains unknown
○ Infant risk factors for SIDS-low birth weight, low APGAR, males, viral
illness, Native American or African American
○ Protective factors for SIDS- safe sleep
○ - risk factors-maternal smoking, co-sleeping
➢ Care management
○ Interprofessional care of the family of a SIDS infant-consequences
surrounding event
Cont:
➢ Apparent life-threatening event (ALTE)
○ Aborted or near-miss SIDS-change in color, muscle tone, choking, apnea
➢ Diagnostic evaluation of ALTEs-activities precluding event
➢ Therapeutic management-depends on underlying cause
➢ Care management-anxiety producing, home monitoring
Chapter 32
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Promoting Optimal Growth and Development
➢ “The terrible twos”
➢ Ages 12 to 36 months
➢ Intense period of environmental exploration
➢ Temper tantrums/obstinacy/negativism
Biologic Development
➢ Proportional changes
➢ Weight gain slows to 4 to 6 lbs/year
➢ Birth weight should be quadrupled
by age 2½ years
➢ Height increases about 3 inches/year
➢ Elongation of legs rather than trunk
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➢ Growth is step-like rather than linear
Cont.
Sensory Changes
➢ Visual acuity of 20/40 is acceptable
➢ Hearing, smell, taste, and touch continue developing
➢ All senses are used to explore environment
Cont:
Maturation of systems
➢ Most physiologic systems are relatively mature by the end of toddlerhood
➢ Upper respiratory infections, otitis media, and tonsillitis are common among
toddlers
➢ Body temperature is maintained
➢ Child is physiologically able to control elimination
➢ Defense mechanisms of skin are intact
Biologic Development
Proportional changes
Weight gain slows to 4 to 6 lbs/year
Birth weight should be quadrupled by age 2½ years
Height increases about 3 inches/year
Elongation of legs rather than trunk
Growth is step-like rather than linear
Cont:
Sensory Changes
➢ Visual acuity of 20/40 is acceptable
➢ Hearing, smell, taste, and touch continue developing
➢ All senses are used to explore environment
Cont:
Maturation of systems
Most physiologic systems are relatively mature by the end of toddlerhood
Upper respiratory infections, otitis media, and tonsillitis are common among
toddlers
Body temperature is maintained
Child is physiologically able to control elimination
Defense mechanisms of skin are intact
Cont:
➢ Gross and fine motor development
○ Locomotion
○ Refinement of coordination
○ Between ages 2 and 3 years
○ Fine motor development
➢ Improved manual dexterity
○ Ages 12 to 15 months
➢ Throwing ball
○ By 18 months
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Psychosocial Development
➢ Developing sense of autonomy (Erikson)
○ Autonomy versus shame and doubt
○ Negativism
○ Ritualization that provides sense of comfort
○ Id, ego, superego/conscience
Cognitive Development
Sensorimotor and preoperational phase (Piaget)
Cognitive processes develop rapidly between ages 12 and 24 months
Tertiary circular reactions
Active experimentation
Applying knowledge to new situations
Learning spatial relationships
Cont:
➢ Invention of new means through mental combinations
○ Final sensorimotor stage: Ages 19 to 24 months
○ Imitation of behaviors
○ Domestic mimicry
○ Concept of time: Still embryonic
Cont:
➢ Preoperational phase
○ Begins about age 2 years
○ Lasts until age 4 years
○ Is the transition between self-satisfying behavior and socialized
relationships
○ Preconceptual phase is a subdivision of the preoperational phase
○ Preoperational thought implies children cannot think in terms of
operations
Development of Body Image
➢ Development of body image parallels cognitive development
➢ Child refers to body parts by name
➢ Child recognizes words used to describe appearance
○ Adults should avoid negative labels about physical appearance
➢ Child recognizes gender differences by age 2 years
Development of Gender Identity
➢ Exploration of genitalia is common
○ Genital fondling can occur
○ Parental reaction should be accepting
➢ Gender roles are understood by toddler
○ Playing “house”
➢ Gender identity is formed by age 3 years
Social Development
➢ Separation
○ Differentiation of self from mother and significant others
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➢ Individualization
○ Achievements that mark the child’s expression
○ Major achievements: Occur in the toddler years
○ Transitional objects
Cont:
➢ Language
○ Level of comprehension increases
○ Ability to understand increases
○ Comprehension is much greater than the number of words a toddler can
say
○ At age 1 year, child uses one-word sentences
○ By age 2 years, child uses multi word sentences
Cont:
➢ Personal social behavior
○ Toddlers develop skills of independence
○ Skills for independence may result in determined, strong-willed, volatile
behaviors
○ Skills include feeding, playing, dressing, and undressing self
○ Toddlers develop concern for the feelings of others
Cont:
➢ Play
○ Magnifies physical and psychosocial development
○ Interaction with others: Becomes more important
○ Parallel play
○ Imitation
○ Tactile play
○ Selection of appropriate toys
Coping With Concerns Related to Normal Growth and Development
Toilet training
Sibling rivalry
Temper tantrums
Negativism
Regression
Promoting Optimum Health During Toddlerhood
➢ Nutrition
○ Phenomenon of “physiologic anorexia”
○ Nutritional counseling
○ Dietary guidelines
○ Vegetarian diets
➢ Complementary and alternative medicine
➢ Sleep and activity
○ Sleep problems
Cont:
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➢ Dental health
○ Regular dental examinations
○ Removal of plaque
○ Fluoride
○ Dietary factors
■ Early childhood caries
➢ Atopic dermatitis
○ Therapeutic management
○ Interprofessional care
Cont:
➢ Safety promotion and injury prevention
○ Motor vehicle safety
○ Car seat restraints
○ Motor vehicle-related injuries
➢ Drowning
➢ Burns
Skin Disorders related to Animal Contacts
➢ Arthropod bites and stings
➢ Animal bites
○ Therapeutic management
○ Care management
➢ Human bites