week5

• Growth- an increase in the physical size of a whole or any of its parts 
• Development- continuous, orderly series of conditions that lead to activities, new motives for activities and eventual patterns of behavior
• Developmental age groups

  Infancy- newborn(birth-28 days), Infant(1month-12months)

  Early childhood- Toddler(1-3years), Preschool(3-6years)

  Middle childhood- 10 years.

  Later childhood-Prepubertal(10-13years), adolescence(13-18years)
• Piagest’s stages of development

  Sensorimotor(birth to 2 years)

  • Reflex activity and simple imitative behavior

  Preoperational(2 to 7 years)

  • Egocentric behavior, magical thinking, increasing ability to use symbols and language

  Concrete operational(7 to 11 years)

  • Thought process has become more logical and coherent, less self-centered

  Formal operational(11 years to adulthood)

  • Thought process is more adaptable and flexible, contains abstract thought and tests hypothesis
• Erickson’s stages of development

  Trust vs Mistrust- birth-1 year(baby develops a sense of trust when basic needs are met)

  Autonomy vs shame- 1-3 years(the toddler becomes increasingly independent)

  Initiative vs guilt- 3-6 years(the child enjoys engaging in play and expressive activities)

  Industry vs inferiority- 6-12 years(the school-age-child’s self-worth is linked to activities and participation in social groups)

  Identity vs confusion- 12-17 years(the adolescent is searching for their identity, reliant on peers more than family
• Infancy milestones- holds head up and supports weight with arms, can turn from side to back, follows objects and will turn head to look for voices and sounds, can hold head steady when sitting, supports most of weight when held standing
• Growth and development in toddlerhood

  Scribbles on paper

  Throws a ball

  Likes to push and pull toys

  Can undress self..and is learning to dress self

  Learns how to pour

  Increasingly enjoys talking
• Growth and development milestones in preschool

  Learns to use scissors

  Brushes teeth, can close buttons, and tie shoes

  Communicates with a widening array of people

  Enjoys playing with other children
• Growth and development milestones in school-age

  Enjoy taking part in activities that requiem practice

  Have ability to talk and discuss topics for increasing lengths of time

  Can read and concentrate by filtering out surrounding sounds

  Jump rope and rollerblades
• Growth and development milestones in adolescence

  Eager to try new sports and activities

  May lack coordination…especially during growth spurts

  Spend increasing amounts of time with peer group and friends

  Can apply abstract thought and analysis to conversations
• Coping with hospitalization- regression, repression, rationalization, fantasy
• Newborns and infants younger than 6 months- usually do not resist examination, keep parent in sight, examine on table, crib, distraction with toys, sequence(flexible, auscultate when infant is quiet
• 6 months-1 year- developing stranger anxiety, keep infant with parent, examine on parents lap PRN, sequence-same newborns
• Toddlers-1-3 years- shy, anxious, active, cautious, wary, keep parent nearby, dont ask if you can examine toddler, sequence:save instruments until end
• Preschoolers-3-6 years- usually cooperative, leave undergarments on child, involve them in care, assess stuffed animal first, positive feedback
• Early childhood- usually willing to cooperate, sit on examining table, developing modesty, let child listen
• Teens- modesty very important, cover parts of body not being assessed, unless adolescent requests parents; presence, allow for privacy during exam, reassurance that they are developing normally
• Heart rate in children

  Newborn 30-60

  Infant 25-55

  Toddler 20-30

  Preschool 20-25

  School-age 14-22

  Adolescent 12-18
• Lead placement

  White to the right

  Smoke over fire
• Blood pressure measurements

  Newborn 80/55

  Infant 80/55

  Toddler 90-110/55-75

  Preschooler 90-100/55-75

  School-age 100-120/60-75

  Adolescent 100-120/70-80
• Resp rate and rhythm- observer for 60 seconds

  Audible breath sound

  • Quiet,stridor, grunting

  Work of breathing

  • Posture
  • Retraction of accessory muscles
  • Nasal flaring

  Auscultation

  • Air entry
  • Adventitia

  Required equipment

  • Spo2 monitor
• Respirations: Newborn 30-60

  Infant 25-55

  Toddler 20-30

  Preschooler 20-25

  School-age 14-22

  Adolescent 12-18
• Gastrointestinal center

  Appetite and diet

  Abdominal assessment

  • Bowel sounds x4
  • Size, shape, tone

  Bowel movements

  • Frequency and consistency
  • Flatus
  • Alterations

  Nasuea and vomiiting

  Swallowing difficulties

  Oral lesions

  Equipment
• Genitourinary system

  • Voiding patterns
  • Urine characteristics
  • Urine output
  • Equipment
• Musculoskeletal system

  Muscular symmetry/atrophy

  Range of motion

  • Strength, movement, presence of swelling, sensation, CMS checks

  Equipment
• Pediatric interventions

  General concepts related to pediatric procedures

  • Least invasive to most invasive

  Preventing or minimizing physical stressors

  • Comfort holds

  Preventing or minimizing child and family separation

  Promoting sense of control 

  Enhancing communication

  Teaching children and families
• Comfort holds- evolved in 5 years, more natural position, on parent, less stressful for child
• Psychological and somatic impacts

  Believe what child tells you towards pain

  Avoid: codine and tramadol- are not metabolized effectively in children body
• Pain- sensory and emotional experiences associated with actual or potential tissue

  Drugs used to relieve pain

  Narcotics- opium derivatives used to treat many types of pain
• Transmission of these impulses can be modulated or adjusted

  Internuerons can act as “gates”

  Several factors including learned experiences, cultural expectations, individual tolerance, and the placebo effect, can activate the descending inhibitory nerves from the upper central nervous system
• Pain management in children: general principle

  • Its a matter of perspective
  • May be acute or chronic
  • Paralyzed by ancient mythology
  • Challenges exist when assessing a child's pain
  • Painful consequences
• Past- neonates dont feel pain- not true

  Acute

  Chronic

  Scared of IV, might be vague about pain and location

  Work with child
• Indicators

  What the child is doing

  How the child's body is reacting

  How the child's behavior has changed
• Assess the child using QUESTT

  Q: question the child

  U: use pain rating scales

  E: evaluate behavior and physiological changes

  S: secure the parents involvement

  T: take into consideration: cause of pain

  T: take action and evaluate results
• Physiological changes

  Vitals- tachycardia, hypertension, shallow breaths
• FLACC scale

  Face(facial expressions, constant frown, furrowed eyebrows)

  Legs(comfortable or uncomfortable)

  Activity level(has it changed?)

  Cry(tired, hunger, in pain)

  Concolibility(soother)
• FACES scale- Pre-schoolers, school age kids

  Color then in

  - might not always be accurate as some children pick the smiley face because thats how they want to feel

  
• VAS

  Numerical scale

  School age kids- adolescents

  Might be difficult because they may not have experienced a lot of pain

  Developmental age not chronological age
• Pharmacological approaches

  • Acetaminophen
  • Ibuprofen
  • Narcotic doses
  • Always have narcotic antagonist ready in case of emergency
• Non-pharmalogical therapies

  • Beavioural cognitive strategies- relaxation, distriction
  • Biophysical interventions- heat and cold applications, massage and pressure, coaching to cope