Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Chapter 12 Conception Through Adolescence

2Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Stages of Growth and Development  Human growth and development are continuous and complex.  Stages are typically organized by age groups.  Growth and development are based on timing and sequence of developmental tasks.

3Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Selecting a Developmental Framework for Nursing An organized, systematic approach ensures that a care plan will meet the needs of the child and the family. A developmental approach helps nurses plan and organize care according to the child’s developmental stage.

4Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study  Maria is a student nurse who volunteers in the newborn nursery at the local hospital two evenings a week while in nursing school. Maria knows that she wants to be a neonatal nurse when she graduates from school. Every year, the hospital offers a postgraduate externship to two new nursing school graduates who wish to pursue a career in neonatal nursing.  Also, the newborn nursery nurses help Maria hone her nursing skills by allowing her to practice assessments and procedures under their guidance.

5Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Intrauterine Life  Terminology of gestation (pregnancy):  Pre-embryonic stage = First 14 days  Embryonic stage, Embryo = Day 15 through week 8  Fetal stage, Fetus = End of week 8 until birth  Placenta  Trimesters  During gestation or the prenatal period, the embryo grows from a single cell to a complex, physiological being.

6Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Health Promotion During Pregnancy Counsel avoidance of teratogens (drugs and alcohol; smoking; some herbal supplements). Promote a healthy diet. Prepare for developmental challenges. Counsel about age-related risks. Discuss causes and safe treatments for common pregnancy discomforts.

7Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Transition from Intrauterine to Extrauterine Life  APGAR score  Physical changes  Independent circulatory and respiratory functioning  Maintenance of body temperature  Prevention of infection  Psychosocial changes; attachment

8Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Quick Quiz! 1. A pregnant teenager asks the clinic nurse why she should not smoke during the first trimester. The nurse’s best response should be A. The distribution of body hair can be altered. B. The organ systems are beginning to develop. C. Development of fingers and toes can be affected. D. The sex of the baby is determined in the first 3 months.

9Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Newborn/Neonatal Period  Assessment: Physical changes  Measure height, weight, head and chest circumference, temperature, pulse, and respirations.  Observe general appearance, body functions, sensory capabilities, reflexes, and responsiveness.  Assess gestational age.  Attachment

10Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Sutures and Fontanels

11Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Tonic Neck Reflex

12Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Neonatal Neurological Function  Observe: Level of activity, alertness, irritability, and responsiveness to stimuli and the presence and strength of reflexes  Normal reflexes: Blinking in response to bright lights, startling in response to sudden loud noises or movement, sucking, rooting, grasping, yawning, coughing, sneezing, palmar grasp, swallowing, plantar grasp, Babinski, and hiccoughing  Normal behavioral characteristics: Periods of sucking, crying, sleeping, and activity

13Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Newborn: Neonatal Period  Cognitive changes: Innate behaviors, reflexes, sensory functions  Crying as communication  Need for sensory stimulation  Psychosocial changes  Attachment bond forms within first month.  Illness may compromise attachment process.

14Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

15Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Newborn: Neonatal Period (cont’d)  Health promotion  Screening (hearing, inborn errors of metabolism [IEMs])  Car seats (federally approved; properly fitted)  Crib safety (slats no more than 2.4 ″ apart; snug- fitting mattress; new standards—NO drop side rails)  Sleep (on their backs)  Avoid smoking around the infant.

16Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Maria continues her assessment of the newborn girl.  Which of the following is a normal reflex found in newborns? (Select all that apply.) A. Blinking in response to bright lights B. Startling in response to sudden loud noises C. Performing sucking, rooting, and grasping movements D. Touching the nose on verbal command

17Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Infant  1 month old to 1 year old  Physical changes Increases in height and weight Development of sight, hearing, fine and gross motor movements  Cognitive changes Development of vision, hearing, and touch Language and memory development  Psychosocial changes Separation of self from others Purposeful smiling

18Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

19Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Infant (cont’d)  1 month old to 1 year old  Need for stimulation  Health risks Injury prevention Child maltreatment  Health promotion Nutrition Immunizations Sleep

20Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Toddler  12 to 36 months  Physical changes Growth and development; fine and gross motor movements  Cognitive changes Memory, language  Psychosocial changes Sense of autonomy, parallel play

21Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

22Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Toddler (cont’d)  12 to 36 months  Health risks Poisoning, drowning, motor vehicle accidents  Health promotion Nutrition Toilet training

23Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Maria is working with one of the neonatal nurses during her volunteer shift. Maria assists the nurse with an assessment of a newborn girl. Maria palpates the newborn’s head and feels the fontanels.  What should Maria do next? A. Alert the neonatal nurse that there is a problem with the newborn’s head. B. Palpate harder to see if a dent can be made in the fontanels. C. Proceed with the assessment because palpable fontanels are a normal finding. D. Try to adjust the skull bones to move over the fontanel.

24Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Preschooler  3 to 5 years old  Physical changes Growth slows but continues. Large and fine motor movements continue to develop.  Cognitive changes Curiosity abounds: “Why?” Understanding is linked to concrete experiences.  Psychosocial changes Increased social interaction, play

25Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Preschooler (cont’d)  3 to 5 years old  Stressors  Health risks Injury prevention Home safety Bicycle helmets  Health promotion Nutrition Sleep Vision

26Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Maria knows that infants should be placed in which position for sleep?

27Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. School-Aged Children and Adolescents  6 to 18 years old  Expansion, development, and refinement of physical, cognitive, and psychosocial skills  Play and work with others  Puberty (~12 years) signals the end of middle childhood.

28Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. School-Aged Child  6 to 12 years old  Physical changes: Consistent growth, improved coordination  Cognitive changes abound.  Psychosocial changes: Self-concept Peer relationships Sexual identity Stress

29Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

30Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. School-Aged Child (cont’d)  6 to 12 years old  Health risks: Accidents, infections  Health promotion Perceptions Health education Health maintenance Safety Nutrition

31Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Quick Quiz! 2.You are caring for a 5-year-old who is hospitalized for stabilization of asthma. To render age-specific care, an action you can take would be to A. Allow the child to handle medical equipment. B. Respond immediately to the child’s every need. C. Tell the child to be good. D. Rationalize the child’s complaint as part of the developmental stage.

32Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Adolescence  Adolescence: Psychological maturation  Puberty: Reproduction becomes possible  13 to 20 years old  Physical changes in four areas: Increased rate of growth Sex-specific changes (shoulder and hip width, menarche) Distribution of muscle and fat Development of reproductive system

33Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Adolescence (cont’d)  Cognitive changes  Ability to think rationally  Communication skills in situations  Psychosocial changes  Search for personal identity  Development of ethical system  Consideration of future

34Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Communication With Adolescents  Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and school opens the channels for further discussion.  Ask open-ended questions.  Look for the meaning behind the child’s words or actions.  Be alert to clues to their emotional state.  Involve other individuals and resources when necessary.

35Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.. (© Petrenko Andriy.)

36Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Adolescence (cont’d)  Health risks  Accidents = Leading cause of death  Violence and homicide  Suicide  Substance abuse  Eating disorders  STIs  Pregnancy

37Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Warning Signs of Suicide  The following warning signs often occur for at least a month before suicide is attempted: Decrease in school performance Withdrawal Loss of initiative Loneliness, sadness, and crying Appetite and sleep disturbances Verbalization of suicidal thought

38Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Adolescence (cont’d)  Health promotion  Health education  Minority adolescents  Gay, lesbian, and bisexual adolescents  Adolescents are much more likely to use health care services if they encounter providers who are caring and respectful.