1. Chapter 17 The Pediatric Client

2. 17-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Fundamental Concepts of Growth and Development  Growth refers to the quantitative changes in physical size of the body and its parts.  Development refers to behavioral changes and increasing competency in functional abilities and skills.

3. 17-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Maturation describes the increasing complexity of a person’s capabilities.  Maturation involves biological growth, functional changes, and learning that come with age. Fundamental Concepts of Growth and Development

4. 17-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Principles of Growth and Development  Occurs in a cephalocaudal direction and proximodistal manner  Occurs from simple to complex and from the general to the specific

5. 17-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  All individuals go through the same developmental processes.  Growth and development do not proceed at a consistent rate.  The pattern of growth and development is continuous, orderly, and predictable. Principles of Growth and Development

6. 17-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Every person proceeds through stages of growth and development at an individual rate.  Every stage of development has specific characteristics.  Each stage of development has certain tasks to be achieved or acquired during that specific time. Principles of Growth and Development

7. 17-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Principles of Growth and Development  Some stages of growth and development are more critical than others.  A critical period can be a time of the most rapid growth or development in a particular stage of the life cycle.  Growth and development may temporarily be stalled or regress during critical periods “touch points.”

8. 17-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Influencing Growth and Development  Heredity  Health Status  Life Experiences  Cultural Expectations

9. 17-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Influencing Growth and Development  Heredity The genetic composition of an individual determines physical characteristics. Determines to a great extent the rate of physical and mental development.

10. 17-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Influencing Growth and Development  Health Status Illness or disability can interfere with the achievement of developmental milestones.

11. 17-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Influencing Growth and Development  Life Experiences A child’s experiences can influence the rate of growth and development.

12. 17-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Influencing Growth and Development  Cultural Expectations The age at which an individual masters a particular task is determined in part by culture.

13. 17-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Theoretical Perspectives of Human Development  Physiological growth of an individual is influenced primarily by interaction of genetic predisposition, the central nervous system, the endocrine system, and maturation.

14. 17-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Theoretical Perspectives of Human Development  Psychosocial Dimension Consists of subjective feelings and interpersonal relationships.

15. 17-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Theoretical Perspectives of Human Development  Self-concept is a view of one’s self, and is likely the most important key to a person’s success and happiness. Body Image Self-Esteem Ideal Self

16. 17-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Characteristics of an Individual with a Positive Self-Concept  Self-confidence  Willingness to take risks  Ability to receive criticism without defensiveness  Ability to adapt effectively to stressors  Innovative problem-solving skills

17. 17-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Psychosocial Dimension  Intrapsychic (psychodynamic) Theory Focuses on an individual’s unconscious processes, which are feelings, needs, conflicts, and drives. Sigmund Freud and Erik Erikson are two major intrapsychic theorists.

18. 17-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Sigmund Freud  Viewed the personality as a three-part structure: the id, the ego, and the superego.  Believed that personality development was completed in the final stages of adolescence.

19. 17-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Erik Erikson  Expanded Freud’s concept of developmental stages to a lifelong process.  Certain psychosocial tasks must be mastered in each of eight developmental stages.  Each stage poses a conflict that can have favorable or unfavorable outcomes.

20. 17-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Psychosocial Dimension Self-fulfilling cycle in positive self-concept

21. 17-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Psychosocial Dimension  Interpersonal Theory (Harry Stack Sullivan) Relationships with others influence how one’s personality develops. Approval and disapproval from significant others shape the formation of one’s personality.

22. 17-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Cognitive Dimension Perception, memory, and judgment Develops throughout the life span Theoretical Perspectives of Human Development

23. 17-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cognitive Dimension  Jean Piaget Observations of children learning to think by playing

24. 17-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Jean Piaget  Intellectual development is characterized by four phases as the child interprets and uses the environment. Sensorimotor Preoperative Concrete Operations Formal Operations

25. 17-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Jean Piaget  The individual learns by interacting with others and the environment through: Assimilation Accommodation Adaptation

26. 17-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Moral Dimension A person’s value system that helps in differentiating right and wrong. Moral maturity is the ability to independently decide for one’s self what is “right.” Theoretical Perspectives of Human Development

27. 17-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Moral Dimension  Lawrence Kohlberg Framework for understanding how individuals, over time, develop a moral code to guide their behavior and make moral judgments

28. 17-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Spiritual Dimension Relationships with one’s self, with others, and with a higher power or divine source Characterized by a sense of personal meaning Theoretical Perspectives of Human Development

29. 17-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Holistic Framework for Nursing  Respect for the diversity of persons, their values, and beliefs  Understanding human responses to health problems and their effects on development

30. 17-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Holistic Framework for Nursing  Planning involvement of children and their families in assuming responsibility for self-care  Tailoring communication skills to the client’s age and development

31. 17-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Stages of the Life Cycle  Nursing implications for each stage of the life cycle include assessment, wellness promotion, and safety considerations.

32. 17-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Stages of the Life Cycle  The prenatal period begins with conception and ends with birth. Germinal Stage Embryonic Stage Fetal Stage

33. 17-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Prenatal Period  Nursing Implications Early prenatal care is essential for a positive pregnancy outcome. -Physical examinations and screenings

34. 17-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion during the Prenatal Period  The uterus is the primary environment affecting prenatal growth and development. Physiological assessment Teaching nutritional guidelines Teaching relaxation techniques to promote a supportive environment

35. 17-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations during the Prenatal Period  A teratogenic substance is any substance that can cross the placental barrier and impair normal growth and development. -Medicines -Illegal drugs -Nicotine -Alcohol

36. 17-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Prenatal Safety Considerations  Nicotine crosses the placental barrier, and interferes with oxygen transport to the fetus. Increased risk of premature birth, retarded growth, learning difficulties, and fetal death

37. 17-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Prenatal Safety Considerations  Alcohol consumption is most dangerous during the first 3 months of pregnancy.  Fetal alcohol syndrome is considered to be the leading cause of mental retardation among infants.  The effects of alcohol on the fetus are permanent.

38. 17-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Neonate First 28 days of life following birth. Major physiological adjustments to extrauterine life. The major psychological task of neonates is to adjust to the parental figures. Bonding is the formation of attachment between parent and child. Stages of the Life Cycle

39. 17-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Neonate  Nursing Implications Complete and thorough physical assessment includes evaluation of neonate’s reflexes, respiratory and cardiac functioning. The Apgar assessment tool is performed at 1 minute and again at 5 minutes. Parents are encouraged to cuddle the newborn and establish eye contact.

40. 17-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Neonate  Bonding between a parent and neonate; consider the factors that may have an impact on the early attachment between this father and daughter.

41. 17-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion during the Neonate Period  Teaching basic newborn needs (to be held, rocked, and talked to).  Teaching hygienic practices.  Monitoring nutritional status.  Conducting screening tests.  Promoting early parent-neonate interaction.

42. 17-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations during the Neonate Period  Accidents are the primary cause of neonatal mortality. Teaching parents about infant seats  Maintenance of skin integrity

43. 17-43 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Infant From the first month to the first year of life Continued adaptation with rapid physiologic growth and psychosocial development Stages of the Life Cycle

44. 17-44 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Implications during the Infant Period  Safety, prevention of infection, and teaching parents about incorporating the child into the family  Provision of support, reassurance, and information to the parents

45. 17-45 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion for the Infant  Breast feeding/formulas  Introduction of solid foods  Immunization  Promotion of sleep  Growth and development concepts

46. 17-46 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion for the Infant  Teaching parents preventive measures regarding respiratory infections and parasitic diseases

47. 17-47 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations for the Infant  Consistent and proper use of infant car seats is one of the most effective safety measures parents can take.

48. 17-48 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Toddler Begins at 12 to 18 months of age, when a child begins to walk alone; ends at approximately age 3. Child becomes more independent. The toddler’s frequent use of the word “no” is an expression of developing autonomy. Stages of the Life Cycle

49. 17-49 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Implications during the Toddler Stage  Toddlers need to have regular health examinations and immunizations.  Play is an effective tool for building rapport with toddlers.  Parents are encouraged to actively participate during examination and immunizations.

50. 17-50 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion for the Toddler  Nutritional needs change as growth rate slows and caloric needs decrease from infancy.  Expect sporadic eating patterns.  Establish a mealtime routine.  Avoid power struggles during meals.

51. 17-51 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Toddlers, with their increased mobility and curiosity, are especially prone to accidental poisonings.  Use age-appropriate toys and child-proof the home and surrounding environment. Safety Considerations for the Toddler

52. 17-52 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Preschooler Ages 3 to 6 years. Physical growth slows and psychosocial and cognitive development accelerate. The child’s world begins to expand. The child is better able to communicate. Stages of the Life Cycle

53. 17-53 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Preschooler  Nursing Implications Play is the mechanism used to learn about the environment and develop relationships. Play is a tool used by nurses with preschoolers to help reduce fear and anxiety.

54. 17-54 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion for the Preschooler  Optimum time to promote lifelong health- promoting lifestyles.  It is important for nurse to communicate at the child’s level of comprehension.  Immunization is a major wellness intervention.

55. 17-55 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations for the Preschooler  Eagerness to explore the environment and cognitive immaturity lead to risk of an accident.  Common accidents are burns, falls, drowning, animal bites, and ingestion of poisonous substances.

56. 17-56 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations for the Preschooler  Role modeling by adults is the best method of developing safety habits in the preschooler. These habits will tend to be lifelong.

57. 17-57 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  School-Age Child Ages 6 to 12 years. The child’s world expands greatly. Play time becomes more structured and less spontaneous. Stages of the Life Cycle

58. 17-58 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. School-Age Child  Involvement in academics, sports, and social activities stimulates the development of creativity and provides outlets for its expression.

59. 17-59 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. School-Age Child  Nursing Implications Common health problems may affect growth and development. Hospitalized children and children with illnesses who require home care have very special needs.

60. 17-60 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion and the School-Age Child  Promote healthy lifestyles with children in schools.  Parent Education Proper nutrition Immunizations Dental care Safety precautions Adequate rest/sleep.

61. 17-61 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations and the School-Age Child  Many accidents occur during play.  Common injuries are related to use of skates, skateboards, in-line skates, and bicycles.  Children must also be taught to use caution with strangers.

62. 17-62 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Preadolescent Ages 10 to 12 years. Begins to experience hormonal changes that will result in the onset of puberty. Girls generally experience preadolescence at a younger age than boys. Stages of the Life Cycle

63. 17-63 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Nursing Implications Sensitivity and a nonjudgmental approach Attending to the child’s language Encouraging the child to ask questions about any health-related concerns Preadolescent

64. 17-64 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Wellness Promotion for the Preadolescent  Information about nutrition, rest, and activity, and the physiological changes that are occurring Growth spurt Sexual and psychosocial changes

65. 17-65 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations for the Preadolescent  Risk for sports and play injuries  Risk for violence, both in and away from the home  Education about violence, substance abuse, sex education, and development of healthy lifestyle

66. 17-66 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Adolescent Onset of puberty to ages 18 to 20 Major transition from child to adult Stages of the Life Cycle

67. 17-67 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Adolescent  Establishing a sense of personal identity uses a great amount of the adolescent’s psychic energy.  Emphasis on physical attractiveness sometimes results in eating disorders.

68. 17-68 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Nursing Implications The nurse must honor the adolescent’s choice to withhold sensitive information from parents. Adolescents should be treated in a respectful, dignified manner. A nonjudgmental attitude is essential to the establishment of rapport with adolescents. Adolescent

69. 17-69 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Adolescent  Wellness Promotion Hygiene Nutrition Sex education Developmental changes Substance abuse prevention

70. 17-70 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Considerations for the Adolescent  Risk for Accidents Testing limits Impulsive behavior Sense of being invulnerable Rebelling against adult advice

71. 17-71 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Adolescent Safety Considerations  The stressors of adolescence cause many health problems in adolescents.  Stressors affect sexual behavior, risk for suicide, and substance abuse.

72. 17-72 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Adolescent Safety Considerations  Sexual Behaviors Teenage pregnancy Sexually transmitted diseases

73. 17-73 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Adolescent Safety Considerations  High Risk of Suicide Often, suicide is perceived by the adolescent as the only alternative to an overwhelming situation.

74. 17-74 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Adolescent Safety Considerations  Substance Abuse Using alcohol or other drugs is a common maladaptive attempt to cope with stressors.