Family Theories and Composition

Family Theories

• Family Systems: Families are viewed as interconnected units. A change in one member impacts the entire system. Families both initiate and react to change. Excessive or insufficient change can contribute to dysfunction.
• Family Stress: Stressors can be anticipated or unexpected. Understanding family stress provides guidance for adapting to these inevitable challenges.
• Developmental: Families are viewed as groups influenced by societal contexts. Family functioning at one stage affects subsequent stages.

Family Composition

• Traditional Nuclear: Married couple with biological children (full siblings only).
• Nuclear: Two parents (married or unmarried) with children (biological, adopted, step, foster).
• Blended/Reconstituted: Families with step-parents, step-siblings, or half-siblings.
• Extended: Includes parents, children, and additional relatives (related or unrelated individuals).
• LGBTQIA: Two parents/partners with children, potentially with legal or common-law ties.
• Foster: Children placed in an approved living environment separate from their original family.
• Binuclear: Parents have separated from their marriage but remain involved in child-rearing.
• Communal: Share resources, property, and services without monetary exchange.
• Polygamous: Spouse with multiple partners and children. These families may reside in the same or separate households.

Parenting Styles

• Authoritarian: Parents use strict rules and expectations without explanation. They control a child's behavior and attitudes.
• Permissive: Parents have minimal control over children's behaviors. Decisions are made with children's input.
• Authoritative: Setting rules with explanations empowers children. Deviations from rules are addressed thoughtfully.
• Uninvolved: Indifferent and emotionally detached parenting.

Nursing Actions for Child Physical Examinations

• Environment: Create a warm, well-lit, and non-threatening room. Keep medical equipment out of sight.
• Privacy: Ensure privacy considerations for the examination.
• Rapport: Build rapport through play and conversation. Engage the child before starting the exam.
• Accessibility: Allow the child to manipulate medical equipment if appropriate.
• Efficiency & Communication: Complete the assessment quickly. Allow the child to ask questions.

Infant Development

• Measurements: Average head circumference (31-35 cm), length (48-53 cm), and weight (6-9 lbs). Expect a 10% weight loss within 3-4 days of birth due to fluid loss.
• Physical: Posterior fontanel closes by 2 months; anterior fontanel closes between 12-18 months. Birth weight doubles by 5 months, triples by 12 months. Teething typically begins between 6-8 months.
• Milestones (2 months): Head supports head while partially supported(head lag), open hands, simple grasps, observing, gazing, crying/sounds, calm when held, facial contact and smiles.
• Milestones (4 months): Supports head independently, pushes up to elbows, holds toy, hand to mouth. shows interest in observing, open mouth when notices bottle. sounds, facial contact, smiling.
• Milestones (6 months): Rolls front to back, sits up with hands supporting, holds bottle, hand-to-hand object transfer, pincer grasp. objects in mouth, grab objects, high-pitched sounds, stick out tongue, laughs.
• Milestones (9 months): Sits independently, uses fingers for grasping, bangs objects, looks for dropped object, lots of sounds, understands commands, shy with strangers, facial expressions.
• Developmental Trends: Cephalocaudal (head-to-toe), proximodistal (center-outward), bilateral and symmetric.
• Car Seat: Rear-facing at a 45-degree angle.
• Nutrition: Breast milk for the first 6 months, Vitamin D supplementation, Iron supplements essential, no water for 4 months, no honey or cow's milk until 1 year, introduce solid foods at 4-6 months beginning with iron-fortified cereals, and new foods are introduced gradually to assess for allergies, finger foods at 9-10 months (corresponding to the pincer grasp development), 4-6 oz of fruit juice at 6 months.
• Sleep: Sleep on back. Nocturnal sleep patterns usually become established by 3-4 months. Infants commonly sleep 14-15 hours daily.
• Attachment: Separation anxiety emerges around 6 months; stranger fear from 6-8 months. Reactive attachment disorder arises from a deficit of caregiver attachment.
• Object Permanence: Develops around 9-10 months (awareness that objects still exist even when out of sight).
• Infant Reflexes: Details on various reflexes and their expected ranges.
• Toys: Blocks, stuffed animals, rattles, balls.
• Language: Basic comprehension ("no") starts around 9 months. 3-5 words spoken around 1 year old, syllables are combined around 10 months.

Toddler Development

• Milestones: Detailed descriptions of motor, cognitive, language, and social milestones at various ages (12, 15, 18, 24 months, and 30 months). Specific examples include block towers and using spoons, and general details such as gaining independence.
• Weight: Four times birth weight by 30 months and height increasing 3 inches annually.
• Moral Development: Egocentric, difficulty understanding consequences, behavior based largely on punishment and reward.
• Physiological Anorexia: Less appetite due to active play and other factors.
• Nutrition: Whole milk until age 2, then switch to 2%, limit milk servings to encourage other food intake, iron intake, and finger foods.
• Potty Training: Usually between 18 months and 4 years. Recognition of readiness and communication of need essential.

Preschool Development

• Physical: Gross motor milestones (riding tricycles, jumping, skipping or various ages). Fine motor milestones (drawing, using scissors, dressing).
• Language: Vocabulary, increasing sentence complexity (3-4 words to 4-5 words by the appropriate ages.
• Fears and Perceptions: Understand fears and imaginative play contributing to fears.
• Cognitive Development: Magical thinking, animism, centration.
• Nutrition: Half the plate for preschoolers should consist of fruits and vegetables.

Hospitalization Impact and Separation Anxiety

• Impact on Hospitalization: Explains how different developmental stages of children respond to hospitalization, including various age groups and milestones. This section details different responses from infant through teenager ages.
• Separation Anxiety Response: Describes the stages of separation anxiety (protest, despair, detachment).
• Types of Play: Explores onlooker, solitary, parallel, associative, and team play, correlating these with ages and developmental stages.

Pain Assessment

• Pain Assessment Tool: Discusses specific pain assessment tools for various age groups (FLACC, FACES, Numeric, Oucher) and their appropriate usage.
• Pain in Infants, Toddlers & School-Aged Children: Specific considerations for pain assessment based on the age of the child. These include examples like cry types or behavioral or physical reactions to pain.

Lead Exposure

• Pathophysiology: Describes lead exposure sources, emphasizing the common origins in older homes.
• Diagnosis: Suggests assessments for lead in blood at relevant ages, particularly in older neighborhoods.
• Intervention: Highlights intervention strategies, emphasizing referrals if elevated lead levels are present. Information on Chelation therapy and its usage for elevated levels.

Immunizations

• Schedule: Provides a schedule of required vaccinations based on age. Includes detailed specifics for various age periods.
• Contraindications and Precautions: Covers situations when delays or adjustments in vaccines might be needed.

Theorists (Erikson, Piaget, Kohlberg, Fowler)

• Erikson: Presents psychosocial stages of development.
• Piaget: Summarizes cognitive development stages.
• Kohlberg: Descriptions of moral development stages.
• Fowler: Provides insights into faith development stages from infancy through adolescence.

Additional Information

• Ear Drops: Different methods for administering ear drops to patients of different ages.
• Leading Causes of Death: Broad overview of leading causes of death in different age categories.
• Urine Sample Acquisition: Techniques for obtaining urine samples in children of varied ages.