Growth and Development Stages

Growth & Development

• Parallel play (ages 1-2) involves children playing next to each other without interacting.
• Symbolic play (ages 5-7) involves group activities with rules and secret codes.
• Competitive play (ages 7-10) involves accepting competition with rules and physical activity.
• Cooperative play (ages 3-5) involves children playing together creatively, each with a specific role.
• A baby’s birth weight usually doubles by 5-6 months and triples by age 1 year.
• The formula to assess the number of teeth in a child under 2 years is: (Age in months) - (6) = # of teeth

Piaget's Stages of Development

• Sensorimotor stage (birth to age 2) involves primary cognition through senses.
• Preoperational stage (ages 2-7) involves the development of motor skills and language.
• Concrete operational stage (ages 7-11) involves organizing thoughts logically.
• Formal operational stage (ages 11-15) involves abstract thinking to handle difficult concepts.

Erikson's Stages of Development

• Trust vs. Mistrust (4 weeks to age 1) involves getting needs met.
• Autonomy vs. Shame & Doubt (age 1-3) involves trying out speech.
• Initiative vs. Guilt (age 3-6) involves questioning.
• Industry vs. Inferiority (age 6-12) involves learning to win recognition, exploring, and collecting.
• Identity vs. Role diffusion (adolescents) involves separating from family and integrating personality.

The Child's Experience of Hospitalization

• Separation anxiety can occur during hospitalization
• Three stages of separation anxiety include:
  • Protest, where toddlers may call out "mommy" repeatedly.
  • Despair, where children appear sad or depressed.
  • Denial or detachment, where children deny the need for a parent and focus on their toys.

Health Care Adaptation for the Child and Family

• Infant medication response factors are influenced by age, as infants may have immature organ function.
• When administering Ear Drops/Exam:
  • For children <3 years old, pull the ear down and back.
  • For children >3 years old, pull the ear up and back.
• For lumbar puncture position in older children, position them side-lying with knees to chest.
• For infants during lumbar puncture, position them sitting and bending forward

The Child with Sensory or Neurological Condition

• Otitis Media:
  • Symptoms include fever, ear pain (otalgia), inflammation of the middle ear space, rubbing or pulling affected ear, restlessness, and irritability.
• Otitis Externa ("Swimmer's ear"):
  • Symptoms include pain and tenderness, a feeling of fullness, and muffled sound.
  • Treatment includes irrigation, antibiotics, or antivirals.
• Amblyopia ("Lazy eye"):
  • Vision favors one eye.
  • Treatment includes glasses or patching to force use of the weaker eye.
• Strabismus ("Cross eye"):
  • Is the inability to direct both eyes in the same direction or on the same object.
  • Symptoms include eye squinting or frowning, reaching for objects and missing, covering one eye, tilting the head, dizziness, and/or headaches.
• Conjunctivitis ("Pink eye"):
  • Involves inflammation of the conjunctiva or mucous membrane.
  • Symptoms include edema, itching, crusting of eyelids, inflamed pink conjunctiva, tearing, and purulent drainage.
  • It is contagious until 24 hours after the first dose of antibiotics.
  • Wipe from inner eye to out
• Febrile Seizure:
  • It's a seizure caused by fever, commonly between ages 6 months and 5 years.
• Head Injury:
  • Asymmetrical pupils may occur
  • It is a Medical Emergency

Pediatric Cardiac

• Cyanosis:
  • Symptoms include clubbing of fingers and toes, polycythemia, and unoxygenated blood in circulation.
• Congenital Heart Defects:
  • Atrial Septal Defect: Blood flows from the Left Atrium to the Right Atrium.
    • It is acyanotic.
    • Also known as Persistent Foramen Ovale (PFO).
    • Murmur
  • Ventricular Septal Defect: Blood flows from the Left Ventricle to the Right Ventricle.
    • Acyanotic
    • Loud harsh murmur
  • Patent Ductus Arteriosus: Blood flows from the Aorta to the Pulmonary Artery.
    • Acyanotic
    • Machinery sounding murmur
    • Typically closes within 3 days after birth
  • Tetralogy of Fallot: Four abnormalities result in insufficient oxygenated blood pumped to the body:
    • Stenosis (narrowing) of the pulmonary artery
    • Hypertrophy of the right ventricle
    • Dextroposition of the aorta (dextro=right)
    • Ventricular Septal Defect (opening between Left and Right Ventricle)
  • Coarctation of the Aorta: Obstruction of blood flow from the ventricles due to narrowing of a vessel.
    • Elevated BP and bounding pulses in upper extremities, and decreased or absent pulses and decreased BP in lower extremities.

Heart Failure

• Heart Failure occurs when the heart cannot effectively pump blood.
  • The symptoms include tachycardia at rest (earliest indicator), fatigue during feedings, and sweating.
• Left-sided failure is most often seen in children and results in the backup of blood into the lungs.
  • Symptoms include tachypnea, cough, dyspnea, crackles, orthopnea, exertional dyspnea, blood-tinged sputum, tachycardia, cyanosis, and fatigue.
• Right-sided failure results in the backup of blood in the systemic circulation.
  • Symptoms include an enlarged liver, weight gain/dependent edema, distended jugular veins, anorexia, GI distress, tachycardia, cyanosis, and fatigue.
• Kawasaki:
  • It's an acute febrile disease causing vasculitis.
  • Symptoms include high fever, red conjunctiva without discharge, pharynx and oral mucosa inflammation, strawberry tongue, non-painful lymph node swelling, swelling of hands, peeling skin, swelling of weight-bearing joints, increased platelets, and coagulation.
  • Treatment involves IV immunoglobulin (to postpone immunizations for 11 months) and low-dose aspirin.

Pediatric Respiratory

• Asthma:
  • It involves obstruction of the airway due to swelling and mucus production.
  • It is a leading cause of school absenteeism, ER visits, and hospitalization.
  • Symptoms include wheezing, difficult breathing, chin/neck or chest itches, and restlessness.
• Status Asthmaticus is a medical emergency.
• RSV/Bronchitis:
  • It is caused by a virus, peaking in winter.
  • Spread by direct contact with respiratory secretions.
    • Use gown/gloves and hand hygiene!
  • Symptoms include tachypnea, low-grade fever, cough, rhinorrhea, progressing to respiratory distress with chest retraction, nasal flaring, and use of accessory muscles.
• Epiglottitis:
  • Swelling of tissues above the vocal cords is an emergency
  • Cough is absent.
  • Caused by H. influenzae B (HIB).
  • Keep a trach kit at the bedside before examining the throat.
• Tonsillectomy:
  • Preoperative Care:
    • Provide age-appropriate explanations.
    • Check for loose teeth.
  • Postoperative Care:
    • Observe for bleeding (frequent swallowing or clearing of throat).
    • Avoid coughing, clearing the throat, or blowing the nose.
    • Give clear liquids, like popsicles.
    • No purple, red, or brown dyes.
• Cystic Fibrosis:
  • It is a life-threatening genetic disease where sticky, thick mucus builds up in organs, blocking and damaging them.
    • Respiratory System – obstructed secretions.
    • Digestive System – secretions prevent digestive enzymes from flowing to the GI tract, results in poor absorption of food
      • Bulky, foul-smelling stools that are frothy because of the undigested fat content
    • Skin - loss of electrolytes in sweat causes “salty” skin surface.
      • Free access to salt
    • Reproductive System - secretions decrease sperm motility; thick cervical mucus can inhibit sperm from reaching fallopian tubes
  • Inherited recessive traits with both parents carrying a gene for disease
• Croup Syndrome (Acute Croup / Laryngotracheobronchitis):
  • It is a viral condition manifested by fever, barky cough, and congestion.
    • Congestion in the upper airway can lead to respiratory distress (stridor).
  • Treatment includes cool-mist humidification, symptomatic care, and increased fluids.

Pediatric Hematology

• Anemia:
  • It involves a reduction in the amount of circulating hemoglobin.
  • Hemoglobin contains iron and is responsible for O2 transport.
  • Hgb <11 suspect anemia and a normal Hct 33%
  • Symptoms include weakness/fatigue, spoon-shaped nails, pallor, tachycardia, dizziness, cold hands and feet, and dark circles.
  • Caused by blood loss, decreased RBCs, bone marrow suppression, GI malabsorption, dietary deficiency, and RBC destruction
• Iron-Deficiency Anemia:
  • When the demand for stored iron is greater than what the body can supply.
    • Most common nutritional deficiency of children in the U.S
    • Newborns and adolescents are at greater risk
  • Iron found foods include:
    • Heme from animal products like red meat, seafood, and poultry.
    • Non-heme from plants and iron-fortified products.
• Sickle Cell Anemia:
  • The sickle cells outnumber the normal cells, causing clumping & thrombosis.
    • Lifespan of RBC is shorter. Dehydration increases risk. Ischemia leads to complications
  • It is a genetic disorder so both parents must be carriers of the trait to pass it on -Treatment = Control pain with morphine (NO Demerol), rehydrate pt, decrease O2 consumption
• Leukemia:
  • It is a malignant disease of the blood-forming organs, resulting in the uncontrolled growth of immature white blood cells (50K to 100K).
    • Most common childhood cancer
    • Anemia, Thrombocytopenia, Weak bones, Leukopenia
• Hemophilia:
  • It involves a defect in clotting factors
  • Transmitted by females to offspring
  • Patients will bleed a lot.

Nursing Care of the Chronically and/or Terminally Ill Child

• Types of Illness:
  • Acute Illness – lasting less than 6 months
  • Chronic Illness – lasting over 6 months
  • Terminal Illness - potential to cause death
• Stages of Grief:
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• Child's Response:
  • Infant - does not understand concepts of death, react on an emotional level to anxiety of parents
  • Preschooler – thinks death is temporary and may blame self for a sibling's death
  • School-age - realizes death is final, may be interested in the details of death, may fear parents will die, and may try to "take care of parents".
  • Adolescent - can understand the abstract concept of death but has feelings of own immortality and may express anger at the death of a sibling