Child and Development PPT PDF

NURS 2546 Health of Families and Social Groups Week 11- The school aged child and the adolescent: Assessment, Injury and Safety Fall 2024  Learning Objectives 1. Describe the normal growth & development of a school-aged child 2. Describe aspects of head-t...

NURS 2546 Health of Families and Social Groups Week 11- The school aged child and the adolescent: Assessment, Injury and Safety Fall 2024  Learning Objectives 1. Describe the normal growth & development of a school-aged child 2. Describe aspects of head-to-toe assessment of s school-aged child (up to 10 years) 3. Identify expected findings in a head-to-toe assessment (including Vital Signs) of a school-aged child up to 10 years of age 4. Describe specific aspects that need to be included when taking a health history of a school-aged child 5. Discuss the different approaches that nurses can use to interview the school-aged child 6. Discuss the psychological, cultural & diverse aspects of the family with school-aged children 7. Discuss health promotion for school-aged children 8. Identify and discuss the different safety and injury prevention and nursing roles  Learning Objectives 1. Describe the normal growth & development of adolescents (male and female) 2. Describe the aspects of head-to-toe assessment 3. Identify expected findings in a head-to-toe assessment (including Vital Signs) 4. Describe the specific aspects that need to be included when taking a health history of an adolescent client 5. Discuss the different approaches that nurses can use to interview the adolescent patient 6. Discuss how the nurse can assess for sensitive topics such as sexual orientation, sexual/gender identification, STIs, sexual abuse & related topics 7. Discuss the psychological, cultural & diverse aspects of the family with adolescents 8. Discuss health promotion of adolescents 9. Identify and discuss the different safety and injury prevention and nursing roles  Chapter 39: The school-aged child & family - pp: 956-968 Readings Chapter 40: The adolescent & family - pp: 973-987 Growth & Development of School-aged Children (Ages 5-11 years) Biological, emotional, and cognitive changes School-aged children vary in many ways according to race, gender, ethnicity, and class For e.g. Medicine Wheel in Indigenous Teachings (7-14 yrs as “fast life” Growth in Height and Weight: Children gain approximately 2-3kg and grow around 5cm each year 5 years ~ 18.7kg, 110 cm 10-12 years ~ 24.5-58 kg and between 127-162.5 cm Boys tend to be slightly taller and heavier than girls initially (may become obese) By end of school-age years, most girls begin to surpass boys in ht. and wt. Physical maturity is not necessarily correlated with emotional and social maturity Growth & Development of School-aged Children (Table 39.1) Physical and Motor Development Mental Adaptive Personal-Social Socialization Peer groups Early: few gender differences exist, share games, and other activities. Later: become more marked 1st: learn to appreciate other’s perspectives, argue, persuade, and compromise to sustain friendships 2 nd: Become more sensitive to peer group norms, adapting behaviour to gain acceptance. Learn to dress, talk, and behave in a manner acceptable to the group. 3rd: Peer interactions foster close “best friend” relationships. Growth & Development of School- aged Children (Table 39.1) Age 5 yrs: handedness is established. Tie shoelaces, use scissor, or pencil well. Age 6 yrs: loss of first tooth. Like to draw, print and color/vision reaches maturity. Age 7 yrs: jaw begins to expand to accommodate permanent teeth Age 8-9yrs: use of cursive writing, read classic books Age 10-12 yrs: write letters, read things with enjoyment, more coordinated and steadier on their feet Slimmer look Posture increases: Climbing, biking, and other activities easier Decrease in head and waist circumferences Face grows faster; skull and brain grow very slow and increase little in size Teeth—primary (deciduous) teeth are lost during this age span Assessment Approach: School-age Children Include the school-age child in history taking and assessment Through play, drawing pictures Additional details provided by the parents Provide age-appropriate explanations and terminologies Consider the child and family’s previous health care experience Assessment General appearance Vital signs Apical impulse location:______ Growth Measurements Head-to-toe assessment Least to most invasive least= not touching the child, invasive= blood pressure or axilla temp. Order of examination must be varied to suit the situation and consider the child and family’s previous experiences Screening Maturatio Emotion: wider differences b/w children are observed at the end of middle n of childhood, may create emotional issues Heart: grows slowly, smaller in relation to the rest of the body Systems than any other period of life HR and RR: steadily GI: fewer stomach upset, decrease better blood glucose BP: Increases control, an increased stomach capacity. Caloric needs are less than preschoolers and adolescents. Bladder capacity: is well developed, greater in girls than in boys, “enuretic” MSK: bones cont. to ossify throughout childhood. Skeletal lengthening and less fat, increase Immune system: muscle. Caution in carrying heavy localize infections and loads e.g. use a backpack instead of a produce an antibody- tote bag antigen response.  Preadolescence: generally lasting about 2 years, spanning from end of middle childhood up to approx. age 13th birthday Puberty signals the beginning of the development of 2 nd sex characteristics Girls: 10 years Boys: 12 years Prepubescence Age of onset of pubescence: average of 2 years earlier in girls Either early or late appearance of these characteristics can be a source of embarrassment and uneasiness to both sexes How early is too early?______  Question A 12-year-old girl asks the school nurse if it is normal that she hasn’t started her period yet, while some of her friends have. What is the nurse’s best response? a) “You should have started you period by now; let’s talk to your doctor about it.” b) “Every girl develops at her own pace, but most start their period between 8 and 10.” c) “It’s normal for girls to start their periods anytime between the ages of 9 and 16.” d) “You’re probably not eating enough nutritious food, which can delay your period.”  Erikson’s Psychosocial Development Theory A sense of industry or accomplishment vs a sense of inferiority Children are eager to develop skills and participate in meaningful and social useful work They acquire a sense of personal interpersonal competence, want to engage in tasks that can be carried through to completion Gain satisfaction Social activities where they compete with others, cooperate with others and to cope effective with people. Take pride in learning new skills E.g. __________ Reinforcement in the form of grades, material rewards, additional privileges, and recognition provides encouragement and stimulation Peer approval is a strong motivating power No child is able to do everything well so they will feel some degree of inferiority when they encounter specific skills they cannot master Piaget’s Cognitive Development Theory Concrete operation –using thought processes to experience events and actions Egocentric Mental processes see things from another’s point of view Making judgements based on what they see  what they reason. (perceptual thinking  conceptual thinking) Able to use memories of past experiences to evaluate and interpret the present Concept of conservation  Question A nurse is assessing the cognitive development of an 8-year-old child. Which activity observed during the visit best demonstrates that the child is functioning at the expected developmental level? a) Using abstract thinking to explain the concept of justice b) Accurately solving a math problem that involves adding and subtracting apples c) Engaging in pretend play and believing in imaginary friends d) Focusing on the immediate consequences of actions without considering others’ perspectives  Bullying “any recurring activity and targeted aggression that is intended to harm or bother, either physical or otherwise” (p. 962) Bullies: defiant toward adults, antisocial, break school rules, dominant personalities, lack of from parental involvement and nurturing, and may experience or witness violence or abuse at home Boys: direct Girls: indirect Cyberbullying May experience headaches, stomach aches, school absenteeism, withdrawal, anxiety, depression, low self-esteem and may lead to suicide Needs to be managed by adults, acknowledge the problem and take steps in to stop it Children need empowerment strategies Antibullying interventions at schools Online safety—do not give out personal information. Choose strong passwords. Be careful what you share online. Set social media account and profile “private.” Don’t meet up with people you meet online. How common is bullying? Coping with concerns related to normal growth and development School experience (family centered care) Be supportive, be positive. Support and encourage activities Foster the development of hobbies and collections Meet the teachers. Demonstrate an interest in what the child is learning. Avoid dictating a study time but do enforce rules Latchkey children Limit-setting and discipline. Set the stage: (1) a calm, organized and comfortable space; (2) age-appropriate toys; (3) routine with scheduled time quiet activities and some outdoor and other physical activities; (4) standard sleep routines and (5) regular mealtimes and healthy snacks to avoid irritability from hunger No spanking Coping with concerns related to normal growth and development Dishonest behaviour: Lying, stealing, and cheating Together with an appropriate and reasonable punishment Stress and fear Cause long-term adjustment and health issues Conflict with family, interpersonal relationships, poverty, and chronic illness, increasing violence in society Identify the source of the stress promptly Work to reduce the source of stress Referral Guidance for Parents During School Years Age 5 to 6 years: Prepare parents for potential strong food preferences and potential refusal of specific food items Prepare parents to expect an increasingly ravenous appetite Prepare parents for emotionality as the child experiences mood changes Help parents anticipate the child’s continued susceptibility to illness Review the immunization schedule with parents—if tetanus schedule of 4 initial doses is completed before age 4, a fifth dose of tetanus toxoid is recommended at school entry by age 6 (Government of Canada, 2021) Teach injury prevention and safety, especially bicycle safety Encourage parents to respect the child’s need for privacy Prepare parents for the child’s increasing interests outside the home Help parents understand the need to support the child’s interactions with peers Guidance for Parents During School Years Age 7-10 years: Prepare parents to expect an improvement in their child’s health with fewer illnesses, although allergies may increase or become apparent Prepare parents to expect an increase in minor injuries in their child Advise parents to use caution in selecting and maintaining sports equipment and re-emphasize focus on safety (see Chapter 35) Prepare parents to expect increased involvement with peers and interest in activities outside the home Emphasize the need to encourage independence in the child while maintaining limit-setting and discipline Prepare maternal figure to expect more demands from the child at age 8 years Prepare paternal figure to expect increasing admiration from the child at age 10 years; encourage father-child activities Prepare parents for prepubescent changes in girls  Ages 11 to 12 years: Help parents prepare the child for body changes of pubescence Prepare parents to expect a growth spurt in girls Make certain the child’s sex education is adequate with accurate information Prepare parents to expect energetic and stormy behaviour at age 11 Guidance for Parents years, possibly becoming more even-tempered at age 12 years Encourage parents to support the child’s desire to “grow up” but to During School Years allow regressive behavior when needed Prepare parents to expect an increase in the child’s masturbation Instruct parents that the amount of rest the child needs may increase Help parents educate the child regarding experimentation with potentially harmful activities Guidance for Parents During School Years Health Guidance Immunizations- Human Papilloma Virus (HPV), Hep. B, Meningitis Help parents understand the importance of regular health and dental care for the child Encourage parents to teach and model sound health practices, including diet, rest, activity, and exercise Stress the need to encourage children to engage in appropriate physical activities Emphasize the importance of providing a safe physical and emotional environment Safety & Injury Prevention Age 6 to 9 years (Greig Health) Strategies for Good Sleep Habits– School age Children 10-12 hours ADOLESCENCE Normal Growth and Development During Adolescence 13-19 years Growth, cognition, identify, relationships with parents, relationships with peers, sexuality and psychological health (Table 40.1) Pubertal growth spurt gains, Final 20% to 25% of height Up to 50% of the ideal adult body weight Boys: Less rapid epiphyseal closure, taller, longer arms and legs, wider shoulder Girls: broader hip development Hypertrophy of the laryngeal mucosa and enlargement of the larynx and vocal cords. Deeper voice. Active sebaceous gland- Acne Heart, blood volume, and systolic BP increase in size and strength; HR decreases; Respiratory vital capacity increases; Decline in basal metabolic rate  Age Timeline School-aged Early Teens—ages 11 to 14 Middle Teens – Late Teens – children— (2 nd sex characteristics ages 15 to 17 ages 18 to 20 ages up to 10 yrs appear) Pubertal Sexual Maturation Puberty: the reproductive organs begin to function, and the 2 nd sex characteristics develop Females: 1st menstrual period Males: less obvious indications Tanner stages of sexual maturation (1 to 5)– assessment of pubertal development Sequence is predictable Based on the visual or described secondary sex characteristics and genital development Changes that occur throughout the body as a result of hormonal changes Girls: breast size and shape and distribution of public hair Boys: Size and shape of the penis and scrotum and shape and distribution of pubic hair Fig 40.2 and 40.3 TANNER STAGES Stage Physical Development (Girls) Physical Development (Boys) 1. Pre-Puberty No breast development or pubic hair No genital growth or pubic hair 2. Early Puberty Breast buds form; sparse, fine pubic hair begins Testes enlarge; sparse, fine pubic hair begins 3. Mid-Puberty Breasts enlarge; darker, coarser pubic hair Penis lengthens; darker, coarser pubic hair 4. Late Puberty Areolae protrude, pubic hair covers more area Penis thickens; pubic hair covers more area 5. Full Maturity Breasts mature; pubic hair adult-like and fully Genitals mature; pubic hair adult-like and fully distributed distributed Box 40.1 Usual Sequence of Maturational Changes Assessment Privacy and confidentiality Caregiver presence with permission Consent/autonomy Vital signs– similar to adults General appearance Head-to-toe assessment Least to most invasive Erikson: Identity Vs. Confusion Developing a sense of identity A stable, coherent picture of oneself Establishing autonomy from parents Group identify Individual identify Peer support is paramount  Adolescent Conceptions of Self Adolescent egocentrism Self-absorption Health-related beliefs Changes in social cognition Understanding of others’ thoughts and feelings Roles Effect on health-related choices  Question A 16-year-old boy is expressing feelings of isolation and withdrawal from friends and family. He tells the nurse she doesn’t know who he is anymore. What is the nurse’s best response? a) “This is a common experience for adolescents as they are still developing their sense of identity.” b) “You are going through a phase, and this will pass once you get older.” c) “It sounds like you may be experiencing depression, and we should refer you for counseling.” d) “It’s unusual to feel this way at your age, and it would be good to talk to your parents about it.” Piaget: Emergence of Formal Operational Thought Formal operational period Abstract thinking Concrete thought Think beyond the present (e.g. college and occupational possibilities) Decision-making abilities increase May not use formal operational thought and reasoned decision making all the time— “choices”  Promoting Optimal Health During Adolescence Eating habits and behaviours Influence of peers Obesity Hypertension and hyperlipidemia Personal care Vision, hearing Posture Body art, Tanning Mental health Stress reduction Nursing role: develop skills to cope with stress and change and skills to become involved in personally meaningful activities School and learning problems  Promoting Optimal Health During Adolescence Infectious diseases/immunizations Sexual health Media influences are pervasive Knowledge often inaccurate Need for factual information, presentation based on developmental maturity Importance of sexual aspects of interpersonal relationships Pregnancy, abortion and birth control CONTENT WARNING  Promoting Optimal Health During Adolescence Safety promotion and injury prevention Physical injuries are the greatest single cause of death among Canadian youth Injury prevention requires a multidimensional approach Box 40.3 Motor vehicle—related injuries Drowning Poisoning Nursing care Parents’ need for support and guidance (p. 988) Information needs regarding developmental changes and process of detachment Parents’ possible need for help in letting go Sleep- 9 to 10 hours Guidelines: Interviewing Adolescents (p. 982) Ensure confidentiality and privacy; interview the adolescent without their parents Ask which pronouns the adolescent would prefer be used during your discussion Offer a nonthreatening explanation for the questions you ask: “I’m going to ask a number of questions to help me better understand your health” Maintain objectivity; avoid assumptions; judgements, and lectures Ask open-ended questions when possible; move to more directive questions if necessary Begin with less sensitive issues and proceed to more sensitive ones Use language that both the adolescent and you understand. Clarify terms, such as “having sex” or “hooking up.” Restate: Reflect back to the adolescent what they said, along with feelings that may be associated with their descriptions Ask the adolescent if the practitioner may share general (or specific) information gathered in the health examinations and interview with their parents. Reiterate that the teen’s confidentiality will be maintained if they refuse to give permission (unless life-threatening information is shared) HEEADSSS  Sensitive topics include: Sexual orientation, sexual/gender identification, STIs, sexual abuse, and related topics Cognizant of the significant psychological, psychosocial, and How to Assess for medical challenges Sensitive Topics? Approach in a non-judgemental, sensitive, and respectful manner; maintain confidentiality; Appreciate the adolescent’s feelings and remain sensitive to their need to talk about the topic Use preferred pronouns; tell them what you think, but not what to do, empower the teen  Rejection or estrangement from family Social issues Social rejection and exclusion related to sexual Physical, social or emotional harassment, including cyberbullying orientation and Pressure to “change” their sexual orientation or gender identity Lack of positive role models and representation in educational gender identity (p. materials or in the media 979) Lack of respect for chosen names and gender pronouns