Wk14 Nursing Process Pt1 PDF

## WK14 NURSING PROCESS PT1.mp4 ### NURSING PROCESS FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT **Nursing assessment of an infant begins with an interview with the primary caregiver.** **Important areas to discuss:** * nutrition * growth patterns * development **IMPORTANT INDICATORS OF GROWT...

## WK14 NURSING PROCESS PT1.mp4 ### NURSING PROCESS FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT **Nursing assessment of an infant begins with an interview with the primary caregiver.** **Important areas to discuss:** * nutrition * growth patterns * development **IMPORTANT INDICATORS OF GROWTH:** * height * weight * head circumference **ASSESSMENT** **Physical assessment of an infant must be done quickly yet thoroughly because a baby can tire or become hungry, making it difficult to judge overall behavior and temperament.** The primary caregiver should be present to make a child feel comfortable. **Using a calm approach helps the infant remain calm as well.** ### NURSING CARE PLANNING USING ASSESSMENT **APPEARANCE OF THE AVERAGE INFANT** | Age | Characteristic | | :---: |:---| | 3 Months | Follow across midline | | 3 Months | Respiratory rate slows to 20 to 30 breaths/min | | 10 Months | Pincer grasp | | 2 Months | Social smile | | 6 Months | First tooth erupts | | 1 Year | Heart rate slows to 100-120 beats/min | | 1 Year | Abdomen protuberant | | 1 Year | Triples weight | | 1 Year | Grows in height by 50% | | Liver remains immature | | Legs may appear short and bowed | **A typical eruption pattern of decidious teeth:** * **UPPER** * Central incisor: 8-12 months * Lateral incisor: 9-13 months * Cuspid: 16-22 months * First molar: 13-19 months * Second molar: 25-33 months * **LOWER** * Second molar: 23-31 months * First molar: 14-18 months * Cuspid: 17-23 months * Lateral incisor: 10-16 months * Central incisor: 6-10 months ### INFANT GROWTH AND DEVELOPMENTAL MILESTONES | Month | Motor Development |Fine Motor Development | Socialization and Language | Time Reflexes Fade | Play | | :---: |:---|:---|:---|:---|:---| | 0-1 | Largely reflex actions | Keeps hands fisted; able to follow object to midline with eyes | - | - | Enjoys watching face of primary caregiver; needs play time in prone position | | 2 | Holds head up when prone | Demonstrates social smile | Makes cooing sounds; differentiates cry | Grasp reflex fading | Enjoys bright-colored mobiles | | 3 | Holds head and chest up when prone | Follows object past midline with eyes | Laughs out loud | Landau reflex is strong | Spends time looking at hands (hand regard); "tummy time" important during the day | | 4 | Turns back to front; no longer has head lag; bears partial weight on feet | - | - | Stepping, tonic neck, extrusion reflexes are fading. | Needs space to practice turning | | 5 | Should turn readily front to back and back to front | Uses palmar grasp | May say vowel sounds (oh-oh) | Tonic neck reflex fading | Handles rattles well | | 6 | Begins to show ability to sit | - | - | Moro and tonic neck reflex have faded. | Enjoys bathtub toys, rubber ring for teething | | 7 | Reaches out to objects; first tooth (central incisor) erupts | Transfers hand to hand | Shows beginning fear of strangers | - | Likes objects that are good size for transferring | | 11 | Cruises (walks with support) | - | - | Landau reflex fades.| Cruising can be main activity | | 12 | Stands alone; some infants take first step | - | - | - | Likes toys that fit inside each other (pots and pans); nursery rhymes; will like pull toys as soon as walking | ### NURSING DIAGNOSIS **Focus on basic needs such as sleep, nutrition and activity and the parents' adjustment to their new role.** * Ineffective breastfeeding related to maternal fatigue * Disturbed sleep pattern (maternal) related to baby's need to nurse every 2 hours * Deficient knowledge related to normal infant growth and development * Imbalanced nutrition, less than body requirements, related to infant's difficulty sucking * Health-seeking behaviors related to adjusting to parenthood * Delayed growth and development related to lack of stimulating environment * Risk for impaired parenting related to long hospitalization of infant * Readiness for enhanced family coping related to increased financial support * Social isolation (maternal) related to lack of adequate social support * Ineffective role performance related to new responsibilities within the family ### OUTCOME IDENTIFICATION AND PLANNING **Outcomes established for infant care need to be realistic based on the family's new circumstances** **Parents of infants, especially first-time parents, must do a lot of adjusting, and this takes time.** **Try to suggest activities that can be easily incorporated into the family's lifestyle.** If your assessment data indicate that a child needs more exposure to language and you know both parents work during the day, for example, you might suggest the parents ask their child's caretaker to talk to their infant more. **Encourage parents to spend additional time each evening reading or reciting nursery rhymes to their baby.** **The combined interventions should increase the baby's language skills.** ### OUTCOME EVALUATION **Evaluate expected outcomes at each visit to detect changes in parents' understanding of caring for their infant.** **Help parents understand all aspects of infant care, not just a single element.** * Mother states she feels fatigued but able to cope with sleep disturbance from night waking. * Parents state five actions they are taking daily to encourage bonding. * Father states both he and spouse are adjusting to new roles as parents. * Parents verbalize appropriate techniques they use to stimulate infants. * Infants demonstrate age-appropriate growth and development. * Infant exhibits weight, height, and head and chest circumference within acceptable norms. ### ASSESSMENT **Whether a child is seen for a routine checkup or has come to a health care center because of a specific health concern, assessment begins with taking a careful health history.** **Asking parents about a toddler’s ability to carry out activities of daily living offers assessment information not only on the child’s developmental progress but also important clues about the child-parent relationship.** **Careful observation is another crucial element of nursing assessment of a toddler.** This is because parents may become so emotionally involved in a health concern they may not describe it with complete objectivity. **APPEARANCE OF THE AVERAGE TODDLER** | Characteristic | Age | | :---: |:---| | Speaks in two-word sentences | 2.5 Years | | 20 deciduous teeth present | 2.5 Years | | Heart rate: 90 to 110 beats/min | 2.5 Years | | "Pouchy" abdomen from weak abdominal muscles | 2.5 Years | | Chest circumference becomes bigger than head circumference | 2 Years | | Noticeable lordosis | 2 Years | | "Baby fat" begins to disappear | 2 Years | | Wide-based gait | 2 Years | ### MILESTONES OF A TODDLER GROWTH AND DEVELOPMENT | Age (in Months) | Fine Motor | Gross Motor | Language | Play | | :---: |:---|:---|:---|:---| | 15 | Puts small pellets into small bottles; scribbles voluntarily with a pencil or crayon; holds a spoon well but may still turn it upside down on the way to mouth | Walks alone well; can seat self in chair; can creep up stairs | 4-6 words | Can stack two blocks; enjoys being read to; drops toys for adult to recover (exploring sense of permanence) | | 18 | No longer rotates a spoon to bring it to mouth | Can run and jump in place; can walk up and down stairs holding onto a person's hand or railing; typically places both feet on one step before advancing | 7-20 words; uses jargoning; names one body part| Imitates household chores such as dusting; begins parallel play (playing beside, not with, another child) | | 24 | Can open doors by turning doorknobs; can unscrew lids | Walks up stairs alone, still using both feet on same step at same time | 50 words; two-word sentences (noun or pronoun and verb), such as "Daddy go," "Dog talks" | Parallel play evident | | 30 | Makes simple lines or crosses with a pencil | Can jump down from chairs | Verbal language increasing steadily; knows full name; can name one color; holds up fingers to show age | Spends time playing house, imitating parents' actions; play is "roughhousing" or active. | **All during the toddler period, children play beside other children, not with them.** **This side-by-side play (parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period.** **Caution parents that if two toddlers are going to play together, they must provide similar toys because an argument over one toy is likely to occur.** By age 2 years, when toddlers **begin to spend time imitating adult actions** in their play such as wrapping a doll and putting it to bed or "driving the car," they begin to use fewer toys than before. **The act of imitating has become their play.** By the end of the toddler period, both boys and girls begin to like roughhousing and spend at **least part of every day in this very active, stimulating type of play.** Because of this rough activity, most toddlers have at least one black-and-blue mark on their legs at all times from tripping over their feet while trying to run too fast or from jumping or bumping into a chair or doorway. **Examine these and document their presence but don’t mistake them for child maltreatment.** ### NURSING DIAGNOSIS **Focus on the parents’ eagerness to learn more about the parameters of normal growth and development or issues of safety or care.** * Health-seeking behaviors related to normal toddler development * Deficient knowledge related to best method of toilet training * Risk for injury related to impulsiveness of toddler * Interrupted family process related to need for close supervision of 2-year-old * Readiness for enhanced family coping related to parents’ ability to adjust to new needs of child * Readiness for enhanced parenting related to increased awareness for poison prevention * Disturbed sleep pattern related to lack of bedtime routine ### COMMON GUIDELINES FOR TOILET TRAINING 1. Children are physically ready for toilet training when they can walk securely. Plan 1 or 2 weeks of psychological “readiness” activities such as showing your child "grown up" pants and how other family members use the toilet, activities that will help him realize the task of toilet training is a step toward growing up, not something only toddlers do. 2. Check that training pants pull down readily and slacks are free of complicated buttons or grippers; otherwise, your child will have accidents because he cannot undress quickly enough. 3. Purchase either a potty chair that sits on the floor of an infant seat that is placed on the regular toilet. If you choose a toilet seat, place a footstool in front of the toilet so your child has some support for his feet. 4. Begin with defecation training because this is so much easier to grasp than urination. Sit your child on the potty chair or toilet **at the time he usually defecates**, such as when he wakes up in the morning. 5. Praise your child if he does defecate. Remind him to wash his hands afterward. 6. Be careful not to flush the toilet while your child is sitting on **it because 2-year- old children are unable to realize they will not be flushed away**. Encourage your child to flush the toilet independently after you have helped him get reäressed. 7. Do not allow a child to remain on a potty chair for much longer than 10 minutes (less than that if he is resistant). Also, do not allow your child to use the chair to eat or as a play table, so he doesn't become confused as to its purpose. 8. If your child does not seem ready on a day-to-day basis, **return him to diapers** for a short period. Be careful not to make this feel like failure or equate "good" with being dry and "bad" with being wet. Continue with readiness activities. Reintroduce training pants and attempt toilet training again when your child seems more ready. 9. When children have mastered defecation, it's time to include urination. Boys enjoy **standing to urinate and aiming at objects** in a toilet bowl, such as pieces of breakfast cereal. 10. Some toddlers have difficulty remaining dry at night until they are 3 to 4 years old. Do not pressure your child to accomplish nighttime dryness but assume he is doing the best he can. Change him to training pants for the night by explaining (not punitively) that it is hard to keep dry while he sleeps. After your child has been dry during the night for about 1 month, he has probably mastered nighttime dryness. 11.Do not wake your child during the night and carry him to the bathroom to void. This system may keep him dry during the night, but it does not help him stay dry for long periods. ### OUTCOME IDENTIFICATION AND PLANNING **To help parents resolve a concern during the toddler period, focus largely on family education and anticipatory guidance.** **Urge them to establish realistic goalsa and outcomes so they can meet the rapidly changing needs of their toddler and learn to cope with typical toddler behaviors.** **Otherwise, parents can expect too much of a toddler and grow frustrated instead of enjoying being a parent of a child this age.** ### IMPLEMENTATION **When teaching about typical toddler behavior, teach parents a good rule is to think of a toddler as a visitor from a foreign land who wants to participate in everything the family is doing but does not know the customs or the language.** **They need to help their toddler learn these the same as they would that stranger.** **Also teach parents not only how to approach a current problem but also how to learn adequate methods for resolving similar situations that are sure to arise in the future.** **If parents do not learn methods that can be applied throughout their child’s growing years, they may win battles but lose wars.** For instance, parents may find that promising children a treat when they are in the middle of a temper tantrum will stop the tantrum, but it will not prevent other tantrums from occurring in the future (and, in fact, may encourage them). **Health visits provide opportunities to help parents learn healthy coping techniques.** In addition, demonstrating good communication skills with toddlers can serve as a model for healthy communication behavior with them. ### OUTCOME EVALUATION **Expected outcomes must be evaluated frequently during the toddler period because children change so much and learn so many new skills during this time that their abilities and associated parental concerns can change from day to day.** * Parents state child maintains a consistent bedtime routine within the next 2 weeks. * Parents state they have childproofed their home by putting a lock on kitchen cupboard by next clinic visit. * Grandmother states she has modified usual activities to conserve strength to care for toddler granddaughter by 1 weeks' time.