2022-2023 Pediatric Nursing PDF

2022-2023 Pediatric Nursing Overview about Growth and development Introduction Pediatric nursing is the branch of nursing that covers the childhood growth and development, child health and illness. A good understanding of how children change in terms of growth and development in the early is ve...

2022-2023 Pediatric Nursing Overview about Growth and development Introduction Pediatric nursing is the branch of nursing that covers the childhood growth and development, child health and illness. A good understanding of how children change in terms of growth and development in the early is very important and without this understanding it is not possible to practice pediatric nursing well. Definitions 1- Growth: Is a natural increase in physical size of the whole body or any of its parts and can be measured in inches or centimeters and in pounds or kilograms. 2- Development: It is progressive increase in the skills and capacity of function. Stages of growth and development 1- Fetal or embryonic ……from conception to birth. 2- Newborn (neonatal) ………from birth to four weeks or 1st month or 1st 28 days. 3- Infancy …….. From four weeks to one year. 4- Toddler ……..from one year to three years. 5- Early childhood (preschool) …….from three to six years. 6- Late childhood (school) ….. from six to twelve years or puberty. 7- Adolescence ……… from puberty to beginning of adult life. Introduction about the stages of growth and development 1- Prenatal period: Conception to birth. Germinal: Conception to approximately 2 weeks. Embryonic: 2 to 8 weeks. Fetal: 8 to 40 weeks (birth).A rapid growth rate and total dependency make this one of the most crucial periods in the developmental process. 2- Infancy period: Birth to 12 months.  2022-2023 Pediatric Nursing Neonatal: Birth to 27 or 28 days. Infancy: 1 to approximately 12 months. The infancy period is one of rapid motor, cognitive, and social development. Through mutuality with the caregiver (parent), the infant establishes a basic trust in the world and the foundation for future interpersonal relationships. The critical first month of life, although part of the infancy period, is often differentiated from the remainder because of the major physical adjustments to extra uterine existence and the psychological adjustment of parent. 3- Early childhood: 1 to 6 years. Toddler: 1 to 6 years. Preschool: 3 to 6 years. This period, which extends from the time the children attain upright locomotion until they enter school, is characterized by intense activity and discovery. It is a time of marked physical and personality development. Motor development advances steadily. Children at this age acquire language and wider social relationships, learn role standards, gain self-control and mastery, develop increasing awareness of dependence and independence, and begin to develop a self-concept. 4- Middle childhood: 6 to 11 or 12 years. Frequently referred to as the ―school age‖, this period of development is one in which the child is directed away from the family group and centered around the world of peer relationships. There is steady advancement in physical, mental, and social development, with emphasis on developing skill competencies. Social cooperation and early moral development take on more importance with relevance for later life stages. 5- Later childhood: 11 to 19 years. Prepubertal: 10 to 13 years. Adolescence: 13 to approximately 18 years. The period of rapid maturation and change known as adolescence is considered to be a transitional period that begins at the onset of puberty and extends to the point to entry into the adult world usually high school graduation. Biologic and personality maturation are accompanied by physical and emotional changes , and there is  2022-2023 Pediatric Nursing redefining of the self-concept, in the late adolescent period the young person begins to internalize all previously learned values and to focus on an individual, rather than a group, identity. Principles of Growth and Development  Growth is an orderly process, occurring in systematic fashion.  Rates and patterns of growth are specific to certain parts of the body.  Wide individual differences exist in growth rates.  Growth and development are influences by are influences by a multiple factors.  Development proceeds from the simple to the complex and from the general to the specific.  Development occurs in a cephalocaudal and a proximodistal progression.  There are critical periods for growth and development.  Rates in development vary.  Development continues throughout the individual's life span. Factors affecting growth and development Growth and development are due not to one factor, but to a combination of many factors, all interdependent. 1- Heredity and constitutional make-up: A. Genetic: members of families bear physical resemblances, and there is a high degree of correlation of stature with weight among siblings. The rate of growth is more a like among siblings than among unrelated persons. Note: Before evaluating the largeness or smallness of a child, the size of the parents should first be observed. B. Race: Distinguishing characteristics called racial or sub racial developed in prehistoric man. As to height, there are tall and short examples among all races and sub races e.g., American race are tall while Chinese are short.  2022-2023 Pediatric Nursing C. Nationality: Each nationality has own physical characteristics of national group because the inhabitants of the various nations of Europe tend to be made up of homogenous sub racial groups with specific characteristics. 2. Sex: Sex is determined at conception. The male infant is both longer and heavier than the female infant. Boys maintain this superiority until about 11 years of age. Then girls, who nature earlier and so reach the period of accelerated growth earlier than boys, are taller on the average than they. Boys, during the prepubertal spurt of growth and thereafter, are again taller than girls. 3. Environment: One example of the influence of environment upon potential height is found among the first and second generations of Japanese in this century. The children are generally taller than their parents because they have had the advantage of better food and living conditions than their parents. Prenatal factors: Prenatal conditions are part of the environmental climate in which the child develops and should not be forgotten in considering actual development in relation to probable optimal development. The influence of the intrauterine environment on the child‘s future development is great, particularly since the uterus shields the fetus from the full impact of external adverse conditions. Harmful prenatal factors: 1) Maternal diseases: The mother may suffer from metabolic endocrine disturbances e.g. diabetes mellitus which affect the fetus. Congenital rubella leads to malformed baby. Heredity disorders leads to dwarfism.  2022-2023 Pediatric Nursing Metabolic disorders leads to rickets. Chronic illness leads to congenital cardiac anomalies. All diseases and acute illness may cause growth retardation. 2) Maternal nutrition: The fetus may suffer from nutritional deficiencies when the mother‘s diet is insufficient in quantity or quality, regardless of her socioeconomic status of living. Severe maternal nutritional deficiencies during prenatal period may negatively influence on physical and mental state of her fetus. Drugs: Some drugs have tetratogenic affect on the fetus if mother has taken during pregnancy for examples: - Thalidomide ……..leads to limb and cardiac malformation. - Amphetamine ……. Leads to congenital heart diseases. - Cytotoxics …….. leads to intrauterine growth retardation. - Corticosteroids ……….. high dose leads to cleft palate , Prolonged dose lead to anencephaly. Postnatal environmental factors: An environment that provides satisfying experiences promotes growth. Factors which influence that child‘s development are more likely to be of environmental origin than genetic. Among the most important environment factors are the following: A) External factors: 1- Socioeconomic status of the family: The environment of the lower socioeconomic groups is apt to be less favorable than that of the middle or upper groups. Parents in unfortunate financial circumstances are less likely to understand the principles of modern scientific child care, they lack money to buy the essentials of health and diet, and often they one  2022-2023 Pediatric Nursing unable, unwilling, or unsure of how to obtain medical care and hospitalization. 2- Nutrition: Nutrition is related to both the quantitative and qualitative supply of food elements. But the child‘s use of a good diet may be impaired by faulty absorption or animilation of food substances. 3-Climate and season: Climatic variations influence the infant‘s health. Since the entire area lies within the temperature zone. The seasons of the year influence growth rates in height and weight, especially in older children. Weight are lowest in spring and early summer and greatest in the late summer and autumn. 4-Illness and injury: Illness and injury, with their accompanying debility and nutritional impairment, have a great influence on weight and same influence on growth. 5-Exercise: Exercise promotes physiologic activity and stimulates muscular development and fresh air and moderate sunshine favour health and growth. 6-Ordinal position in the family: The child‘s position in the family is a factor in development for several reasons, among them the following: (1) Children learn from older siblings. (2) The youngest child may be relatively slow in certain areas of development because he is given little encouragement express himself. (3) The only child is likely to develop more rapidly along intellectual lines than the average child because he is constantly with adults an is mentally stimulated by their companion ship. B) Internal environmental factors: 1. Intelligence: Intelligence is correlated to some degree with physical development i.e. the child of high intelligence is likely to be better developed than the less gifted  2022-2023 Pediatric Nursing child. Intelligence influences mental and social development. 2. Hormonal balance: Hormonal balance in the young child is important. Normal secretions of the endocrine glands promote normal growth of the body. 3. Emotions: Emotional disturbances influence growth, since the disturbed child neither sleeps nor eats as well as one who is happy and contended. Types of growth 1. Physical growth: Physical growth includes many things, among them the following: Changes in general body growth, which results from different rates of growth in different parts of the body during the consecutive stages of development. Head circumference: The circumference of the head is important, since it is related to intracranial volume. An increase in circumference permits an estimation of the rate of brain growth. chest diameter: Chest measurements increases as the child grows and the shape of his chest changes. Weight: Weight is influenced by all the increments in size and is probably the best gross index of nutrition and growth. There is a wide variation within normal limits for each year of childhood. Height: Yearly increments in height diminish from birth to maturity. There is great variation in the yearly increases in stature among children of the same age. Some children reach adult height in their early teens, but others continue to grow throughout late adolescence.  2022-2023 Pediatric Nursing 2. Physiological growth: Which can be assessed through measurements of: - Temperature. - Respiration. - Pulse. - Blood pressure. Types of development 1. Development of the locomotors system: Development of the locaomotor system is directly related to: 1. Development of the CNS. 2. Environmental factors → training. 3. Development of the peripheral loco-motor system, i.e., bones, joints and muscles. There is a normal sequence in the development of locomotion, just as there is for mental development and for emotional and social adequacy. A child should be given the opportunity for learning by either experience or instruction – whenever he is ready to acquire the skill or learn by indirect experience through instruction from others. 2. Mental development: Mental development depends on numerous factors. It is demonstrated in problem solving and in a general understanding of what to do in a given situation. By the time the child is a year old he should be in the process of learning decision making him and of accepting the decision of those adults in whose love he feels secure. Patterns of growth and development There are definite and predictable patterns in growth and development that are continuous, orderly, and progressive. These patterns, or trends, are universal an basic to all human beings, but each human being, accomplished these in a manner and time  2022-2023 Pediatric Nursing unique to that individual. 1. Directional trends. Growth and development proceed in regular, related directions or gradients and reflect the physical development and maturation of neuromuscular functions. The first is the cephalocaudal, or head-to-tail, direction. Infants achieve structural control of the head before they have control of the trunk and extremities, hold their erect before they stand, use their eye before their hands, and gain control, of their hands before they have control of their feet. Second, the proxy-modistal, or near-to-far, trend applies to the midline-to- peripheral concept. The third trend, differentiation, describes development from simple operations to more complex activities and functions. From very broad, global patterns of behavior, more specific, refined patterns emerge. All areas of development (physical, mental, social, and emotional) proceed in this direction. Generalized development precedes specific or specialized development; gross, random muscle movements take place before fine muscle control. 2. Sequential trends: In all dimensions of growth and development there is a definite, predictable sequence, with each child normally passing through every stage. Children crawl before they creep, creep before they stand, and stand before they walk. Late facets of the personality are built on the early foundation of trust. The child babbles, then forms, words, and finally, sentences; writing emerges from scribbling. Physiologic and structural growth Physiologic and structural changes of particular relevance to general pediatrics include the following: 1. Respiratory rate and pulse rate decrease sharply during the first 2 yr and then more gradually throughout childhood; blood pressure rises steadily beginning at approximately 6 yr of age. 2. Development of par nasal sinuses continues throughout childhood. The ethmoids, maxillary, and sphenoid sinuses are present from birth; the frontal sinuses first appear radio logically around 6 yr of age. 3. Lymphoid tissues develop rapidly, reaching adult size by 6 yr of age and  2022-2023 Pediatric Nursing continuing to hypertrophy throughout childhood and early adolescence before receding to adult size. 4. The metabolism of medications and a child‘s response to them change rapidly in the 1st mo of life and again under hormonal influences in puberty. No single pattern is characteristic of all medications, and individual variation is the rule. 5. Nutritional needs as well as wide variety of biochemical and hematologic vales undergo marked developmental changes. Newborn ♦ Growth and development for newborn. Definition: Newborn stage is the first 4weeks (28 days) or first month of life. It is a transitional period from intrauterine life to extrauterineenvironment. I. Physical growth Weight: Most newborn infants weight 2.700 to 4.000 kg. at birth. Physiological weight loose of 5% to10 % of weight by 3-4 days after birth as a result of:- 1- Withdrawal of hormones from mother. 2- Loss of excessive extra cellular fluid. 3- Passage of me conium (feces) and urine. 4- Limited food intake.