Hatfield Pediatric Day 1 PDF

PEDIATRIC NURSING DAY 1 Principles of Growth and Development Growth and Development of the Infant: 28 Days to 1 Year Growth and Development of the Toddler: 1 to 3 Years Growth and Development of the Preschool-Aged Child: 3 to 6 Year Growth and Development of the Sch...

PEDIATRIC NURSING DAY 1 Principles of Growth and Development Growth and Development of the Infant: 28 Days to 1 Year Growth and Development of the Toddler: 1 to 3 Years Growth and Development of the Preschool-Aged Child: 3 to 6 Year Growth and Development of the School-Aged Child: 6 to 10 Year Growth and Development of the Adolescent: 11 to 18 Year Marian College Vocational Nursing Program Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 22: Principles of Growth and Development Foundations of Growth and Development #1 ❖ Growth: physical increase in the body's size ❖ Development: progression of changes in the child toward maturity or maturation ❖ Cephalocaudal growth: orderly pattern from the head downward ❖ Proximodistal growth: starts in center and progresses outward Copyright © 2022 Wolters Kluwer · All Rights Reserved Foundations of Growth and Development #2 ❖ Developmental tasks: milestones of basic achievements associated with each stage of development; each must be successfully completed before moving on to next stage ❖ Patterns of growth o Height: increases in predictable pattern; often seen in spurts; patterns are monitored and plotted on growth chart o Weight: progresses in predictable pattern; also monitored and plotted on graph o Body proportions: vary and change throughout life Copyright © 2022 Wolters Kluwer · All Rights Reserved Foundations of Growth and Development #3 Copyright © 2022 Wolters Kluwer · All Rights Reserved Foundations of Growth and Development #4 ❖ Standards of growth o Use of growth chart, monitor development, compared to other children and past measurements o Used only for comparison, may reveal potential issue which needs addressed ❖ Standards of development o Denver Developmental Screening Test o Range of time versus exact time of development o Is only a guide which can help reveal potential issue which needs addressed Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #1 ❖ Genetics o Parent traits could reappear in later generations o Can influence physical characteristics such as gender, race, eye color, height, and weight, as well as overall growth and development o Some diseases, physical, and mental disorders are genetically transmitted o Personality characteristics, including temperament, are genetically influenced Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #2 ❖ Nutrition o The quality of nutrition during the growing years has major effect on overall health and development and throughout life o Needs adequate food and nutrients to grow, resist infection and disease, develop proper motor skills, develop good eating habits Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #3 ❖ Nutrition (cont.) o Healthy eating: enjoy your food; focus on whole fruits; vary veggies; make half of grains whole; vary protein routine; get dairy, calcium-rich foods; eat less saturated fat; drink and eat less sodium; don’t sugarcoat it o Physical activity: Set a good example; establish a routine; have an activity party; set up a home gym. Move it! Give activity gifts Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #4 ❖ Environment o Many aspects of environment affect growth and development: family structure, socioeconomic level, play and entertainment o Play and entertainment: ▪ Play essential part of development ▪ Entertainment can have positive or negative influences ▪ Should encourage child to use imagination in positive way Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #5 ❖ Environment (cont.) o The homeless family ▪ Related to various causes ▪ Creates additional stress, problems getting appropriate care or basic needs met ▪ Lack of adequate shelters ▪ Nurse should focus on positive factors; offer down-to-earth suggestions and help family ▪ Provide information about outreach programs in community Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #6 ❖ Environment (cont.) o Divorce and the child ▪ Child reaction may vary from feeling guilty for divorce to blaming parents for divorce ▪ Counseling important step for child ▪ Nurse should clarify who is custodial parent ▪ Children react in various ways if parent(s) remarry Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #7 ❖ Environment (cont.) o The Latchkey child ▪ Comes home to empty house because parent(s) are still at work ▪ Often have fears of being home alone ▪ If several siblings, older child may be expected to be caregiver to younger siblings ▪ Need plan of action in place; safety measures ▪ Suggest after-school program/activities Copyright © 2022 Wolters Kluwer · All Rights Reserved Influences on Growth and Development #8 ❖ Environment (cont.) o The runaway child ▪ Most are 10 to 17 years old ▪ May be in response to circumstances they view as too difficulty to handle ▪ Some are throwaways ▪ Risk for stealing, drug dealing, prostitution, live on streets ▪ Numerous programs available ▪ No quick fix Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Many factors influence a child’s growth and development. Being a “latchkey child” can be influential because of what? a. Young children are often abused by older siblings forced to be caregivers b. Older siblings who are caregivers after school often do not have clear-cut guidelines or expectations c. Older siblings who are caregivers after school miss out on much of their childhood d. Young children often become afraid of older siblings who are caregivers after school Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 b. Older siblings who are caregivers after school often do not have clear-cut guidelines or expectations Rationale: When more than one child is involved and the older child is responsible for the younger one, conflicts can arise. The older child may have to assume responsibility that is beyond the normal expectations for the child’s age. This can be a difficult situation for the caregivers and the children. The caregivers must carefully outline permissible activities and safety rules. Copyright © 2022 Wolters Kluwer · All Rights Reserved Theories of Child Development #1 ❖ Sigmund Freud ▪ Oral stage (ages 0 to 2 years) ▪ Anal stage (ages 2 to 3 years) ▪ Phallic (infant genital) stage (ages 3 to 6 years) ▪ Latency stage (ages 6 to 10 years) ▪ Genital stage (ages 11 to 13 years) Copyright © 2022 Wolters Kluwer · All Rights Reserved Theories of Child Development #2 ❖ Erik Erikson o Trust versus Mistrust (ages 0 to 1 year) o Autonomy versus Doubt and Shame (ages 1 to 3 years) o Initiative versus Guilt (ages 3 to 6 years) o Industry versus Inferiority (ages 6 to 12 years) o Identity versus Role Confusion (ages 12 to 18 years) o Intimacy versus Isolation (early adulthood) o Generativity versus Self-Absorption (young and middle adulthood) o Ego Integrity versus Despair (old age) Copyright © 2022 Wolters Kluwer · All Rights Reserved Theories of Child Development #3 ❖ Jean Piaget o Sensorimotor phase (ages 0 to 2 years) o Preoperational phase (ages 2 to 7 years) o Concrete operations (ages 7 to 11 years) o Formal operations (ages 12 to 15 years) Copyright © 2022 Wolters Kluwer · All Rights Reserved Theories of Child Development #4 ❖ Lawrence Kohlberg o Preconventional (premoral) level ▪ Stage 0, no moral sensitivity (ages 0 to 2 years) ▪ Stage 1, punishment and obedience orientation (ages 2 to 3 years) ▪ Stage 2, naïve instrumental self-indulgence (ages 4 to 7 years) Copyright © 2022 Wolters Kluwer · All Rights Reserved Theories of Child Development #5 ❖ Lawrence Kohlberg (cont.) o Conventional level ▪ Stage 3, good-boy orientation (ages 7 to 10 years) ▪ Stage 4, law and order orientation (ages 10 to 12 years) o Postconventional (principled) level ▪ Stage 5, social contract orientation (ages 13 to 18 years) ▪ Stage 6, personal principles (not attained very frequently) Copyright © 2022 Wolters Kluwer · All Rights Reserved Theories of Child Development #6 ❖ Carl Jung o Focused on inner sequence of events that shape personality o Archetypes: predetermined patterns for growth and development o First 3 years: coordinating experiences and learning to make conscious personality o Following years: make sense of environment o Responses to experiences is more critical Copyright © 2022 Wolters Kluwer · All Rights Reserved Theories of Child Development #7 ❖ Concern that theories are gender- and culturally specific has led to new research ❖ Carol Gilligan o Moral development of males and females ❖ Patricia Green o Empirical and theoretical understanding of cultural diversity Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Erik Erikson developed a theory on the growth and development of children based on what? a. Psychosexual stages of development b. Cognitive development c. Psychosocial development d. Archetypes Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 c. Psychosocial development Rationale: Building on Freud’s theories, Erikson described human psychosocial development as a series of tasks or crises. Copyright © 2022 Wolters Kluwer · All Rights Reserved Developmental Considerations for Communicating With Children and Family Caregivers #1 ❖ Communicating is primary source of data collection ❖ Offer anticipatory guidance ❖ Understanding the growth and development of the child and influences on the child and family caregivers is important for effective communication Copyright © 2022 Wolters Kluwer · All Rights Reserved Developmental Considerations for Communicating With Children and Family Caregivers #2 ❖ Principles of communication o Includes spoken and written words, body language o Listening = attending + following o Time management o Nurses need to accept their own feelings o Use open-ended questions followed by guided statements o Avoid communication blocks o Use professional interpreter as needed Copyright © 2022 Wolters Kluwer · All Rights Reserved Developmental Considerations for Communicating With Children and Family Caregivers #3 ❖ Communicating with infants o Evaluate actions and respond to sensory cues o Spend time calming down and connecting with infant o Establish relationship with family caregiver o Use sensory play activities Copyright © 2022 Wolters Kluwer · All Rights Reserved Developmental Considerations for Communicating With Children and Family Caregivers #4 ❖ Communicating with young children o Allow family caregiver to hold child as you initiate conversation o Avoid sudden abrupt or noisy approaches o Allow young child to handle or explore equipment o Get on eye level with child when speaking with child o Speak in slow, clear, positive voice with simple words, keep sentences short, be positive o Do not use analogies o Pay attention to nonverbal cues Copyright © 2022 Wolters Kluwer · All Rights Reserved Developmental Considerations for Communicating With Children and Family Caregivers #5 ❖ Communicating with school-aged children o Begin by calming down or connecting with child o Briefly acknowledge family caregivers o Include child in plan of care o Provide simple, concrete responses to questions o Be sensitive to child’s concerns o Play, reenactment, or artwork can give insight into how well child understands a procedure or experience o Elicit child’s cooperation by offering reasonable and limited choices Copyright © 2022 Wolters Kluwer · All Rights Reserved Developmental Considerations for Communicating With Children and Family Caregivers #6 ❖ Communicating with adolescents o Might be challenging o Respond positively to individuals who show genuine interest in them o Focus interview on them instead of problem o Might need to relate information do not wish others to know, respect confidentiality o Listen in open-minded, nonjudgmental way o Avoid asking prying or embarrassing questions o Make contracts so communication can remain open and honest Copyright © 2022 Wolters Kluwer · All Rights Reserved Developmental Considerations for Communicating With Children and Family Caregivers #7 ❖ Communicating with family caregivers o Identify child’s family caregivers and clarify roles o Include caregivers in providing information, problem solving, and planning of care; keep informed of what is going on o Pay attention to verbal and nonverbal clues provide positive reinforcement and ask open-ended questions o Compare what is actually happening with what the caregiver expects to be happening o Be alert to negative reactions from child o Provide anticipatory guidance related to normal growth and development Copyright © 2022 Wolters Kluwer · All Rights Reserved The Nurse’s Role Related to Growth and Development ❖ Understanding factors and influences and normal or expected patterns related to growth and development of the infant, child, and adolescent ❖ Talking to the child at their level of development ❖ Teaching and working with family caregivers ❖ Be aware that the child’s age and stage of growth and development can affect the way the child copes with the situation or responds to treatment Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 There are several principles of communication that effect communication with children. What is one of them? a. Time management b. Use gestures when talking c. Talk to them on a professional level d. Listen in a judgmental way Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 a. Time management Rationale: Time management is an important aspect of communication. Communicate in a calm, unhurried manner. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 23: Growth and Development of the Infant: 28 Days to 1 Year Introduction ❖ A 1-month-old has busy schedule ahead ❖ Will become a person with strong emotions of love, fear, jealousy, and anger; gain ability to rise from supine to upright position and move about purposefully ❖ According to Erikson, will develop a sense of trust, which happens when the needs of the infant are consistently met ❖ If food, love, attention, and comfort not received, learns to mistrust environment and those responsible to care for child Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #1 ❖ Weight and height o During first 6 months, weight doubles, height increases about 6 inches o Growth slows slightly during second 6 months o By 1 year of age, has tripled birth weight and grown 10 to 12 inches o To determine if child is reaching acceptable levels of development, must compare own initial measurements to current ones o Growth graph is helpful Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #2 Copyright © 2022 Wolters Kluwer · All Rights Reserved  Physical Development #3 ❖ Head and skull o Head circumference ▪ Averages 13.7 inches (35 cm) at birth; slightly larger than chest ▪ About 1 year, has grown to about 18 inches (47 cm) o Fontanels and cranial sutures ▪ Posterior: usually closed by second or third month ▪ Anterior: increases slightly after birth, begins decreasing by 6 months, closing between 12th and 18th months ▪ Sutures: ossify in later childhood Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #4 ❖ Skeletal growth and maturation o Skeletal system completely formed in cartilage at the end of 3 months of gestation o Bone ossification and growth occur during remainder of fetal life and throughout childhood o Bone age can be determined by radiologic examination Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #5 ❖ Eruption of deciduous teeth o Calcification starts early in fetal life o First usually erupt between 6 and 8 months o Babies in good health, normal development may differ in timing of tooth eruption o Teething is a normal process of development o Without high fever or upper respiratory conditions o Nutritional deficiency or prolonged illness in infancy may interfere with calcification of both deciduous and permanent teeth Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #6 Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #7 ❖ Circulatory system o Changes in levels of hemoglobin and RBCs o Average blood pressure 85/60 mm Hg o Apical pulse count necessary, count for full minute o Average: 90 (asleep) to 170 (awake) to 190 (crying) Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #8 ❖ Body temperature and respiratory rate o Temperature follows average normal range o Respirations: average 30 bpm, range of 30 to 45 bpm according to activity ❖ Neuromuscular development o Nerve cells mature and fine muscles begin to coordinate in orderly pattern of development o Small time lag may be insignificant o Large time lag may require greater stimulation or watchful attitude See Table 23-1 Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #9 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? When assessing the infant head you would expect the anterior fontanel to be closed by 3 months of age. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 False Rationale: The posterior fontanel is usually closed by the second or third month of life. The anterior fontanel may increase slightly in size during the first few months of life. After the 6th month, it begins to decrease in size, closing between the 12th and 18th months. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Psychosocial Development #1 ❖ Develops sense of trust when fed on demand ❖ Eventually learns not every need is met immediately on demand ❖ Learns that environment responds to desires expressed through one’s own efforts and signals ❖ Need balance between not encouraging development and anticipating every need ❖ Need opportunity to discover that through one’s own actions environment may be manipulated to suit one’s own desires ❖ See Table 23-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved  Psychosocial Development #2 ❖ Some actions are reflexes after birth, become clearly intentional as infant grows ❖ Finds that repetition of chance movements brings interesting changes, acts become clearly intentional ❖ Cannot apply abstract reasoning, understands only through five senses ❖ Out of sight means out of existence, cannot tolerate o Peek-a-boo example of how infant learns, confirms existence of others even when are temporarily out of sight Copyright © 2022 Wolters Kluwer · All Rights Reserved  Nutrition #1 ❖ Rapid growth creates a need for nutrients greater than at any other time of life ❖ Breast-feeding is highly recommended for infants ❖ Most requirements for first 4 to 6 months supplied by either breast milk or commercial infant formula ❖ Breast-fed infants need supplements of iron and vitamin D ❖ Most commercial infant formulas are enriched with vitamins C and D, and iron ❖ Fluoride needed in small amounts Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #2 ❖ Addition of solid foods o No exact time, at about 4 to 6 months milk alone is not likely sufficient o See Table 23-3 ❖ Infant feeding o Have tendency to push solid food out of their mouths with tongue thrust forward because of the extrusion reflex o Have to learn how to move food to back of mouth to swallow, will take time and patience Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #3 ❖ Infant feeding (cont.) o Protect clothing o Use small spoon giving small amounts to start, usually 1 or 2 tsp daily o Offer one food at a time, allowing 4 or 5 days before introducing another o When teething, between 4 and 7 months, teething biscuit or cookie can offer comfort o At about 9 to 10 months, when teeth erupt, offer chopped foods instead of pureed foods Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #4 ❖ Infant feeding (cont.) o Offer breast milk in cup at 12 to 13 months o Adjustment will take time o Whole milk versus reduced-fat milk Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #5 ❖ Preparation of foods o Various products available on market o Should read labels carefully o Vegetables and fruits can be cooked and strained or pureed o Preparation and storage require careful sanitary practices o Healthy baby’s appetite is best index of proper amount of food o Avoid making an issue of likes or dislikes Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #6 ❖ Self-feeding o Around 7 or 8 months may grab spoon, use fingers to check out food o May favor fingers over spoon at first but will return to spoon o This is a necessary part of infant’s learning Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #7 ❖ Weaning the infant o Must be gradual without fuss or strain o At 5 or 6 months may be ready to try sipping from a cup, but will be gradual process o Should not take bottle to bed, can result in early childhood caries or otitis media o Offer yogurt, custard, cottage cheese, and other milk products if necessary for calcium and vitamin D needs Copyright © 2022 Wolters Kluwer · All Rights Reserved  Nutrition #8 ❖ Women, Infants, and Children Food Program (WIC) o Special supplemental food program for pregnant, breast-feeding, or postpartum women, infants, and children as old as 5 years o Federal government program that provides nutritious supplemental foods, nutrition information, and healthcare referrals o Foods prescribed: iron-fortified infant formula and cereal, milk, fruits and vegetables, whole wheat bread, canned fish, dry beans, peanut butter, cheese, juice, eggs o Purchased with vouchers or distributed through clinics Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Susie Smith, 6 months old, is in the clinic for her well-baby checkup. Susie’s mother is breast-feeding her and asks about vitamin supplements. What would be your best response? a. Susie is still being breast-fed so she doesn’t need nutritional supplements b. Susie will become anemic if you don’t start feeding her iron-rich solid foods c. Just start supplementing your breast milk with some commercial baby formula fortified with iron d. Most babies, by the time they are about Susie’s age, need supplements of iron Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 d. Most babies, by the time they are about Susie’s age, need supplements of iron Rationale: At about 4 to 6 months of age, the infant’s milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular the infant’s iron supply becomes low and supplements of iron-rich foods are needed. Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #1 ❖ Routine checkups o Six visits recommended during first year: 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months o Receives immunizations o Data collection: growth and development, nutrition, sleep, caregiver–infant relationship, any potential problems o Document weight, height, head circumference o Reinforce family teaching Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #2 ❖ Immunizations o Protection available against: diphtheria, tetanus, pertussis, rotavirus, hepatitis A and B, polio, measles, mumps, German measles (rubella), varicella (chickenpox), Haemophilus influenzae meningitis, pneumococcal diseases, meningococcal disease o AAP and CDC have established recommended schedule o Side effects: minor, low-grade fever, local reaction of tenderness, redness, swelling at injection site o Encourage fluids, acetaminophen for fever, cuddling infant o Maintain nonjudgmental viewpoint when discussing with family caregivers Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #3 ❖ Family teaching o Well-baby visits provide opportunity to reinforce teaching o Offer anticipatory guidance o Discuss normal growth and development milestones o Infant’s overall progress is most important concern, not how infant compares to others o Provide ample time for discussions o Encourage questions about concerns Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #4 ❖ Bathing the infant o Daily bath unnecessary, but may be nice in very hot weather o Use of small tub or large basin preferable o Schedule enough time o Avoid scented or talcum powder, scented lotions o Trim nails as needed Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #5 ❖ Caring for the diaper area o Change soiled diapers frequently to prevent diaper rash o Check every 2 to 4 hours while awake o Cleanse area with water and mild soap, as needed or use diaper wipes o Cloth versus disposable Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #6 ❖ Dressing the infant o Clothing should not bind but allow freedom of movement, be appropriate for weather o Dress infant with same amount of clothing that the adult finds comfortable o Avoid overdressing when weather is hot, diaper may be enough, but protect from sun o Provide hat during cold weather o Shoes not always necessary, protect from harsh surfaces, allow movement of feet and toes Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #7 ❖ Promoting sleep o Most sleep 10 to 12 hours at night, take 2 or 3 naps during day o No pillows in bed with infant o Everyone different but all need consistency o Create and encourage good sleep habits o Bed should be for sleep, not playpen Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #8 ❖ Dental care o Teething begins after sixth month, start practicing good dental hygiene o Gentle cleansing while holding infant o Toothpaste not recommended due to possibility of swallowing it o Use toothbrush after several teeth have erupted Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #9 ❖ Accident prevention o Important to discuss safety issues with family caregivers o Car safety, childproofing, preventing aspiration, falls, burns, poisoning, and bathing accidents o Safety precautions should stay one step ahead of infant o Teach older siblings to be watchful for possible dangers Copyright © 2022 Wolters Kluwer · All Rights Reserved  The Infant in the Healthcare Facility ❖ Hospitalization hampers normal pattern of living, do not understand pain, discomfort, and limited normal activity ❖ Infant may become apathetic and cease to learn ❖ In addition to nursing care, touching, rocking, and cuddling are essential for the hospitalized infant ❖ Age-appropriate sensory stimulation and play within the constraints of the infant's condition are important ❖ When an infant is hospitalized, the family caregiver can give the child stimulation, care, and attention by feeding, holding, and diapering the infant Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 What are the most common side effects from immunizations? a. Irritability and vomiting b. Nausea and swelling at injection site c. High-grade fever and pain at injection site d. Localized tenderness and low-grade fever Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 d. Localized tenderness and low-grade fever Rationale: The most common side effect is a low-grade fever within the first 24 to 48 hours and possibly a local reaction, such as tenderness, redness, and swelling at the injection site. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 24: Growth and Development of the Toddler: 1 to 3 Years Growth and Development of the Toddler #1 ❖ Dramatic changes take place o Physical growth slows considerably o Mobility and communication skills improve rapidly o Determined and often stubborn little person creates new set of challenges o Favorite words: no, mine, want o Temper tantrums appear o Time of unpredictability: Learning new skills, curiosity increases, starts to explore more, tries new things Copyright © 2022 Wolters Kluwer · All Rights Reserved Growth and Development of the Toddler #2 ❖ Tries to assert independence, is curious about the world around them, and at times fears separation from family caregivers ❖ Parenting can be frustrating and a challenge, especially related to creating a safe environment and disciplining ❖ Erikson's developmental task o Autonomy (independence) while overcoming doubt and shame o Seeks independence, wavers between dependence and freedom, and gains self-awareness Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development ❖ Time of slowed growth and rapid development ❖ Each year gains 4.5 to 6 lb (2 to 2.7 kg) and about 3 inches (7.62 cm) ❖ Continued eruption of teeth, particularly molars ❖ Learns to stand alone and walk ❖ May have learned partial or total toilet training ❖ See Table 24-1 for Growth and Development landmarks Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #1 ❖ Continue to improve and refine language skills ❖ Growing awareness of self ❖ Tends to test personal independence to limit ❖ Behavioral characteristics o Negativism ▪ Answer “no” ▪ Limit number of questions asked and make a statement Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #2 ❖ Behavioral characteristics (cont.) o Ritualism ▪ Help develop security ▪ Follow habitual practice ▪ Can provide measure of security to child o Dawdling ▪ Asserting independence ▪ Compromise between following wishes of caregiver and choosing action ▪ Depends on situation for caregiver response Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #3 ❖ Behavioral characteristics (cont.) o Temper tantrum ▪ Reacting with rebellion to wishes of caregiver ▪ Should remain calm and patient ▪ Do not yield to child’s whim ▪ Try to calm child and prevent injury ▪ Provide safe, quiet place for child to calm down Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #4 ❖ Play o Parallel play with others o Imitation of role models o Toys should involve gross motor skills and fine motor skills o May not be ready for sharing o Inspect toys for loose pieces and sharp edges o Avoid small items which can be put in mouth o Adult close by, staying quiet, and observing Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #5 ❖ Discipline o Training or instructing in order to produce a particular behavior pattern, especially moral or mental improvement, and self-control o Punishment means to penalize for wrongdoing o Learn self-control gradually o Consistency and timing important o Very challenging period for rest of family o Time-out chair Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #6 ❖ Sharing a new baby o New baby presents as rival for mother’s affection o May regress to more infantile behavior o Some special preparation may be necessary o Help child feel new baby is “our baby,” let child help with new baby o Save time to spend alone with toddler just as before o Do not make grow up too soon Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Toddlers are infamous for their use of the word “no.” What is this negativism indicative of? a. Intention to disobey b. Rebellion against parental boundaries c. Assertion of individuality d. Assertion of age-appropriate maturity Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 c. Assertion of individuality Rationale: Certainly the toddler’s response to nearly everything is a firm “no,” but this is more an assertion of individuality than an intention to disobey. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #1 ❖ Needs foods from major food groups each day ❖ 1,000- to 1,400-calorie diet o Fruits: 1-1.5 cups o Vegetables 1-1.5 cups o Grains 3-5 oz o Protein foods 2-4 oz o Dairy 2-2.5 cups Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #2 ❖ Eating problems may appear o Growth rate has slowed, may want or need less food o Strong drive for independence and autonomy compels assertion of will to prove individuality o Food jags are common, desire for only one kind of food ❖ Messiness to be expected and prepared for ❖ Learning process that takes time but as the toddler learns, improvement occurs Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #3 ❖ Tips for feeding toddlers o Serve small portions o No one food is essential to health o Like simply prepared foods served warm or cool o Provide social atmosphere o Prefer finger foods o Plan regular mealtimes with small nutritious snacks between meals Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #4 ❖ Tips for feeding toddlers (cont.) o Dawdling at mealtime is common, mealtime should not exceed 20 minutes, calmly remove food without comment o Do not make desserts reward for good eating habits o Offer regularly planned nutritious snacks, midway between meals and at bedtime o Total amount eaten each day more important than amount eaten at a specific meal Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #1 ❖ Routine checkups o 15 months for immunization boosters, then annually o Assessment of growth and development, oral hygiene, toilet training, daily healthcare, family caregiver–toddler relationship, parenting skills o Effective communication essential o See Table 24-3 Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #2 ❖ Family teaching o Bathing: set regular time; always supervise; provide toys; avoid use of bubble bath o Dressing: allow toddler to dress self as desire; provide clothes easy for toddler to handle o Dental care: teach to brush teeth at about 2 years; first dental visit soon after first birthday; encourage proper care of baby teeth, will affect normal growth of permanent teeth Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #3 ❖ Family teaching (cont.) o Toilet training: timing important aspect; muscles must be developed enough; child may start to connect different actions and results to going potty; families need to be alert for readiness of child to learn; patience and understanding of family caregivers is essential o Tips for toilet training ▪ Provide potty chair ▪ Leave child on potty chair only a short time ▪ Have child wash hands after sitting on potty chair Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #4 o Tips for toilet training (cont.) ▪ Dress in clothes easy to remove ▪ Allow toddler to observe others ▪ In beginning, may have bowel movement or wet diaper soon after leaving potty, not willful defiance ▪ Empty potty chair after child leaves bathroom ▪ Do not flush toilet while child sitting on it ▪ Do not tease about reluctance or inability to conform ▪ Do not expect perfection Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #5 ❖ Family teaching (cont.) o Sleep ▪ Need 12 to 14 hours during first year, decreases to 10 to 12 hours by 3 years ▪ Soon gives up morning nap, but most continue afternoon nap ▪ Bedtime rituals common and important Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? Nursing assessments that are made at well-child visits include the caregiver–child relationship and parenting skills. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 True Rationale: Routine physical checkups include assessment of growth and development, oral hygiene, toilet training, daily healthcare, the caregiver–toddler relationship, and parenting skills. Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #6 ❖ Accident prevention o Constant supervision in controlled environment very important and vital o Accidents are a leading cause of death between ages of 1 and 4 years o Common causes: motor vehicle accidents, drowning, burns, poisoning Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #7 ❖ Accident prevention (cont.) o Motor vehicle accidents ▪ Many are preventable with appropriate restraints ▪ Federally approved child safety seats should be used correctly ▪ Adults should set examples ▪ Accidents also result when child playing in driveway and not seen by adult driving vehicle Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #8 ❖ Accident prevention (cont.) o Preventing motor vehicle accidents ▪ Never start vehicle until child is securely in car seat ▪ Pull over if child manages to get out of car seat ▪ Never permit child to stand in car that is in motion ▪ Remind toddler to wait at corner until adult there to escort to cross street ▪ Remind toCopyright cross only at corners © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #9 o Preventing motor vehicle accidents (cont.) ▪ Instill awareness of traffic signals and meanings ▪ Never let child run into street after a ball ▪ Remind child to never walk between parked cars ▪ As driver, always be on alert for children running into street when in residential area or running in a parking lot Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #10 ❖ Accident prevention (cont.) o Drowning ▪ Pools should be fenced in on all four sides with secure gate ▪ Do not leave toddler unsupervised with pool, even small plastic pools ▪ Do not leave toddler unsupervised if live around any body of water, even if just a small bucket of water Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #11 ❖ Accident prevention (cont.) o Burns ▪ Most often from scalds from immersions and spills and from exposure to uninsulated electrical wires or live extension cord plugs ▪ Playing with matches ▪ Burns can have long-term or permanent effects Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #12 ❖ Accident prevention (cont.) o Preventing burns ▪ Do not let electrical cords dangle over counter or table; repair frayed cords ▪ Use safety caps in electrical outlets ▪ Turn handles of pans on stove toward back ▪ Place cups of hot liquid out of reach ▪ Do not use overhanging tablecloths with toddlers ▪ Use caution with microwave-heated foods Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #13 o Preventing burns (cont.) ▪ Supervise at all times in bathtub so cannot turn on hot water tap ▪ Ensure home water heater thermostat not above 120°F ▪ Keep matches and lighters out of reach and properly stored ▪ Never leave small children unattended Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #14 ❖ Accident prevention (cont.) o Ingestion of toxic substance ▪ Toddler may sample anything ▪ Poisoning most common medical emergency ▪ Mr. Yuk stickers may help, but not sufficient ▪ All toxic items must be placed under lock and key or totally out of reach of child; can be very resourceful in getting and opening containers ▪ Common medications: acetaminophen, salicylates, laxatives, sedatives, tranquilizers, analgesics, antihistamines, cardiac medications, cough/cold medicines, birth Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #15 o Preventing poisoning ▪ Keep harmful products and household cleaning products locked up and out of child’s sight and reach ▪ Use safety latches or locks on drawers and cabinets ▪ Read labels with care before using any product ▪ Replace child-resistant closures and safety caps immediately ▪ Never leave alcohol or e-cigarettes/nicotine refill cartridges, gum, patches within child’s reach Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #16 o Preventing poisoning (cont.) ▪ Keep products in original containers ▪ Never put nonfood products in food or drink containers ▪ Remind children not to drink or eat anything unless given to them by trusted adult ▪ Do not take medicine in front of toddlers ▪ Do not refer to medicine as candy ▪ Check home for old medications and dispose of correctly Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #17 o Preventing poisoning (cont.) ▪ Keep button battery compartments on household products taped and secured, properly store batteries ▪ Keep plants off floor and out of children’s reach ▪ Keep lotion, cream, powder, cosmetics, insect repellent out of children’s reach ▪ Post Poison Help Line near telephone ▪ Program Poison Help Line number in cell phones or home phone Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 Toddlers are curious, and often what is in their hands goes into their mouths. What is one of the most common substances involved in the poisoning of a toddler? a. Shaving lotion b. Birth control pills c. Toxic plants d. Multivitamins Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 b. Birth control pills Rationale: The following medications are most commonly involved in cases of childhood poisoning: Acetaminophen, salicylates (aspirin), laxatives, sedatives, tranquilizers, analgesics, antihistamines, cold medicines, and birth control pills. Copyright © 2022 Wolters Kluwer · All Rights Reserved The Toddler in the Healthcare Facility #1 ❖ Keep in mind the toddler's developmental tasks and needs ❖ Very frightening for toddler: o Inability to communicate well o Discomfort from pain o Separation from family o Presence of unfamiliar people and surroundings o Physical restraint o Uncomfortable or frightening procedures Copyright © 2022 Wolters Kluwer · All Rights Reserved The Toddler in the Healthcare Facility #2 ❖ Maintaining routines o Conduct social assessment to determine home routines and try to continue as much as possible o Include in nursing care plan o Nursing care plan should provide opportunities for independence o Separation anxiety is high o Nurse becomes surrogate parent o Allow security of lovely o Use terms toddler will understand Copyright © 2022 Wolters Kluwer · All Rights Reserved The Toddler in the Healthcare Facility #3 ❖ Special considerations o Maintain control, promote safety, and help establish toddler’s sense of security while allowing development to continue o Avoiding putting toddler back in diaper’s when on unit; provide potty chairs o Explain what is going on, what is expected from toddler, and what toddler can expect from you o Eating habits may be potential problem o Safety promotion may be challenging Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #4 ❖ Is the following statement true or false? ❖ It is important to allow the toddler as much independence as possible while a client in a healthcare facility. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #4 ❖ True ❖ It is important to allow the toddler to continue growing and developing as much as possible even while a client in a healthcare facility. The nurse will still need to provide appropriate care and guidance but can still allow the toddler the opportunity to make some decisions and have some independence during the process. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 25: Growth and Development of the Preschool Child: 3 to 6 Years Growth and Development of the Preschool Child ❖ Social circle enlarges ❖ Language, play patterns, and appearance change markedly ❖ Curiosity and ability to explore grows ❖ Sometimes have problems separating fantasy from reality ❖ As per Erikson, the major developmental task is initiative versus guilt ❖ Try to find ways to do things to help, but may feel guilty if scolded when they fail because of inexperience or lack of skill Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #1 ❖ Physical growth slows o Gains about 4 to 5 lb each year (1.8 to 2.3 kg), grows about 2.5 to 3.0 inches (6.3 to 7.8 cm) o Boys tend to be leaner than girls o Gross and fine motor skills continue to develop rapidly o By age 5, generally can throw and catch a ball, climb effectively, ride a bicycle o See Table 25-1 Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #2 ❖ Dentition o By 6 years, skull is 90% of adult size o Deciduous teeth have completely emerged o Toward end of preschool stage, begin to be replaced by permanent teeth o Timing varies among ethnic and economic groups Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #3 ❖ Visual development o Visual development still immature at age 3 o Eye–hand coordination good, but judgment of distances generally faulty o Vision should be checked to screen for amblyopia o Generally achieves 20/20 vision by age 6 o Mature depth perception may not develop until 8 to 10 years Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #4 ❖ Skeletal growth o Between 3 and 6 years, greatest amount of skeletal growth occurs in feet and legs o Contributes to change from wide-gaited, potbellied look of toddler to slim, taller figure of 6-year-old child o Carpals and tarsals mature in hands and feet, better hand and foot control Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #1 ❖ Characteristics: o Rapid language development o Imagination o Sexual and social development o Variety of types of play Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #2 ❖ Language development o Between ages of 3 and 5, language development generally rapid o Most 3-year-olds can construct simple sentences, speech may have hesitations and repetitions o By end of 5 years, use long, rather complex sentences o Use language changes, may talk to self at 3 o Egocentric or noncommunicative language (Piaget) Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #3 ❖ Delays or other difficulties may be related to o Hearing impairment or other physical problems o Lack of stimulation o Overprotection o Lack of parental interest or rejection by parents ❖ Regularly engage child in conversations ❖ Reading to child helps develop language ❖ Be aware of potential cultural patterns, bilingual families, different dialects Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 What age group delights in using swear words? a. 3 to 4 years b. 4 to 5 years c. 5 to 6 years d. 6 to 7 years Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 b. 4 to 5 years Rationale: 4- and 5-year-old children delight in using “naughty” words or swearing. Bathroom words become favorites, and taunts such as, “You’re a big doo-doo” bring heady excitement to them. Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #4 ❖ Development of imagination o Make it difficult for the child to separate fantasy from reality o Believe words or thoughts can make things real o Often have imaginary playmates o Often leads to fear of dark or nightmares, resulting in sleep problems o Caregivers must acknowledge these concerns, be patient with explanations, and offer reassurance to the child Copyright © 2022 Wolters Kluwer · All Rights Reserved  Psychosocial Development #5 ❖ Sexual development o Freud: oedipal or phallic (genital) period o A preschooler's sexual curiosity and exploration of his or her genitalia is normal o A calm, understanding family caregiver can help the child develop positive attitudes about himself or herself as a sexual being o Teach about “good touch” and “bad touch” o Counseling may be needed, if child showing excessive activities Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #6 ❖ Social development o Play ▪ Imitative play: pretending to be someone ▪ Dramatic play: act out troubling situations ▪ Cooperative: organized groups, team sports ▪ Associative: play together without organization ▪ Parallel: alongside each other, independently ▪ Solitary independent: plays by self ▪ Onlooker: watching television ▪ Unoccupied behavior: daydreaming Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #7 ❖ Social development (cont.) o Play (cont.) ▪ Drawing: develop fine motor skills ▪ Need all kinds of play to develop well ▪ Too much onlooker play may result in highly inaccurate impressions of people and their behaviors; time spent watching television or electronic devices should be limited Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #8 ❖ Social development (cont.) o Aggression ▪ Temper tantrums, name calling, threats ▪ Push, hit, kick someone ▪ Normal reaction which must be properly handled ▪ Unhappy home situation more likely to increase aggression in children Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #9 ❖ Social development (cont.) o Discipline ▪ Should teach sense of responsibility and inner control ▪ Caregivers must understand and agree to limits and discipline measures ▪ Child will learn to play one against the other if caregivers disagree and handle similar situations differently ▪ Taking away privileges when misbehave more effective ▪ See TableCopyright 25-3 © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #10 ❖ Social development (cont.) o Preschool or day care experience ▪ Provides group experiences ▪ Transition can be threatening to some ▪ Gradual introduction to changes can produce most satisfactory adjustment ▪ More time child spends in facility, more time child will want to spend with caregivers when at home ▪ Will gradually increase child’s independence Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #11 ❖ Social development (cont.) o The disadvantaged child ▪ Have not achieved sense of security and trust ▪ Environmental enrichment often unavailable in families with limited social, cultural, and economic resources, led to Head Start ▪ Caregiver participation is central component ▪ Home visits, counseling, referral services provided ▪ Improves outcomes Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? Play is an important part of the preschooler’s life. Preschool children who spend time playing interactive video games are said to be engaged in onlooker play. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 False Rationale: Watching television is one form of onlooker play in which there is observation without participation. Playing interactive video games would be an example of solitary independent play. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #1 ❖ Do not need large quantities of food ❖ Appetite is erratic ❖ 1,200 to 1,800 calorie diet o Fruits 1–1.5 cups o Vegetables 1.5–2.5 cups o Grains 4–6 oz o Protein foods 3–5 oz o Dairy 2.5 cups Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #2 ❖ May need to have meals supplemented ❖ Suggested snacks (varies by age) o Raw vegetables: carrots, cucumbers, celery, green beans, bell peppers, mushrooms, turnips, broccoli, cauliflower, tomatoes o Fresh fruit: apples, oranges, pears, peaches, grapes, cherries, melons, bananas, berries o Unsalted whole-grain crackers, whole grain bread, small sandwiches, natural cheese, cooked meat, nuts, sunflower seeds, cookies, plain popcorn, yogurt Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #3 ❖ Culture can influence food choices ❖ Food should never be used as a reward or bride ❖ Preschoolers have definite food preferences ❖ Introduce new foods one at a time ❖ Show growing independence and skill in eating Copyright © 2022 Wolters Kluwer · All Rights Reserved  Health Promotion and Maintenance #1 ❖ Routine checkups o Up-to-date immunizations: diphtheria-tetanus-pertussis, polio, MMR, varicella o Annual health examination: monitor growth and development, screen for potential health problems o Recommended screening procedures: urinalysis, hematocrit, lead level, tuberculin skin testing, Denver Developmental Screening Test o Vision, hearing, dental o Tell child in advance of upcoming examinations Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #2 ❖ Family teaching o Bathing ▪ Need continual supervision ▪ Caregiver handles faucets and sets water temperature ▪ Assist with ears, necks, and faces; hair ▪ Caregiver sets time limits ▪ Teach child how to properly wash hands Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #3 ❖ Family teaching (cont.) o Dressing ▪ Give child opportunity to choose what to wear ▪ Family should accept child’s choice without negative comments ▪ If choice matters, provide child with limited choices o Dental care ▪ Needs supervision ▪ Encourage healthy eating, use of fluoride Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #4 ❖ Family teaching (cont.) o Toileting ▪ Treat accidents as matter-of-fact ▪ Teach girls to wipe from front towards back ▪ Handwashing ▪ Bed wetting not uncommon Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #5 ❖ Family teaching (cont.) o Sleep ▪ Ready to give up nap ▪ Encourage period of quiet activities or reading before bedtime ▪ Dreams and nightmares common ▪ Fear of the dark Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #6 ❖ Accident prevention o Burns, poisoning, falls common accidents o Seat belt use, wearing bicycle safety helmets, and practicing street safety will help in prevention of accidents o Caregivers must be good examples Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #7 ❖ Accident prevention (cont.) o Safety suggestions for preschoolers ▪ Look both ways before crossing the street ▪ Cross the street only with an adult ▪ Watch for cars coming out of driveways ▪ Never play behind a car or truck ▪ Watch for cars or trucks backing up ▪ Wear a safety helmet when bike riding ▪ Learn your name, address, and phone number Copyright © 2022 Wolters Kluwer · All Rights Reserved  Health Promotion and Maintenance #8 ❖ Accident prevention (cont.) o Safety suggestions for preschoolers (cont.) ▪ Stay away from strange dogs and dog while it is eating ▪ Take only medicine that caregiver gives you ▪ Don’t play with matches or lighters ▪ Stay away from fires ▪ Don’t run near a swimming pool or swim without an adult ▪ Don’t go anywhere with a stranger or allow anyone to touch you in a way you don’t like Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #9 ❖ Infection prevention o Learns to share with family and playmates and the process often shares infections o Cover your mouth with tissue when coughing or sneezing o Throw tissues into trash and wash hands o Cough into sleeve at elbow o Wipe carefully after bowel movements o Wash hands after going to bathroom, coughing, or blowing nose Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #10 ❖ Infection prevention (cont.) o Do not share partly eaten food o If eating utensil falls on floor, wash it right away o Do not eat food that falls on the floor o Do not drink from another person’s cup o Do not share a toothbrush with someone else Copyright © 2022 Wolters Kluwer · All Rights Reserved  The Preschooler in a Healthcare Facility ❖ Keep in mind the preschooler's developmental tasks and needs ❖ Play is an effective way to let children act out their anxieties and learn what to expect from the hospital situation ❖ Explain procedures in words appropriate for the child's age ❖ May revert to bed-wetting ❖ Hospital routines should follow home routines as closely as possible ❖ Allow child to participate in care Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 Bathing is still a fun time for most preschoolers. Many exciting times can be had splashing in the tub with favorite toys. What temperature should water heaters maintain in order to prevent accidental burns? a. 110°F (43°C) b. 115°F (46°C) c. 120°F (49°C) d. 125°F (52°C) Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 c. 120°F Rationale: The hot water heater should be turned to no higher than 120°F (49°C) to avoid the danger of burns. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 26: Growth and Development of the School-Aged Child: 6 to 10 Years Growth and Development of the School-Aged Child #1 ❖ First day of school is major milestone ❖ Dramatic changes occur in thinking process, social skills, activities, attitudes, and use of language ❖ Every aspect of life subject to comparison ❖ Most reach school age with necessary skills, abilities, and independence to function successfully ❖ Show increasing interest in group activities, making things, use motor, cognitive, and social skills ❖ Success provides self-confidence and feeling of competence ❖ Erikson: industry versus inferiority Copyright © 2022 Wolters Kluwer · All Rights Reserved Growth and Development of the School-Aged Child #2 ❖ If unsuccessful in completing activities develop feeling of inferiority ❖ Health concern of community o State requirements for examinations and immunizations o Few major diseases have onset during this time o Accidents serious hazard Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #1 ❖ Physical growth is slow and steady ❖ Weight o Average annual weight gain is about 5 to 6 lb (2 to 3 kg) o By age 7, about 7 times birth weight ❖ Height o Annual increase about 2.5 inches (6 cm) o Preadolescent growth spurt: girls age 10, boys age 12 Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #2 ❖ Dentition o Starts to lose deciduous teeth about age 5-6 o 6-year molars appear, key to help shape jaw and affect alignment of permanent teeth Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #3 ❖ Skeletal growth o 6-year-old: flatter but protruding abdomen and lordosis o 10-year-old: spine straighter, abdomen flatter, body generally more slender and long-legged o Bone growth mostly in long bones o Maturation more rapid in girls than boys and in African American than whites o See Table 26-1 Copyright © 2022 Wolters Kluwer · All Rights Reserved Physical Development #4 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? Erikson’s developmental task for this age group is industry versus inferiority. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 True Rationale: Erikson’s developmental task for this age group is industry versus inferiority. Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychosocial Development #1 ❖ Interested in engaging in meaningful projects and seeing them through to completion ❖ Results in refinement of motor, cognitive, and social skills and development of positive sense of self ❖ Excessive or unrealistic goals defeat the child and possibly lead to feeling inferior, rather than self-confident ❖ With positive support, the child develops coping mechanisms, a sense of right and wrong, a feeling of self-esteem, and an ability to care for oneself ❖ Cognitive skills develop, at 7 years enters concrete operational stage (Piaget) Copyright © 2022 Wolters Kluwer · All Rights Reserved  Psychosocial Development #2 ❖ Develops the cognitive skills to understand conservation of numbers, mass, weight, and volume ❖ Each child is a product of personal heredity, environment, cognitive ability, and physical health ❖ Every child needs love and acceptance with understanding, support, and concern when mistakes are made ❖ See Tips for Reinforcing Family Teaching: Guiding Your School-Aged Child Copyright © 2022 Wolters Kluwer · All Rights Reserved Development from Ages 6 to 7 Years ❖ Magical thinking ❖ Trouble distinguishing fantasy from reality ❖ Attending day care, preschool, or Head Start helps make transition into first grade better ❖ Those without this may need trial basis ❖ Group activities important ❖ Begin to enjoy participating in real-life activities ❖ Love making things Copyright © 2022 Wolters Kluwer · All Rights Reserved Development from Ages 7 to 10 Years #1 ❖ Between 7 and 8, begin to shake off acceptance of parental standards and become more impressed by peers ❖ Interest in group play increases and becomes very important ❖ Individual friendships form ❖ Beginning of many neighborhood team sports ❖ Decentration: seeing several aspects of a problem at the same time and to understand the relation of various parts to the whole situation ❖ Magical thinking is replaced with cause-and-effect relations Copyright © 2022 Wolters Kluwer · All Rights Reserved Development from Ages 7 to 10 Years #2 ❖ During seventh or eighth year, have increased understanding of conservation of continuous quantity ❖ Reversibility: ability to think in either direction ❖ Classification: ability to put group objects into a hierarchical arrangement o Love to collect certain items Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 A school-age child aged 7 to 10 years moves from preoperational, egocentric thinking to what? a. Concrete, operational, centered thought b. Concrete, operational, decentered thought c. Cognitive, operational, centered thought d. Cognitive, operational, decentered thought Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 b. Concrete, operational, decentered thought Rationale: Important changes occur in a child’s thinking processes at about age 7 when there is movement from preoperational, egocentric thinking to concrete, operational, decentered thought. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #1 ❖ Increased activity requires more food to supply necessary energy ❖ Needs appropriate servings from all four food groups ❖ 1,600 to 2,200 calorie diet ❖ Fruits: 1.5–2 cups ❖ Vegetables 2–3 cups ❖ Grains 5–7 oz ❖ Protein foods 5–6 oz ❖ Dairy 2.5–3 cups Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #2 ❖ Can learn to eat most foods, tastes develop, allow child to express food dislikes and permit refusal ❖ Will learn by examples set by others ❖ Snacking habits should be carefully supervised ❖ Obesity is a concern o Genetic tendency, environment, sedentary lifestyle, poor diets o Encourage physical activity, limiting dietary fat, bullying, nagging, and feelings of inferiority and guilt can contribute Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #3 ❖ Health teaching should reinforce importance of proper diet ❖ Family and cultural food patterns ❖ School lunch program versus home-packed lunches ❖ Old enough to be partially responsible for preparing own lunches Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance ❖ Routine healthcare and health education o Health habits o Safety o Sex education o Substance abuse education Copyright © 2022 Wolters Kluwer · All Rights Reserved Routine Checkups ❖ Yearly physical examinations by health care provider ❖ Twice-a-year dental visits for cleaning and application of fluoride ❖ Immunizations: tetanus-diphtheria-pertussis, human papillomavirus ❖ Scoliosis examination ❖ Vision and hearing screening (annual or biannual) by school nurse Copyright © 2022 Wolters Kluwer · All Rights Reserved Family Teaching ❖ Still needs reinforcement of healthy habits by family caregivers ❖ Proper dental hygiene ❖ Well-balanced diet ❖ Exercise, extracurricular activities ❖ Sleep o 6-year-old: 12 hours of sleep o School-aged: 10 to 12 hours of sleep Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 ❖ Is the following statement true or false? ❖ The best way to teach the school-aged child about proper eating is for the family caregiver to set the example and eat a proper diet themselves. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 ❖ True ❖ The best way to teach the school-aged child about proper eating is for the family caregiver to set the example and eat a proper diet themselves. The child will follow the example of the adults and will try to be “like them.” Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Education ❖ Includes basic hygiene, sexual functioning, substance abuse, accident prevention ❖ Schools should include topics in curriculum o Health classes taught by health educator o Health and sex education integrated into curriculum, taught by classroom teacher ❖ Community programs may be available for children ❖ Nurses can become active in community to help make these kinds of programs available Copyright © 2022 Wolters Kluwer · All Rights Reserved Sex Education #1 ❖ Many think sex education is just about adult sexuality and reproduction ❖ Should include helping child develop positive attitude towards own body, own sex, and own sexual role ❖ May be limited to one class in fifth grade: information about menstruation, separate classes for boys and girls ❖ Most children do not have home where this information is taught, need healthy, positive information to help develop healthy attitudes about own sexuality ❖ Printed material available for family caregivers who may feel uncomfortable with topic Copyright © 2022 Wolters Kluwer · All Rights Reserved Sex Education #2 ❖ Exposure to information through media may lead to misconceptions and misunderstandings concerning sexuality ❖ Schools are working to integrate appropriate information in a sensitive, age-appropriate manner Copyright © 2022 Wolters Kluwer · All Rights Reserved  Substance Abuse Education #1 ❖ May try cigarette smoking, chewing tobacco, using electronic cigarettes, alcohol, and other substances at a very young age ❖ Inhalants: substances whose volatile vapors can be abused, especially deliriants which contain chemicals that give off fumes that produce symptoms of confusion, disorientation, excitement, hallucinations o Many commonly found in home: model glue, rubber cement, cleaning fluids, kerosene and gasoline vapors, butane lighter fluid, paint thinner, varnish, shellac, hair spray, nail polish remover, shoe polish, computer keyboard cleaner, propellant in whipped cream spray cans, aerosol spray paint, upholstery/fabric protection spray cans Copyright © 2022 Wolters Kluwer · All Rights Reserved Substance Abuse Education #2 ❖ Family caregivers need to learn facts about drugs and alcohol ❖ U.S. Department of Education provides reference: Tips for Parents on Keeping Children Drug Free ❖ See Tips for Reinforcing Family Teaching: Guidelines to Prevent Substance Abuse Copyright © 2022 Wolters Kluwer · All Rights Reserved  Accident Prevention ❖ Accidents are a leading cause of death during this period ❖ They must learn certain safety rules and practice them ❖ Function of traffic lights ❖ Know their full name, caregivers’ names, home address, and telephone number ❖ Appropriate way to call for emergency help ❖ Safe-home program ❖ Meet with police officers ❖ See Tips for Reinforcing Family Teaching: Safety Topics for Elementary School-Aged Children Copyright © 2022 Wolters Kluwer · All Rights Reserved The School-Aged Child in the Healthcare Facility #1 ❖ Increased understanding of bodies, continued curiosity about how things work, and development of concrete thinking help school-aged child understand and better accept healthcare experience ❖ Nurse needs to understand how concepts about birth, death, the body, health, and illness change between ages of 6 and 10 years o See Table 26-3 ❖ Explain all procedures, showing equipment and materials to be used, outlining realistic expectations, answer all questions Copyright © 2022 Wolters Kluwer · All Rights Reserved The School-Aged Child in the Healthcare Facility #2 ❖ Need privacy ❖ May not want physical contact with adults ❖ May be uncomfortable having someone of different sex bathing them ❖ Child may regress, try to prevent ❖ Reassure family ❖ Discipline and rules in place ❖ Opportunities for interaction with peers, learning situations, doing crafts and projects Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #4 ❖ Is the following statement true or false? ❖ Showing the child the various equipment and materials which may be used for a medical procedure will help the child better understand and accept what is happening. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #4 ❖ True ❖ The nurse should take the time to show the child the various equipment and materials which may be used for a medical procedure as it will help the child better understand and accept what is happening, lessen fears and anxiety about what is happening, and encourage questions which the child may have. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 27: Growth and Development of the Adolescent: 11 to 18 Years Growth and Development of the Adolescent #1 ❖ Early adolescence (preadolescence, pubescence) o Period between ages 10 and 12 years o Begins with dramatic growth spurt, signals advent of puberty ❖ True adolescence o Period between ages 13 and 18 years o Begins with onset of menstruation and production of sperm Copyright © 2022 Wolters Kluwer · All Rights Reserved  Growth and Development of the Adolescent #2 ❖ Fascinated and sometimes fearful and confused by changes occurring in bodies and thinking processes ❖ Begin to look grown up but lack adult judgment and independence ❖ Uncertainty and turmoil can create conflicts which can delay development and prevent maturing into fully functioning adult ❖ Must develop own identity, a sense of being independent people with unique ideals and goals ❖ Stress, anxiety, and mood swings are typical of this phase; add to feelings of role confusion Copyright © 2022 Wolters Kluwer · All Rights Reserved  Preadolescent Development #1 ❖ Physical development o Girls between ages 9 and 11: growth spurt, about 3 in each year until menarche; begin developing a figure, pelvis broadens, axillary and pubic hair appear, changes in hormone levels; everyone develops at different rates o Boys between ages 11 and 13: grow at slower, steadier rate than girls; scrotum and testes begin to enlarge, skin of scrotum begins to change in coloring and texture, sparse hair at base of penis; nocturnal emissions o See Table 27-1 Copyright © 2022 Wolters Kluwer · All Rights Reserved  Preadolescent Development #2 ❖ Preparation for adolescence o Need information about their changing bodies and feelings o Girls: menstruation o Boys: erections and nocturnal emissions o Both need information about the other sex and changes occurring o Need information to help resist pressures to become sexually active too early, need honest, straightforward answers in atmosphere of caring concern Copyright © 2022 Wolters Kluwer · All Rights Reserved  Adolescent Development #1 ❖ Spans ages of about 13 to 18 years ❖ Some boys may not complete until 20 years ❖ Rate of development varies greatly ❖ Time of many physical, emotional, and social changes ❖ Struggles to master developmental tasks ❖ Completion of earlier developmental tasks are prerequisite ❖ See Table 27-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved  Adolescent Development #2 ❖ Physical development o Girls achieve 98% of adult height by 16 years o Boys may continue to grow until 20 years o Skeletal system outpaces muscular system growth; bone growth usually completed o Primary sex organs enlarge, secondary sexual characteristics appear, hormonal activity increases o Menstruation begins, pregnancy possible, breast development; pubic hair appears o Penis, testes, and scrotum are adult in size and shape; mature spermatozoa produced; pubic hair mature; muscle strength and coordination; “change of voice” Copyright © 2022 Wolters Kluwer · All Rights Reserved  Adolescent Development #3 ❖ Psychosocial development o Freud: from latency stage to genital stage o Erikson: from industry versus inferiority to identity versus role confusion o Piaget: from concrete operational thinking to formal operational thinking o Develop sense of moral judgment and system of values and beliefs that will affect entire life o Foundation of family, religious groups, school, and community experiences still strong influence Copyright © 2022 Wolters Kluwer · All Rights Reserved  Adolescent Development #4 ❖ Psychosocial development (cont.) o Trends and fads dictate choices o Family conflicts o Peer pressure o Need careful guidance and understanding support o Personality development ▪ Erikson: development of identity ▪ Greater variety of choices ▪ Begin to seek intimate relationship Copyright © 2022 Wolters Kluwer · All Rights Reserved  Adolescent Development #5 ❖ Psychosocial development (cont.) o Body image ▪ Closely related to self-esteem ▪ Culture greatly influences beliefs ▪ Lack of perceived inadequacy leads to stress ▪ May attempt inappropriate steps to correct ▪ Need to establish positive body image ▪ May need help accepting body as is, especially for factors which cannot be altered such as height Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 At what approximate age does muscle strength and coordination generally develop in boys? a. 11 years b. 12 years c. 13 years d. 14 years Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 c. 13 years Rationale: Around age 13, muscle strength and coordination begin to develop rapidly in adolescent males. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Nutrition #1 ❖ Need balanced diet consisting of all food groups ❖ Nutritional requirements vary based on growth ❖ Boys need more calories than girls ❖ Needs based on growth not age, need more food to provide necessary energy to meet growth needs ❖ Food choices often influenced by peer pressure, making bad choices such as skipping meals, fast foods, high-caloric, nutritional deficient snacks throughout day ❖ Deficient nutrients: calcium; iron; zinc; vitamins A, D, and B6, folic acid o See Table 27-4 Copyright © 2022 Wolters Kluwer · All Rights Reserved Nutrition #2 Copyright © 2022 Wolters Kluwer · All Rights Reserved  Nutrition #3 ❖ May experiment with food fads and diets ❖ May make bad choices—girls, athletes ❖ May resist pressure from family to eat balanced diet ❖ Culture challenges: low income, belief systems, habits, customs ❖ Dietary restrictions: lactose intolerance, allergies, self-imposed ❖ Choices may be related to religious, ecologic, or philosophic reasons, such as vegetarian diet ❖ Require careful planning to provide adequate nutrients Copyright © 2022 Wolters Kluwer · All Rights Reserved  Nutrition #4 ❖ Vegetarian diet o Semivegetarian: includes dairy products, eggs, fish; excludes red meat and possibly poultry o Lacto-ovo-vegetarian: includes eggs, dairy, fish; excludes meat, poultry, fish o Lactovegetarian: includes dairy; excludes meat, fish, poultry, eggs o Vegan: excludes all food of animal origin including dairy, eggs, fish, meat, poultry o Encourage whole-grain products, legumes, nuts, seeds, fortified soy substitutes Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #1 ❖ Routine checkups o Recommended at least twice during teen years, annual physical examinations encouraged o Complete history o Immunizations o Basic health assessment, vision, hearing o If sexually active, should have appropriate exam to include STIs and Pap smear o Body piercing and tattoos: educate about signs and symptoms of infection o Privacy, individualized attention, confidentiality, and right to participate in decisions important Copyright © 2022 Wolters Kluwer · All Rights Reserved  Health Promotion and Maintenance #2 ❖ Dental checkups o Every 6 months o Dental malocclusion common condition o Orthodontia: treatment of malocclusion with braces o Tongue piercing ▪ Concerns for infection and tooth damage Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #3 ❖ Family teaching o Difficult process for young person and family caregiver o Balance between allowing young person to make own decisions and safeguarding from risky and immature behavior o Concerning issues: sexuality, substance abuse, accidents, discipline, poor nutrition, volatile emotions o Good communication essential o Family caregivers may need anticipatory guidance and emotional support Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Tell whether the following statement is true or false. Teens can feel ashamed about the changes in their body if they are unprepared for these vast changes. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 True Rationale: A good foundation in sex education can help the adolescent take pride in having reached sexual maturity; otherwise, puberty can be a frightening, shameful experience. Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #4 ❖ Health education and counseling o Sexuality ▪ Good foundation in sex education important ▪ Prepares for events of puberty: menstruation; nocturnal emissions ▪ Responsibility concerning responsible sexuality, contraception, and STIs ▪ Importance of regular examinations, understanding what is normal and not normal, self-examinations of breasts and testes ▪ Using the right sources for information Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #5 ❖ Health education and counseling o Sexual responsibility ▪ Safe sex practices ▪ Contraceptive information ▪ Prevention of STIs ▪ Seeking medical treatment when necessary ▪ Rohypnol precautions Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #6 ❖ Health education and counseling o Substance abuse ▪ Influence of peer pressure ▪ “Just for kicks,” “go along with the crowd,” rebellion ▪ Used to escape situation ▪ Alcohol, tobacco, marijuana, cocaine, heroin, ecstasy, other street and prescription drugs ▪ Often accompanied by irresponsible sexual behavior Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #7 ❖ Mental health o Stress may lead to depression, suicide, and conduct disorders o Academic, social, family situation add to stress o May need counseling or just someone to talk to o Internet safety vitally important o Parents need to be aware of computer activities and sites accessed o Discussions with adolescents regarding safety concerns very important o See Internet Safety Box Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #8 ❖ Accident prevention o Increasing number dying from violence, motor vehicle accidents, homicide, suicide, and other causes o Leading cause of death for 15- to 19-year-old: unintentional injuries and homicide o Risky behaviors: unintentional (motor vehicles, fires), intentional (violence, suicide), injuries, alcohol and other drug use, sexual behaviors, tobacco use, dietary behaviors o May result in psychological injury from being victim of violence Copyright © 2022 Wolters Kluwer · All Rights Reserved Health Promotion and Maintenance #9 ❖ Accident prevention (cont.) o Violence on the rise in schools o Domestic violence, child abuse o Peer support groups ▪ Students Against Destructive Decisions ▪ Schools o Need to be taught how to work through issues in nonviolent ways o Promote safety measures o Provide positive role model Copyright © 2022 Wolters Kluwer · All Rights Reserved The Adolescent in the Healthcare Facility #1 ❖ Usually related to major health problem ❖ Must cope with stress of hospitalization, possible dramatic alterations in body image, partial or total inability to conform to peer group norms, interrupted search for identity ❖ Fears loss of control and loss of privacy ❖ Provide opportunities to make choices ❖ Protect privacy ❖ Be aware of possible angry and refusal to cooperate ❖ Interview adolescent and family caregiver separately Copyright © 2022 Wolters Kluwer · All Rights Reserved The Adolescent in the Healthcare Facility #2 ❖ Thoroughly explore developmental level ❖ Listen carefully with empathy to concerns ❖ Encourage maximum participation in self-care ❖ Provide sufficient information to make participation possible ❖ Advise of unit’s rules ❖ Recreation areas important ❖ Access to telephone, computer, email ❖ Encouraged to wear own clothes, style hair, wear makeup Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 ❖ Is the following statement true or false? ❖ A nonjudgmental, matter-of-fact approach is best when discussing complicated issues with adolescents. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 ❖ True ❖ It is best for the nurse to use a nonjudgmental, matter-of-fact approach when discussing complicated issues with adolescents. They are still learning, growing, and developing and should not be criticized or harshly judged as it is likely the issue with which they are dealing with is one for which they were never taught about. Copyright © 2022 Wolters Kluwer · All Rights Reserved References ❖ Hatfield, N.T. & Kincheloe, C.A. (2022). Introductory Maternity & Pediatric Nursing. 5th ed. Philadelphia, PA: Wolters Kluwer / Lippincott, Williams and Wilkins Copyright © 2022 Wolters Kluwer · All Rights Reserved