Intro to Pediatrics 2023 PDF

Welcome to Maternal, Child and Adolescent Family Centered Care 1. 2. 3. 4. 5. 6. Learning Objectives Identify sources of evidenced-informed research related to health concepts and challenges. Demonstrate competence in applying pediatric evidenced-informed health concepts and challenges. Identify an...

Welcome to Maternal, Child and Adolescent Family Centered Care 1. 2. 3. 4. 5. 6. Learning Objectives Identify sources of evidenced-informed research related to health concepts and challenges. Demonstrate competence in applying pediatric evidenced-informed health concepts and challenges. Identify and plan appropriate health promotion activities that will be implemented in pediatric clinical. Demonstrate critical thinking and assessment skills in these populations. Incorporate the concepts of family centered-care in acute and community practice. Demonstrate an appreciation and understanding of interprofessional roles and collegiality. Student Year 1 Year 2 Year 3 Year 4 Professional Nurse Learning Objectives 1. 2. 3. 4. 5. 6. Student Identify sources of evidenced-informed research based information related to health concepts and challenges. Demonstrate competence in applying pediatric evidenced-informed health concepts and challenges. Identify and plan appropriate health promotion activities that will be implemented in pediatric clinical. Demonstrate critical thinking and assessment skills in these populations. Incorporate the concepts of family centered-care in acute and community practice. Demonstrate an appreciation and understanding of interprofessional roles and collegiality. Year 1 Year 2 Year 4 Professional Nurse Our Plan • Interprofessional Education • Review child growth and development • Genetic disorders • Review and apply developmental theory to the case study: John Bolby A word on Interprofessional Education (IPE) • IPE aims to encourage different professionals to meet and interact in learning in order to improve collaborative practice and the quality of health care delivery to patients/clients. • IPE is the process of preparing students in healthcare professions to practice collaboratively within and across their discipline (Canadian Interprofessional Health Collaborative, 2010, p. 6) References: Reeves et al., 2008; Centre For the Advancement of Interprofessional Education, 2002; World Health Organization, 2010. Interprofessional Education (IPE) • An IPE approach provides: 1.more coordinated and comprehensive care, 2.places priority on the preferences of the client, 3.can break down stereotypes and foster respect for the skills and perspectives of all health care providers. Our guest speakers will provide us with opportunities to learn from other professionals And disciplines. References: Kearney, 2008 Interprofessional Education (IPE) Six competencies essential for IPC: Role clarification, Patient/client/family/community-centered care, Team functioning, Collaborative leadership, Interprofessional conflict resolution, and Interprofessional communication Collaborating and becoming partners with the family National Interprofessional Competency Framework (Canadian Interprofessional Health Collaborative, 2010). Interprofessional Education (IPE) 1) Interprofessional communication : Communication skills are essential for all learners/ practitioners and involve the ability to communicate effectively with others, especially those from other professions, as well as patients/clients/ families, in a collaborative, responsive and responsible manner. Communications in an interprofessional environment is demonstrated through listening and other non-verbal means, and verbally through negotiating, consulting, interacting, discussing or debating. Respectful interprofessional communication incorporates full disclosure and transparency in all interactions with others including patients/clients/families. 2) Patient/Client/Family/ Community-Centred Care • In patient/family/client/community-centred care/ services, the interprofessional team integrates and values, as a partner, the input of a patient/client/family or community in the design and implementation of care and/or services. Interprofessional Education (IPE) 3) Role Clarification • Role clarification occurs when learners/practitioners understand their own role and the roles of others and use this knowledge appropriately to establish and achieve patient/client, family, and community goals. Students and practitioners need to clearly articulate their roles, knowledge, and skills within the context of their clinical work. Each must have the ability to listen to other professionals to identity where unique knowledge and skills are held, and where shared knowledge and skills occur. 4) Team Functioning • Learners/ practitioners must be able to share information needed to coordinate care with each other and patients/clients, families and communities to avoid gaps, redundancies, errors that impact both effectiveness and efficiency of care delivery. Interprofessional Education (IPE) 5) Collaborative Leadership • Within collaborative or shared leadership, learners/ practitioners support the choice of leader depending on the context of the situation. Learners/practitioners assume shared accountability for the processes chosen to achieve outcomes. 6) Interprofessional Conflict Resolution. • Learners/practitioners actively engage self and others, including the client/patient/family, in positively and constructively addressing disagreements as they arise Experiences in childhood and adolescents affect lifelong health, and the earlier we invest in children's health, the greater return. Focus on young kids, not just on adults • Help them to become healthy adults • Work to promote their health Health Council of Canada (2006) Videos to view Childhood Development • http://www.evanshealthlab.com/saving-brains-a-grand-challenge/ Jordan’s principle https://www.canada.ca/en/indigenous-servicescanada/services/jordans-principle.html Reserve Referral with the application of Jordan’s principle when their • Province and federal, who is responsible for the funding? needs are not being met • Canadian Government funding • Speak to coordinator nurse upon patient’s discharge • Within RN’s scope for referrals Jordan's Principle • Jordan's Principle makes sure all Indigenous children can access the products, services and supports they need, when they need them. It can help with a wide range of health, social and educational needs. Health disparity INFANT DEVELOPMENT You will use theory and your skills to assess …. Gross Motor: Head and Neck • Newborn: barely able to lift head • Important to think about infant reflexes Reflexes • All reflexes are present at birth • Concerning if any is not present • Guidelines are present for provider to follow what reflexes should be present • All infant reflexes should be gone by 12 months (except blinking and gag reflex) • Infant = 12 months • Toddler = 12 months plus 1 day • 6 months: easily lifts head, chest and upper abdomen and can bear weight on arms while on tummy Guidelines = typical developmental stages; but each individual is independent in growing • • • • • Gain control of their head first (Able to lift head first ) Trunk Legs (Learn how to walk last) Proximal to distal Head to toe Gross Motor: Sitting • 2 months old: needs assistance • 6 months old: can sit alone in the tripod position • Still unstable • 8 months old: can sit without support and engage in play Gross Motor: Crawling Considerations • Lots of kids don’t even crawl • Parents often compare their kids to other kids • Worried • Provide reassurance • Reinforce development is individual • We should know when there’s too many red flags and needs referral • Not a good developmental indicator on its own – vast differences in abilities, ages and some skip crawling all together! Gross Motor: Getting Around • 1 year: stand independently from a crawl position • 13 months: walk and toddle quickly • 15 months: able to run • Some children might just need more time, not necessarily developmentally delayed • Related to lifestyle and family influence (Are they being carried around a lot at home so there’s no need for them to practice walking?) Fine Motor • Newborn has very little control. Objects will be involuntarily grasped and dropped without notice • 6-8 month old: palmar grasp – uses entire hand to pick up an object • By 8-10 months: pincer grasp – can grasp small objects using thumb and forefinger • Can actually use their fingers • Great exercise – use finger to pick up cheerio, prepare for grasp Speech and Language Parents are really concerned when their kids are not talking • Provide reassurance • Kids should have some words by 18 months (using words with intention, express needs usually) • Developmental stages are not definite; some might need more time than typical trajectory • 1-2 months: coos • 2-6 months: laughs and squeals • 8-9 months babbles: mama/dada as sounds • Syllables • Not using words with intentions • 10-12 months: “mama/dada specific Children get vaccine • 18-20 months: 20 to 30 (50) words – 50% understood by • 2, 4, 6, 12, 14, 18 months • 4 y/o strangers • Need to be certain if we need to make referrals by 18 months • 22-24 months: two word sentences, >50 words, 75% • Provide referral because of wait time understood by strangers and see if parent wants to see speech • 30-36 months: almost all speech understood by strangers therapist • The parents always understand what the children is saying 4 y/o • In 6 months, they are going to school and no one can understand them • If children continues with the pattern after 18 months, parents can do referral themselves • Provide information on what speech therapist does, so parents know what to come and do not need to play catch up Don’t Forget about Hearing! • At birth = Universal newborn hearing screening (UNHS) for all newborns in Canada • On assessment remember to ask about ear infections and placement of tubes • Early referral is essential (audiologist, speech language pathologist, ENT) If the children is not speaking, the first thing we do is to check hearing Able to catch earlier Infant Play • Play is an infant’s and child’s work and is a reflection of every aspect of development • Solitary play • Play with each other, interaction with other children Potential “Red Flags”: Infants • Frequently in ‘fisted position’ after 6 months of age • Not bringing both hands to midline by 10 months of age • Floppy tone • Usually in a flexed tone • Not smiling by 4 months of age • Social domain and interaction with others (caregiver) TODDLERS (1-3 Years) Gross Motor • Begins to walk with ease • Runs • Kicks • Throws ball well • Jumps • Stand with one leg Fine Motor If they can’t do that, maybe they were never given the opportunity to do that • Feeding themselves VS being fed by caregiver • 12 months – transfers objects from hand to hand • 18-24 months – building block towers • 24 months – can hold crayon/markers and begins to colour, turns pages of book, builds tower of at least 6 Playing with them is a form of doing blocks assessments with them • 36 months – copies a circle and cross shapes, if asked can colour within the lines • 5 years – beginning to write letters, draws person with Dependent on your place in the family some body parts • Picture that is recognizable by strangers • Often the older sibling talks for the younger ones, so the younger ones never had to and slower development Toddler Specifics… • Stranger anxiety –typically subsides by age 2 ½ to 3 years • Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3 • Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely • Thumb sucking • Toilet Training (urine output min: 1mL/kg/day, approx. 500-600mLs day) • Children do not have the ability to concentrate their urine, so they void more mL/kg than adults • Dependent on • Sphincter control • Understanding on potty training Toddler Play • Parallel Play • Play beside with each other, but not interacting with each other, doing their own things Potential “Red Flags”: Toddlers… • Not walking by 18 months of age • Unaware of changes in environment and routine • Poor or no eye contact • Social domain • Difficulty with calming self • Not responding to noise, sounds, or familiar voices • Hearing • Not engaging in pretend play PRESCHOOL (3-6 Years) Fine Motor and Cognitive Skills – more defined • Buttoning clothing • Holding a crayon / pencil • Building with small blocks • Using scissors • Playing a board game • Have child draw picture of himself Social emotional • Egocentrism Preschool Play • Associative Play • Starting to interact and play with others but not coordinated • Wouldn’t coordinate what games they are going to play, no planning Potential “Red Flags”: Preschool • Lack of socialization and inability to play with others • Inability to follow simple directions and carry out self care tasks • Hand washing • Simple dress • Toileting • Unable to undo large buttons, put on shoes by age 3 years SCHOOL AGE Gross Motor • Usually by 6-8 years able to join team sports • More coordinated, less falls and tumbles Fine Motor • Fine motor skills are refined and more focused Cognitive • Can focus and concentrate for longer periods of time • More self-directed and independent • Can follow instructions • Successful in taking part in more challenging cognitive activities Reading, writing, board games School Age Play • Cooperative Play • • • • Play together Unified Play as a group Coordinated • In hospital/ COVID • Socially isolated • At risk for developmentally delay Potential Red Flags: School Age • Lack of friends and peer involvement • Academic failure • Aggressive behaviour Bullying Fighting Setting fires Abusive to animals Overt and aggressive sexual behaviour Adolescence (±12-18 Years) Social and Cognitive • Gain independence from adult influences • Challenge adult authority, values • Heavier reliance on peers socially • Mood swings • Become experimental – religion/spirituality, drugs, alcohol, sexual activity, gender awareness and identity Potential “Red Flags”: Adolescence • Unable or disinterested in taking part in family life • Inappropriate anger • Suicidal ideation • Addiction • Eating disorders • Bullying • Accidents – vehicular, water A Sampling of Growth Patterns • 2-6 months Typical weight gain: 10-30grams/day, Typical weight gain: 70-210 grams/week Typical height advancement: 1.5cm/mos Gain in head circumference: 1.5 cm/mos *Usually birth weight doubles by 5 months and triples by 12 months Critical decision • 3 months old – 4000g • 4100g the next day • Is it an okay weight gain • Need to look at a week • We cannot force them to eat nor BM • Depends on if they have had BM, eaten, heart conditions… Indicators that we need to think about • Information and data we need to know Feeds solid at around 6 months • Make sure they are having enough nutrition • Formula plus solids • Different from whole milk (not enough of iron in whole milk, unlike formula) • Start whole milk at 12 months 6-8 months introduce cups instead of bottles • Adolescence Definitive growth spurt Girls gain about 7-25 kg over 2-3 years Tends to mature and develop earlier Boys gain 7-29.5 kg over 2-3 years Height – 11-30 cm Factors Affecting Growth and Development • Genetics • Temperament • Health-Nutrition • Intelligence • Gender Lets review the Case Study … • Mark is 4-years old. Social Self help Gross Motor Fine Motor Language Social 2 months 4 months 6 months 12 months 18 months Self-help Gross Motor Fine Motor Language Genetic Diseases • A disease caused by a genetic mutation that is either inherited or arises spontaneously. Autosomal Dominant Inheritance Autosomal Recessive Disorders X-Linked Recessive Disorders: Males are at Risk Genetic Testing • Gene testing involves examining a person's DNA - taken from cells in a sample of blood or, occasionally, from other body fluids or tissues for some anomaly that flags a disease or disorder. Chromosome Abnormality • Can be numerical or structural. • Are quite common (50% of those that abort spontaneously). • Numerical: entire single chromosome added or missing. One or more added sets of chromosomes. • Structural: part of a chromosome missing or added or there is an abnormal rearrangement of material within chromosome known as translocation. Numerical Abnormalities Trisomy: when each body cell contains an extra copy of one chromosome (47). An extra chromosome at every cell. • Common trisomy is Down syndrome where each cell has three copies of chromosome 21.. • Trisomy 13 are less common and have more severe affects (Cognitive developmental disability, hypotonia, CHD, etc) Monosomy • Occurs when each body cell has a missing chromosome (45). • Only one that is compatible with life – Turner’s Syndrome. Most common sex chromosome abnormality in females, single X chromosome. Klinefelter Syndrome • Occurs in boys who have an extra X chromosome. May have a delay in language development and auditory processing. • Diagnosed with chromosomal analysis. Duchenne Muscular Dystrophy • X-linked Recessive Disorder in boys; 30-50% affected children have no family history. • Onset of symptoms usually within first 3-4 years of life (example: pseudohypertrophy or enlargement of calf muscles). • Begins with loss of endurance and strength in the legs and pelvis, eventually progressing to include the musculature within the entire body Nursing Responsibility • Provide emotional support. • Be aware of personal values. • Teaching. • Be aware of grieving process that may be occurring. • Family dysfunction is common. • Locate appropriate support services (Social services, financial and lay support). Diagnostic Methods Prenatal Diagnosis for Fetal Abnormalities and Postnatal: • Physical examination • Imaging procedures • Chromosomal analysis • DNA analysis • Tests for metabolic disorders (PKU, CF) • Hemoglobin analysis (sickle cell) • Immunologic testing for infections such as rubella, herpes. Theoretical Tools – Try One+ Out! • Bowlby’s Attachment Theory • Erikson’s Psychosocial Theory • Piaget’s Theory of Cognitive Development • Freud’s Theory Psychosexual Development • Kohlberg’s Theory of Moral Development • …and many more Attachment Theory John Bowlby • Attachment is a motivational-behavioral control system • BOLWBY identified that infants need one special relationship for internal development. • Successful early attachment to one person facilitates the child to learn to cue her behavior to the subtle social cues of many. • This experience allows the child to develop the ability to engage in social relationships, to make friends, and, to eventually attain physical intimacy. Attachment Theory John Bowlby • A child’s experience with caregivers gives a sense of worth, a belief in the helpfulness of others, and a favorable model on which to build a future relationship. • This relationship enables the child to explore his environment with confidence and to deal with it effectively. What are the positive affects of attachment?