Pediatric Nursing Reviewer PDF - Final Examination

NCM 107: PEDIATRIC NURSING FINAL EXAMINATION REVIEWER NURSING CARE OF A FAMILY WITH A TODDLER Age span:1-3 Years. Transition from immobile, preverbal infants to mobil, verbal children with growing independence. Described as “Little Scientist” DEVELOPMENTAL MILES...

NCM 107: PEDIATRIC NURSING FINAL EXAMINATION REVIEWER NURSING CARE OF A FAMILY WITH A TODDLER Age span:1-3 Years. Transition from immobile, preverbal infants to mobil, verbal children with growing independence. Described as “Little Scientist” DEVELOPMENTAL MILESTONES CHARACTER TRAITS: Rigid, ritualistic, and stereotypic Negativistic, their favorite word is “NO” as their way to search for independence PHYSICAL GROWTH KEY DEVELOPMENTAL CHANGES IN TODDLERS ✓ While toddlers are making great strides ▪ Independence developmentally, their physical growth - Children develop autonomy begins to slow. ( independence) - Shift from caregiver dependent to a. Weight exploring the world with less - Gains from 4-6 lbs (1.8-2.7 kg) per assistance. year Birth weight quadruples by 2.5 ▪ Motor and Verbal Skills years - Toddlers begin walking, talking, and b. Height interacting more with their - Grows about 5 inches per year surroundings. - Height at 2 years is about half of the ▪ Exploratory Behavior expected adult height - Children starts with experimenting c. Head Circumference toys, aiding cognitive and physical - Increases only about 2cm during the development. second year compared to about 12 cm during the first year CAREGIVER ROLE DURING TODDLER d. Chest Circumference PERIOD - By 2 years, chest circumference has ▪ Support Growing Independence grown greater than the head - Encourage children to explore circumference safely. (create a “yes” environment e. Body Contour in a play area at home). - Toddlers tend to have a prominent abdomen because, although they NURSING ASSESSMENT OF A are walking well, their abdominal TODDLER’S GROWTH AND muscles are not yet strong enough DEVELOPMENT to support abdominal contents. They also have a forward curve of the spine at the sacral area (lordosis). f. Dental Development - Eight New teeth (Canines and First Molars) emerge in the second year, Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  with all 20 primary teeth typically Play: Stacks 2 blocks; enjoys present by 2.5 to 3 years. being read to; drops toys for retrieval (exploring permanence). PHYSIOLOGIC STATUS Socialization & Language: Uses 4–6 words. Body System Maturation: 18 Gross Motor: Runs, jumps in 1. Respiratory- Breathing Months place; walks upstairs with help remains abdominal. (both feet on one step). 2. Cardiovascular- Heart rate Fine Motor: No longer rotates slows, and blood pressure spoon when eating. gradually rises. Play: Parallel play begins; 3. Digestive- Stomach acid imitates chores (e.g., dusting); increases, and stomach enjoys pull toys. capacity supports three Socialization & meals a day. Language: Uses 7–20 words; 4. Urinary and Anal Control- names 1 body part; achieves Full myelination of the spinal bowel control. cord enables toilet training 24 Gross Motor: Walks upstairs readiness Months alone (both feet on one step). 5. Immunity- IgG and IgM Fine Motor: Opens doors; antibodies mature by age 2, unscrews lids. ending passive immunity Play: Parallel play continues; from birth. imitates tasks like wrapping a doll or "driving a car." DEVELOPMENTAL MILESTONES Socialization & Less numerous but no less dramatic Language: Has a vocabulary than those of the infant year of ~50 words; forms two-word because this is a period of slow and sentences (e.g., "Daddy go"). steady, not sudden, growth. 30 Gross Motor: Jumps down Toddler development is influenced to Months from chairs. some extent by the amount of social Fine Motor: Draws simple contact and the number of strokes and copies circles. opportunities children have to Play: Plays house; engages in explore and experience new rough housing. degrees of independence. Socialization & It is strongly influenced by individual Language: Verbal skills readiness for a new skill. steadily increase; knows full name, one color, and age. 36 Gross Motor: Rides a tricycle; Age Developmental Milestones Months brushes teeth with little help. 15 Gross Motor: Walks alone Fine Motor: Unbuttons Months well; sits in a chair; creeps buttons; draws a cross. upstairs. Play: Begins to share. Fine Motor: Scribbles with a Socialization & pencil/crayon; puts small Language: Speaks fluently pellets into bottles; holds a (300–900 words); knows full spoon (may turn it upside name and sex; achieves down). nighttime bladder control. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Nursing Significance: - Street Safety: Teach toddlers to cross the street safely by holding a Instruct parents not to offer snacks parent’s hand. within an hour of meals. - Supervision: Encourage parents to Avoid small food items such as supervise tricycle riding and outdoor peanuts, carrots, celery, and play. hotdogs. Remind parents not to use food as a PARENTAL CONCERNS ASSOCIATED reward or punishment. WITH THE TODDLER PERIOD Parents should encourage the use of utensils. a. Toilet Training PROMOTING TODDLER SAFETY One of the biggest tasks during the toddler period. Aspiration and Poisoning Toilet training should begin and end - Toxic Substances: Urge parents to according to the child's ability to lock away all toxic substances and accomplish it. secure safety caps on medications. Bowel training is usually completed - Small Objects: Remove small, easily before bladder training. aspirated objects from the child’s Complete nighttime bladder control environment. typically does not occur until age 4 or 5. Falls The child must have control of rectal - Crib Safety: Instruct parents to keep and urethral sphincters, which is crib rails up and place gates across usually achieved by the time they stairways. walk well. - Window Safety: Secure screens on The child must understand what it all open windows. means to hold urine and stools until - Supervision: Supervise the toddler at they can release them at an play. appropriate time and place. A child must have the desire to Burns delay immediate gratification for - Tablecloths: Advise parents to avoid more socially accepted behavior. using tablecloths. - Hot Surfaces: Teach the toddler Signs of Readiness for Toilet Training: what “hot” means. - Storage Safety: Store matches and ✔ Stays dry for 2 hours, with regular lighters in locked cabinets out of bowel movements. reach. ✔ Can sit, walk, and squat. - Electrical Safety: Secure safety ✔ Can verbalize the desire to void or plugs in all unused electrical outlets. defecate. ✔ Exhibits a willingness to please Motor Vehicle and Other Accidents parents. - Car Seat Safety: Instruct parents to ✔ Wants to have soiled diapers continue using an appropriate-sized changed immediately. car seat. - Hazardous Items: Lock cabinets and b. Ritualistic Behavior drawers containing hazardous items (e.g., knives, firearms). Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Toddlers may insist on using only Fear of separation starts around 6 their spoon at mealtime or only months of age and may persist their blanket at bedtime. through the preschool years. They may refuse to go outside Peak: Most intense around 18 unless their favorite cap is found. months. c. Negativism Three Phases of Separation Anxiety: Definition: Common during toddler 1. Protest: Characterized by anger, years as part of establishing their screaming, and calling for the own identities. parent. Behavior: Toddlers often refuse to 2. Despair: Child may withdraw and comply with requests from parents, not want to talk. replying "no" to nearly everything. 3. Denial: Child may ignore the parent upon return. How to Manage Negativism: How to Prevent Separation Anxiety: ✔ Decrease the number of questions. ✔ Make statements rather than asking ✔ Keep goodbyes brief and say questions. goodbye firmly. ✔ Offer choices to the child to give ✔ Transitional objects (e.g., a favorite them some control. toy or blanket) can be helpful during separation periods. d. Discipline f. Temper Tantrums Definition: Discipline involves setting clear rules or guidelines so A normal response to frustration; children understand what is often lack verbal skills to express expected of them. emotions. Punishment: Is a consequence of misbehavior or disregard for the Management: rules learned. ✔ Stay calm and avoid giving in Effective Discipline Measures: demands to prevent reinforcing the behavior. ✔ Consistency: Enforce rules ✔ Offer comfort and alternative outlets consistently. for emotions (like drawing or a quiet ✔ Timing: Discipline should be place) initiated after misbehavior. ✔ Planning: Plan discipline methods NUTRITIONAL REQUIREMENTS in advance. ✔ Focus on Behavior, Not the Growth and Development: As the Child: Address actions, not the growth rate slows, there is a child's character. decrease in the child’s need for ✔ Private & Non-Shaming: Discipline calories, protein, and fluids. should occur in private and should Calorie Requirement: 102 kcal/kg avoid causing shame. per day. Protein Requirement: 1.2 g/kg per e. Separation Anxiety day. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Milk Intake: Milk should be limited to needs as more no more than 1 quart (1 liter) per important or central day. than those of others. Electra Refers to the FOOD PREFERENCES Complex attachment of a female child to a male 12 Months: Most toddlers begin parent. eating the same foods as the rest of Endomorphic A body type the family. Body Build characterized by a 18 Months: Physiologic anorexia larger body build or (picky eating) may occur; they may rounder physique. experience food jags (preference for Genu Valgus A condition where the certain foods over others). knees angle inward Self-Feeding: Toddlers prefer to feed and touch when themselves and tend to favor small standing, also known portions of appealing foods. as "knock knees." Food Choices: They often prefer Intuitional Thinking based on single foods rather than mixtures Thought intuitive feelings (e.g., eating foods like plain pasta rather than logical instead of pasta with sauce). reasoning, often seen in early childhood. Nursing Care of a Family With a Oedipus Refers to a Preschool Child Complex attachment of a male child to a female Term Definition parent. Secondary A type of stuttering Broken Repitition and Stuttering that develops after Fluency prolongation of sound speech has initially syllables, and words. been fluent, often due Bruxism The involuntary to psychological or grinding or clenching environmental factors. of teeth, usually Connected to broken during sleep, which fluency. can lead to dental issues. Conservation A cognitive ability to understand that certain properties of Preschool Period (Ages 3, 4, 5): objects (like volume or mass) remain the Physical growth slows, but same despite personality and cognitive growth changes in form or continue rapidly. arrangement. Preschoolers seek independence: Ectomorphic A body type They want to dress themselves, Body Build characterized by a choose clothing, feed themselves, slim body build or and wash their hair. lean physique. Caregivers may notice the child Egocentrism The tendency to wearing mismatched socks or trying perceive one’s own to eat soup with a fork, which is thoughts, beliefs, or typical behavior for learning new skills. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  It is essential for caregivers to know easily due to improved cognitive how to differentiate tasks that a abilities. preschooler can manage Immune System Changes: independently from those requiring o Lymphatic tissue increases in adult supervision. Setting size, particularly the tonsils. appropriate limits ensures the child's o IgG and IgA antibodies rise, safety while fostering exploration. making illnesses more localized (e.g., upper NURSING ASSESSMENT OF A respiratory infections). PRESCHOOLER'S GROWTH AND Heart and Circulatory Changes: DEVELOPMENT o Physiologic splitting of heart sounds may be noted. o Innocent heart murmurs may develop due to the changing size of the heart in relation to the chest. o Pulse rate decreases to about 85 beats per minute, and blood pressure remains around 100/60 mm Hg. Bladder: Easily palpable above the symphysis pubis, with frequent voiding (9-10 times per day). Skeletal Changes: The longitudinal arch in the foot becomes well-formed, and muscle strength improves, allowing for activities like gymnastics. Genu valgus (knock-knees) typically resolves by the end of the preschool period. WEIGHT, HEIGHT, AND DEVELOPMENT: PHYSICAL GROWTH Weight Gain: Approximately 4.5 lb (2 kg) per year. Body Contour Changes: The Height Gain: 2 to 3.5 inches (6 to 8 transition from a toddler’s cm) per year. wide-legged gait, prominent lordosis, Head Circumference: No longer and protuberant abdomen to a routinely measured after age 2 as it slimmer, taller, more childlike body changes little after this point. occurs. Body Type: Ectomorphic (slim) or Teeth: Endomorphic (larger) body types become evident. Preschoolers typically have all 20 Handedness: Becomes more deciduous teeth by age 3, with apparent during this period. permanent teeth erupting at school Cognitive age. Development: Preschoolers Preserving deciduous teeth is exposed to more than one language essential as they hold the space for may develop bilingualism more permanent teeth. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 DEVELOPMENTAL MILESTONES 3-5-Year-Olds: o Preschoolers enjoy games 3 Fine Motor: Undresses self, stacks that use imagination and tower of blocks, draws a cross imitation, such as pretending Gross Motor: Runs, alternates feet to be a teacher, firefighter, or on stairs, rides tricycle, stands on one store clerk. foot o Many have imaginary friends, Language: Vocabulary of 900 words which often persist until they Play: Able to take turns, very begin school. imaginative o Four- and five-year-olds 4 Fine Motor: Can do simple buttons alternate between active play Gross Motor: Constantly in motion, and imitative play. jumps, skips o Five-year-olds become Language: Vocabulary of 1,500 interested in group games words and reciting songs learned in Play: Pretending is major activity preschool or kindergarten. 5 Fine Motor: Can draw a six-part figure, can lace shoes EMOTIONAL DEVELOPMENT IN Gross Motor: Throws overhand PRESCHOOL CHILDREN Language: Vocabulary of 2,100 words Initiative vs. Guilt (Erikson's Play: Likes games with numbers or Developmental Task) letters Preschoolers develop a sense of initiative when they are encouraged Language Development in Preschoolers to explore and learn new things. If criticized or punished, they may 3-Year-Olds: develop guilt about trying new o Vocabulary of about 900 activities, affecting their confidence words, asking up to 400 later in life. questions a day (e.g., "Why Exposure to diverse experiences is snow cold?"). and creative play materials is key to o Egocentrism: Perceive their fostering initiative. thoughts and needs as more Activities like visiting a zoo or using important than others' and modeling clay help develop initiative. define objects in relation to themselves (e.g., a spoon is Imitation and Fantasy "what I eat with"). 4-5-Year-Olds: Preschoolers often imitate adults o Enjoy participating in and role-play, such as pretending to mealtime conversations and be a firefighter or teacher. can describe incidents in Play is more about engaging in roles detail. than exact accuracy. o Imitate language they hear, Fantasy play is common, but including inappropriate preschoolers may fear they are language, often to gain "stuck" in the fantasy, showing attention. "magical thinking." Parents should support imaginative Play in Preschoolers play while reassuring children of their identity. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Oedipus and Electra Complexes They may struggle to apply learned rules to new situations, like a Preschoolers may show strong hospital visit. emotional attachments to parents of the opposite sex, known as the Spirituality Oedipus (A boy's attachment to his mother and rivalry with his father) Preschoolers develop a basic and Electra complexes(A girl’s understanding of spirituality through attachment to her father and rivalry religious training and rituals. with her mother.) They may engage in spiritual This attachment is normal but may practices like prayer before meals cause jealousy or feelings of for reassurance and security. competition between parents. HEALTH PROMOTION FOR A Socialization PRESCHOOLER AND FAMILY: SAFETY Preschoolers begin to interact more Promoting Preschooler Safety with peers, sharing and playing together. Independence vs. Supervision: At Four-year-olds may have age 4, preschoolers may project disagreements as they test their role independence but still need in the group. supervision to prevent injury during At five, children begin forming close active play and ensure they do not friendships, often based on shared wander too far from home. experiences. Medicine Imitation: Preschoolers may imitate taking medicine if they COGNITIVE DEVELOPMENT see family members doing so. Gun Safety: Ensure any guns in the Piaget's Preoperational Stage home are unloaded and locked to prevent accidental injury. Preschoolers are in the Automobile Safety: Preschoolers preoperational stage, with intuitive should be reminded to always thought emerging as they ask buckle their booster seat and not "How?" and "Why?" walk in front or behind automobiles. Cognitive skills develop, but they still They may act impulsively, running rely on magical thinking and into the street before remembering centration, focusing on one safety rules. characteristic of an object. Preschoolers do not yet understand Keeping Children Safe, Strong, and Free conservation (e.g., that quantity remains the same despite changes Stranger Danger: in shape or appearance). o Teach children not to talk to or accept rides from adults MORAL AND SPIRITUAL DEVELOPMENT without their parent’s permission. Understanding Right and Wrong o Show children how to call for help in an emergency (e.g., Preschoolers understand right from yell, run to a neighbor's wrong based on parental rules rather house, or dial 911). than reasoning. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  o Explain what police officers original containers. look like and how they can - Contact poison help in emergencies. control. o Teach that secrets about Burns - Don’t allow lighting uncomfortable situations candles or fireplaces. should be shared with Community - Don’t go with others parents or trusted adults. Safety without permission. Bullying Prevention: Explain that - Teach "no" to bullying is unacceptable and should inappropriate be reported. touching. Inappropriate Touch: Educate on General - Monitor child’s the difference between appropriate location. and inappropriate touch or behavior. - Extra caution needed during Motor Vehicle and Bicycle Safety stressful times. Car Safety: Preschoolers should be PROMOTING THE NUTRITIONAL in car seats or booster seats in the HEALTH OF A PRESCHOOLER back seat until they are around 40 lbs. Ensure the seatbelt fits properly Appetite and Meal Prep: (shoulder harness should not cross Preschoolers have smaller appetites the child’s face or neck). due to slower growth. Encourage Bicycle Safety: Promote the use of simple food preparation tasks like safety helmets to prevent head making a sandwich to build initiative. injuries, especially as bicycle Snacks: Limit snacks to 1-2 small, accidents are a major cause of healthy options per day. severe head injuries in preschoolers. Nutritional Requirements: Foods Caregivers should model safe should include variety and color, behavior by wearing helmets based on MyPlate themselves. recommendations. Meat Preferences: Preschoolers COMMON UNINTENTIONAL INJURIES TO may not prefer meat as it’s hard to PRESCHOOLERS chew. Vitamins: Generally unnecessary if a Unintentional Prevention Measure balanced diet from all food groups is Injury consumed. Vitamins should be Motor Vehicles - Teach tricycle and stored out of reach and not exceed and Bicycles street safety. recommended doses. - Always use helmets Vegetarian Diets: Colorful and for biking. appealing but may lack calcium, Falls - Supervise at vitamin B12, and vitamin D. playgrounds. Consider supplements if needed. - Remove drawstrings from clothing. PROMOTING THE DEVELOPMENT OF Drowning - Teach swimming. THE PRESCHOOLER IN DAILY Animal Bites - Avoid stray animals. ACTIVITIES - Supervise with pets. Poisoning - Keep meds out of Dressing: Preschoolers can dress reach. themselves (3-4 years) with - Store substances in Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  supervision. Allow them to choose o Exposure to smoke and clothes, even if mismatched. daycare increases infections. Sleep: Some may resist naps, and o Overprotection from illness nightmares or fear of the dark may can hinder independence. arise. Use a night-light and avoid scary stories. Common Fears: Exercise: Encourage active play and structured games. Limit screen o Fear of the Dark: time to promote motor skills and Reassurance, night-lights, prevent obesity. and monitoring bedtime Hygiene: Supervise handwashing stimuli help. and bathing. Ensure water o Fear of Mutilation: Explain temperature is safe. Help with procedures and provide cleaning fingernails and ears. distraction. Care of Teeth: Encourage tooth o Fear of Separation: Prepare brushing and flossing. Use children with clear, fluoridated water or supplements. comforting timelines. Avoid sweets and encourage tooth-friendly snacks. Behavior Variations: Teeth Grinding: May occur due to anxiety or spasticity in children with cerebral palsy. Refer to a pediatric o Telling Tall Tales: Distinguish dentist if severe. fact from fiction without discouraging imagination. o Imaginary Friends: Normal, PROMOTING HEALTHY FAMILY FUNCTIONING helps with language and expression. o Difficulty Sharing: Requires Encouraging Creativity: Read aloud and answer questions to foster practice and guidance in language development. understanding ownership. Handling Questions: It’s okay to o Regression: Temporary say "I don't know" to deep or return to old behaviors due to philosophical questions. stress (e.g., thumb-sucking). Discipline: Preschoolers have o Sibling Rivalry: Promote strong opinions, leading to conflict. self-esteem by emphasizing Guide them through these struggles a child’s unique privileges. while respecting their opinions. Use o Preparing for a New "time-out" as a non-physical Sibling: discipline technique. Time-out duration should match the child’s a. Start preparation when pregnancy is age (3-5 minutes for preschoolers). visible, before changes to the child’s environment. PARENTAL CONCERNS IN PRESCHOOL b. Move the child to a new bed 3 YEARS months before birth. c. Preschool or childcare should be Common Health Problems: before or 2-3 months after the sibling’s birth. d. Plan for separation during childbirth o Preschoolers have minor and allow visits to ease anxiety. illnesses (e.g., colds, ear o Sex Education for infections). Preschoolers Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  a. Answer questions about anatomy Height - 1 to 2 inches (2.5 to 5 cm) simply and factually using correct terms. lordosis and knock-kneed during b. Teach privacy and appropriate preschool lose this now touch. c. Masturbation is normal, but should be framed as a private activity. 10 years of age o Choosing a Preschool or - brain growth complete thus fine Childcare Center motor is refined a. Preschool helps with social - eye globe reaches final shape development; assess local programs - adult vision level achieved carefully. b. Childcare centers can increase exposure to infections; promote IgG and IgA reach adult levels and hygiene practices. lymphatic tissues continue to grow in o Preparing a Child for size about age 9 yrs. old. School Abundance of tonsillar and adenoid a. Adjust routines for early bedtimes tissue may result in temporary and ensure immunizations are conduction deafness until the up-to-date. tissue recedes normally. b. Present school positively and prepare for new experiences like bus Appendix - swelling of this tissue in rides or lunch routines. the narrow tube leads to trapped o Broken Fluency fecal material and inflammation a. Broken fluency (speech repetition) is (appendicitis). normal in preschoolers. Frontal sinuses - developed at 6 yrs. b. Don’t interrupt or make the child old. Sinus headaches become a conscious of their speech patterns. possibility. CONCERNS FOR PRESCHOOLERS WITH UNIQUE NEEDS Heart left ventricle enlarges to be strong Children with disabilities benefit from enough to pump blood. preschool for socialization. innocent heart murmurs become Provide alternative activities if the apparent due to extra blood crossing child has physical limitations. heart valves. Encourage participation in family meals, even if the child has dietary PR ↓ 70-80 bpm restrictions. BP ↑ 112/60 mmHg maturation of respi system = ↑ NURSING CARE OF A FAMILY WITH oxygen-carbon dioxide exchange = SCHOOL-AGE CHILD (6-12 YEARS OLD ↑ exertion ability and stamina School age children mature slowly but Scoliosis may become apparent steadily. SEXUAL MATURATION PHYSICAL GROWTH Hypothalamus transmits enzyme Weight Gain - 3 to 5 lbs (1.3 to 2.2 APG to begin production of kg) gonadotropic hormones which Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  activates changes to the testes increase in size at puberty. It and ovaries to cause puberty. is affected by hormones. Menstruation is an important Timing of onset puberty varies preparation for future childbearing widely between 8 and 14 years of and for a girl's concept of herself as age. a woman. Sexual maturation: ○ Explanation of menstrual ○ Girls - between 12 and 18 flow, good hygiene and ○ Boys - between 14 and 20 reassurance that they can In a class of 11 year old sixth bathe, shower, and swim is graders, it is not unusual to discover needed. more than half of the girls are Vaginal secretions (may fear they already menstruating. Materials have contracted an infection). must be introduced to the school Vaginal secretions will begin to be age for sex education to be effective. present. Secretions that cause Precocious puberty - abnormal vulvar irritations may indicate that it onset of puberty. is an infection. Menstrual irregularity. This occurs Sexual and Physical Concerns primarily because a girl's cycle is at School age is the time to reinforce first anovulatory. With added previous teaching that their body is maturity and the onset of ovulation, their own, to be used only in the cycles become more regular. way they choose. ○ Malnourishment, obesity, Puberty brings changes to emotions influence menstrual sebaceous glands. regularities. Under the influence of androgen, glands become more active, setting Concern of boys the stage for acne. Increasing genital size Vasomotor instability - leads to Breast development - hypertrophy blushing and ↑ perspiration. of the breasts (gynecomastia) esp. those who are stocky or obese. It is Concerns of girls a transitory phenomenon and will They're much taller by about 2 in. or fade as soon as hormones mature. 5 cm because their growth spurt Body hair growth - pubic hair begins early. appears first and chest and facial Changes in pelvic contour (might hair may not grow until several years misinterpret as weight gain and later. attempt crash diet). Increased seminal fluids begins to Breast development (they tend to be produced. Boys begin to notice slouch and wear loose clothing to ejaculation during sleep (nocturnal hide the size of their breast). BD is emissions). not always assymetrical. ○ Supernumerary (additional) Chronologic Development of Secondary nipples may darken or Sex Characteristics Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Axillary hair present. BOYS Menarche occurs. 9-11 Prepubertal weight gain occurs. TEETH Deciduous teeth are lost and 11-12 permanent teeth erupts. Sparse growth of straight, downy, Average child gains 28 teeth slightly pigmented hair at base of between 6 and 12 years of age. penis. ○ Central and lateral incisors; Scrotum becomes textured; growth first, second, and third of penis and testes begins. cuspids; and first and second Sebaceous gland secretion molars. increases. Perspiration increases. GROSS AND FINE MOTOR DEVELOPMENT 12-13 Pubic hair present across pubis. Penis lengthens. Dramatic linear growth spurt. Breast enlargement may occur. GIRLS 9-11 Breasts: Elevation of papilla with breast bud formation; areolar diameter enlarges. 11-12 Straight hair along the labia. Vaginal epithelium becomes cornified. pH of vaginal secretions becomes acidic; slight mucous vaginal discharge is present. Sebaceous gland secretion increases. Perspiration increases. PLAY Dramatic growth spurt. 6 years Continues to be rough and tumble Begins to spend quite time with 12-13 books as they discover reading as Pubic hair grows darker; spreads an enjoyable activity that opens over entire pubis. doors to other worlds. Breasts enlarge, still no protrusion of Spend hours increasingly nipples. challenging video games. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 7 years Boys show off as girls pass by their Requires more props for play. group. Start of decline of imaginative play Girls talk loudly or giggle at the site Girls begin to prefer teenage dolls of familiar boy and become more and coordination is good enough interest in the way they look and that they can button the miniature dress. dresses and pull on tiny boots. Very interested in rules and fairness Children developed an interest of They strictly enforce rules. collecting items (e.g, cards, dolls, 11 and 12 years rocks or marbles. Enjoy dancing to popular music and The type of item is not as important playing table games. as the quantity. Accomodating enough to play with 8 years younger siblings who need the rules The collections have structured; modified to their advantage. time is spent sorting and cataloging. Time with friends is spent just Enjoys helping in the kitchen with talking. jobs. More interested in seeing their room More involved in simple science tidy. projects and expirements. Twelve year olds like to do jobs like Likes table games but hates to lose, raking leaves or babysitting for so they tend to avoid competitive money. play. They may change the rules in the middle of the game to keep from LANGUAGE losing. Six year olds 9 years ○ talk in full sentences, using They play hard. language easily and with Play is rough and they are not as meaning. interested in perfecting their skills. ○ No longer sound as though Talent for music and arts become talking is an experiment but evident. appear to have incorporated The time they discover the are other language permanently. children in the internet who are ○ Define objects by their use. waiting to talk to them in chat rooms 7 year olds or other social media. ○ Can tell time in hours. Not yet wise enough to recognize ○ Have trouble with concepts the danger of talking to strangers so such as “half past” and supervision is advised. “quarter to”. 10 years ○ Knows the months of the Spend most of their time playing year, and the months in handheld or consoles games. which holiday fall into. Boys and girls play separately ○ Can add and subtract and although interest in the opposite sex make simple change. is apparent. 9 year olds ○ Discover “dirty jokes” Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  ○ Swear words to express ○ Aware of family roles and anger. responsibility. ○ May have a short period of ○ Promises must be kept since intense fascination with they view them as definite, “bathroom language” firm commitments 12 year olds ○ They tattle because they ○ Can carry on an adult have a strong sense of conversation, although justice. stories are limited because of 8 years old a lack of experience. ○ Actively seek company of other children. EMOTIONAL DEVELOPMENT ○ Girls have a close girlfriend They have the ability to trust others and vice versa. and with a sense of respect for their ○ Whispers to share their own worth. secret. Can accomplish simple tasks bcoz 9 years old they have a sense of autonomy. ○ Take the values of their peer Doing things is more important and group seriously. more rewarding than watching things ○ Much more interested on being done (sense of initiative). how others dress. ○ Friend or club age “spite Development Task: Industry Vs. clubs”. Inferiority ○ Ready for activities away Erik Erikson from homem Children attempt to master their new 10 years old developmental step: learning a ○ Enjoys privacy sense of industry or ○ Best gift for them is a box accomplishment. that locks. Learning how to do things well. 11 years old ○ Girls increasingly interested Home as a setting for to learn in boys and vice versa. industry ○ Favorite activities are School as a setting to learn industry. mixed-sex Structured activities ○ Children are secure. Problem solving. 12 years old Learning to live with others. ○ Comfortable in social situations. SOCIALIZATION ○ Boys have erections. 6 years old ○ Some are still children and ○ Plays in group but when tired others are almost in or stressed they prefer one adolescent making social on one contact. interactions sometimes 7 years old difficult. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 COGNITIVE DEVELOPMENT Sports injuries PIAGET Drowning Concrete Operational Thought - the ability Drugs to reason through any problem they can Firearms General visualize. Promoting Nutritional Health of a School New concepts during school age: Age Decentering -the ability to Most children are hungry after appreciate that a change in shape school and enjoy a snack like fruit, does not necessarily mean a change cheese and milk to be healthy. in size. Enjoys helping to plan meal like Accommodation - the ability to jell-o, salad, scrambled eggs, and adapt thought processes to fit what sandwiches. is perceived such as understanding Children require more iron during that there can be more than one their prepuberty. reason for other people's actions. Adequate calcium and fluoride for Conservation - the ability to teeth and bone growth. appreciate that a change in shape does not necessarily mean a change Promoting Development of a School Age in size. in Daily Activities Class inclusion - the ability to understand that objects can belong Dress to more than one classification. Able to dress themselves but are not skilled in taking care of their clothes.. MORAL AND SPIRITUAL DEVELOPMENT Right time to teach children the KOHLBERG importance of taking care of their belongings. Preconventional reasoning begin to mature in terms of moral Sleep development. Younger school.age typically Thet concentrate on “niceness” and requires 10-12 hours of sleep. “fairness”. Older ones require 8-10 hours of Rule oriented. sleep each night. In 6 years olds, a quiet time after HEALTH PROMOTION FOR A SCHOOL school is needed. Night terrors are AGE CHILD still evident. 9 year olds prefer phoning or text Promoting Safety messaging friends than talking to Source of unintentional injury. parents. Motor Vehicle Bicycle Exercise Community Hygiene Burns Falls Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Care of teeth breathing or abnormal tongue position Visit a dentist twice yearly (tongue thrusting & thumb sucking. Pedodontist - specialized in caring Can be a crossbite for children's teeth. (sideways) or anterior of posterior. Common Health Problems of the School Age Concerns and Problems of the School Age Lowest rate of death and serious illness. Problems associated with Language Small health concerns Common problems is articulation. Head lice The child has difficulty pronoun in z, Ringworm s, th, l, r, and w. They substitute w for r or r for l. Two causes of death Unintentional injury Common fears Cancer Anxiety related to beginning school School refusal or phobia Minor illnesses Dental caries Sex Education GI disturbances Topics Upper respi infections Reproductive organ function and physiology of reproduction, so ADHD and ASDs are marked in school age. children understand what menstruation is and why it occurs Caries - (cavities) are progressive, Secondary sexual characteristics, destructive lesions or decalcification of the so children will under- stand what is tooth enamel and dentin. happening in their bodies When the pH of the tooth surface Male sexual functioning, including drops to 5.6 or below (which why the production of increased happens after children eat readily amounts of seminal fluid leads to fermented carbohydrates, such as nocturnal emissions table sugar), acid microorganisms The physiology of pregnancy and (acidogenic lactobacilli and aciduric the possibility for unin- tended streptococci) found in dental plaque pregnancies, which will come with attack the cementing medium of sexual maturity teeth and destroy it. Responsibilities of sexual maturity. Reproductive life planning measures Malocclusion - (a deviation of tooth and the principles of safer sex if position from the normal) may be congenital appropriate to the cultural setting. due to conditions such as cleft palate, a Can be taught through films and small lower jaw, or familial traits tending discussions. toward malocclusion. The condition can result later on from constant mouth Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Stealing - Adolescents both grow rapidly and They steal loose change from their mature dramatically during the mother's purse or father's dresser. period from age 13 to 18 to 20 This usually happens at around 7 years. years of age, when children first learn how to make change and also Physical Growth discover the importance of money. Stealing occurs because, although a Puberty Onset: Begins at 8 to 12 years of child is gaining an appreciation for age. money, this appreciation is not yet balanced by strong moral principles Body Growth Cessation: or an understanding of ownership. Ends around 16-17 years for females, Violence and Terrorism 18-20 years for males, with epiphyseal Children view their world as safe so line closure in long bones. it is a great shock when violence enters their lives. Physical Growth: Bullying Initial weight gain leads to a stocky Recreational Drug Use appearance; later, it transitions to a thin, gangly appearance. Concerns of School Age Child and Family with Unique Needs Boys grow 4-12 in. (10-30 cm) in The child of alcoholic parents. height and gain 15-65 lb (7-30 kg). The child with long-term illness or Girls grow 2-8 in. (5-20 cm) in cognitive challenges. height and gain 15-55 lb (7-25 kg), Nutrition and the school age child stopping growth approximately 3 with a challenge. years after menarche. The overweight or obese child. Girls are typically taller than boys early in adolescence but shorter by the end of the period. Nursing Care of a Family Adolescent (13-20 years old) Cardiovascular and Respiratory Changes: Serves as a transition between Heart and lungs grow more slowly, childhood and adulthood Divided leading to fatigue from activities. into: Early (13-14 years old) Middle Late adolescence: (15-16 years old) Late (17-20 years ○ Pulse rate: ~70 beats/min old) ○ Respiratory rate: ~20 breaths/min GROWTH AND DEVELOPMENT OF AN ○ Blood pressure: ~120/70 ADOLESCENT mmHg Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Male blood pressure becomes slightly higher due to greater body Puberty mass. Puberty is the stage when individuals become capable of sexual reproduction. Girls: Marked by the onset of Skin and Sweat Glands: menstruation (menarche). Androgen stimulation increases Boys: Marked by the production of sebaceous gland activity, often spermatozoa. causing acne. Apocrine sweat glands develop after Typical Age Range: puberty, producing odor in axillae Occurs between 11 and 14 years. and genital areas, requiring more frequent bathing. Menarche Trends: Teeth The average age of first menstruation is decreasing, from 13 Second Molars: Erupt around 13 years to 12.4 years, likely due to years of age. increased weight in girls Third Molars (Wisdom Teeth): Psychological Impact: Early teenagers often have Typically erupt between 18-21 years. questions and concerns about what It can appear as early as 14-15 is normal during puberty years. Secondary Sex Changes Jaw Development: - Secondary sex characteristics distinguish the sexes but are not The jaw reaches adult size toward directly involved in reproduction. the end of adolescence. - Examples: Body hair configuration, Early eruption of third molars before and breast growth. jaw lengthening may cause pain and require extraction. Nutritional Requirements Development: Daily intake should be balanced among the It begins in the late school-age food groups period and continues throughout Average daily calorie requirement varies: adolescence. → Girls (11-14) – 48 kcal/kg/day Sexual Maturity: → Girls (15-18) – 48 kcal/kg/day Classified using Tanner Stages, → Boys (11-14) – 60 kcal/kg/day developed by the original researcher → Boys (15-18) – 42 kcal/kg/day on sexual maturity. ✓ Adolescents need milk and protein in sufficient quantity ✓ Common dietary deficiencies: iron, folate, and zinc Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Developmental Milestones Emotional Development Early to Mid-Adolescence: Play or Recreation Developmental task: Forming a Transition from active games to sense of identity vs. role confusion more adult activities (e.g., music, (Erikson, 1993). texting, following sports). Late Adolescence: Social interaction, often via Developmental task: Forming a electronic media, is crucial for sense of intimacy vs. isolation learning values and responsibilities. (Erikson, 1993). Overuse injuries in sports are common in early adolescence until Early Adolescent Developmental Task: limits and proper training are respected. Identity Versus Role Confusion Part-time jobs at age 16+ teach - Adolescents must decide who they responsibility, teamwork, and money are and what kind of person they management. want to become. Many adolescents engage in Key Areas of Development: charitable activities, showing 1. Accepting their changed body maturity and a desire for meaningful image. interactions. 2. Establishing a value system (deciding the kind of person they want to be). 3. Making a career decision. 4. Becoming emancipated from parents. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Consequences of Failure: ○ Early confidence may turn to Leads to role confusion, resulting self-censorship to appeal to in difficulty functioning as adults boys, leading to a conflict (e.g., indecisiveness or inability to between academic/athletic face challenges). success and maintaining May result in acting-out behaviors friendships. as a way to gain attention and create ○ Struggle with balancing an identity, even if negative (Erikson, independence and 1993). competitiveness with maintaining care for others. Body Image Boys: - Strong problem-solving skills from ○ May feel less pressure, childhood support better adjustment learning to be competitive to body changes. and independent. - Adolescents often feel disappointed ○ Generally have fewer with their height or appearance. emotional conflicts than girls - They are typically harsh critics of during adolescence. their own bodies. - Support from healthcare providers Value System: can help them value qualities like Adolescents develop values through creativity, compassion, and conversations with peers. personality over physical They also need attentive adults to appearance. help them discuss fears, hopes, and pressures. Self-Esteem: Social Coupling: Major changes in self-esteem occur Early adolescents tend to form during adolescence due to the many same-gender groups (girls with girls, changes they experience. boys with boys). Immediate successes (e.g., making They dress similarly to fit in with their the basketball team, having a date) group, which may seem like a loss of are important for adolescents' identity but is part of identity self-esteem. formation. Adolescents who are different (e.g., Parents should offer compassionate overweight, from different understanding (e.g., "It's hard to be backgrounds) may face exclusion or left out") instead of minimizing the bullying. significance of these events. This behavior is part of the process of establishing a sense of identity by Girls: distinguishing themselves from ○ May experience a crisis in others adolescence as they seek to fit into a male-dominated society (Gilligan, 1982). Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Career Decisions Late Adolescent Developmental Task: Career Choices and Identity: Intimacy Versus Isolation 17-20 Adolescents need to choose an occupation to form their identity. Sense of Intimacy: Timing: Many are advised to wait Involves forming long-term, until after two years of college to meaningful relationships with both choose a major, which can delay a sexes (Erikson, 1993). clear sense of identity until age 20. Trust, learned in infancy, is key to Impact on Education: Career building intimacy. decisions can increase interest in Guidance in Relationships: learning, as adolescents see Adolescents need help education as relevant to their future. distinguishing between genuine relationships and those driven by Emancipation from Parents: sexual attraction. Parents should ensure adolescents Emancipation is challenging for both are informed about safer sex parents and adolescents, as some practices. parents aren’t ready for full Empathy: independence, and some Developing empathy allows adolescents aren’t sure they want it. adolescents to understand and The struggle for independence may connect with others’ feelings, be more about winning the right than strengthening intimacy. using it. Strong ties between parents and Socialization adolescents often lead to more (13 years): intense struggles during Self-doubt is common due to emancipation. physical and emotional changes. Infatuations or "crushes" are typical, Parental Guidance: but adolescents lack experience in deep, lasting relationships. Parents should allow more freedom (14 years): (e.g., clothing choices, and Increased self-confidence and after-school activities) while introspection. maintaining reasonable restrictions Become quieter Adolescents seek (e.g., safety rules). role models and may idolize older Emancipation is about changing the individuals or celebrities, though relationship, not severing it, allowing these attachments fade as they form for a healthier, independent more reciprocal friendships. connection. Remind parents that independence (15): is a natural stage of growth, similar Adolescents may fall "in love" five or to a toddler’s desire to run after six times a year. Many of these being held. relationships are based on physical Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  appearance rather than compatibility Promoting Adolescent Safety of inner qualities or values. - Unintentional injuries, most These relationships are often brief commonly those involving motor and intense, fading once the vehicles, are the leading cause of individuals realize they have little in death among adolescents. common. Strong Emotions: Despite the Promoting Nutritional Health for an short-lived nature of these Adolescent attachments, adolescents can still Adolescent Growth and Hunger: feel deep emotional pain when the Adolescents experience rapid relationships end. growth, leading to constant hunger. (16) Without supervision, they may prefer By age 16 years, boys are becoming quick, unhealthy snacks over sexually mature (although they balanced meals. continue to grow taller until about 18 Unhealthy Eating Habits: Peer years of age). Both sexes are better pressure and busy schedules can able to trust their bodies than they result in poor nutrition, leading to were the year before. obesity and nutrient deficiencies. (17) Parental Influence: Stocking healthy they tend to have adult values and snacks and involving adolescents in responses to events. They have left meal planning can encourage better behind the childish behaviors they eating habits without conflict. used in early adolescence—shoving Dieting Risks: Some adolescents and punching—to get the attention may adopt unhealthy weight-loss of others. diets, leading to eating disorders like bulimia or anorexia nervosa. Any Cognitive Development diet should be supervised to ensure Formal Operational Thought: proper nutrition for growth. Begins around age 12 or 13 and develops through adolescence, fully Promoting Nutritional Health With a forming by age 25 (Piaget, 1969). Varied Diet Abstract Thinking: Ability to think abstractly and use deductive Vegetarian Diets- reasoning. Problem Solving: Glycogen Loading- Adolescents that Critical for solving school problems are into strenuous activity, need and everyday situations. Future more carbohydrates for energy. Planning: Adolescents can create hypotheses and assess potential consequences, such as deciding whether to attend college. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Promoting the Development of an unwanted sexual pressure and Adolescent in Daily Activities address misconceptions. Adequate sleep, hygiene, and Sexual Orientation: Adolescence is exercise are important health a time of exploring sexual education topics for adolescents as orientation, and support should be these become an adolescent’s offered for those coming out to their responsibility rather than the families. responsibility of the parent Safer Sex Education: Ensure adolescents know about - Dress and Hygiene contraception and safe sex - Care of Teeth practices, including information on - Sleep date rape and rape prevention, as - Exercise they are at high risk for date rape. Date Rape Awareness: Discuss the Common Health Problems of an risks of drugs like Rohypnol and Adolescent ketamine used in date rape. Adolescents who are intoxicated or Hypertension have amnesia for an assault may Poor Posture have unknowingly ingested such Body Piercing and Tattoos drugs. Fatigue Menstrual Irregularities Stalking Acne - Stalking involves repetitive, intrusive, Obesity and unwanted actions, such as persistent pursuit or threatening Concerns Regarding Sexuality and behavior, aimed at gaining attention Sexual Activity or inducing fear. Increased Sexual Activity and - Cyberstalking: This can also occur Risks: Due to societal acceptance of online, with behaviors like sending premarital sex, more adolescents unwanted emails or text messages. engage in high-risk sexual - Stalking in Adolescence: Stalking behaviors, increasing their exposure behavior can begin as early as to STIs and pregnancy. adolescence, with both males and Health Assessments: Routine females capable of being stalkers or health assessments should include victims. asking about sexual activity and - Prevention: Adolescents should be concerns about sexual risk cautious in situations where they behaviors. could be vulnerable to stalking and Counseling and Communication: report incidents to law enforcement Many adolescents want to discuss for protection, including seeking a sexuality but feel awkward. restraining order. Counseling can help them say no to Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Concerns Regarding Hazing or be a form of adolescent rebellion Bullying related to childhood adversity or - Bullying, which began violence. during school age can easily continue into adolescence stages of substance abuse and actually becomes more Experimentation- where they try serious because this can be drugs for the first time. the time the bullied child has regular use the ability to retaliate through self-destructive behavior or Types of Abused Substances school violence. Prescription and Over-the-counter - Hazing, a form of organized Drugs. - bullying, refers to demeaning Alcohol or humiliating rituals that Tobacco prospective members have Performance-Enhancing to undergo to join sororities, Substance Abuse fraternities, adolescent Marijuana. gangs, or sports teams Amphetamines. - To help prevent this from Cocaine happening to their child, urge Hallucinogens parents to be aware of what Opiates clubs or organizations their adolescent joins and what the requirements for membership are. Help adolescents make sound decisions about what type of hazing their organization advocates by asking them about the subject at health assessments. Concerns Regarding Substance Abuse - Substance abuse refers to the use of chemicals to improve a mental state or induce euphoria. This is so common among adolescents that as many as 50% of high school seniors report having experimented with some form of drug. Use of drugs occurs in adolescence from a desire to expand consciousness, peer pressure, or a desire to feel more confi - dent and mature; it also can Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Concerns Regarding Depression and Self-Injury - Self-Injury: Includes actions like cutting and suicide, with cutting more common in girls, sometimes starting in grade school. - Males have higher success rates, while females attempt more often (8:1 ratio). Suicides are most common in spring/fall and between 3 pm and midnight, linked to school stress and depression. Suicide is the third leading cause of death for 15- to 19-year-olds, though this may be underestimated due to misreporting by coroners. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻