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Lecture 2

NURSE-UN 1255 Lecture Notes - Lecture 2: Child Development Stages, Fetal Alcohol Spectrum Disorder, Intravenous Therapy

Nursing - Undergraduate
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Week 7: Well child continues
1) Toddlerpreschool
a) Ages
i) Toddler: 1-3 years old
ii) Preschool: 3-6 years old
iii) Leading cause of death (1-4yo) is unintentional injuryMVA
iv) Use stories, dolls and books to communicate, parallel play
b) Health supervision visits for Well Visits immunizations, developmental milestones, and regular growth/development
i) 15 months - immunization
ii) 18 months- immunization
iii) 24 months, 2 ½ years (30 months)
iv) 3 years (36 months), 3 ½ years
v) 4 years & 5 years (booster), 6 years
c) Normal vital signs still slightly higher than adults
i) HR: 70-110 bpm
ii) RR: 20-30 bpm
iii) Temperature: 98-99F
iv) Bp: 90-105/55-70 (under 2, do not do BP for well visits, only check on high risk kids- congenital heart issue and renal
disease, and in the hospital)
v) Height: 3 inches/year
vi) Weight: 4-6 lbs/year
vii) Head circumference (measured until 3 yrs old)
viii) BMI: 15.9 (tells % body fat)
(1) Start with 2 yrs old
(2) With kids, we want to know % (not a number, like adult BMI)
d) Developmental screening
i) Delays
(1) Prevalence
(a) 17% of children have a developmental delay, < half are identified prior to starting school
(b) Early intervention (OT, PT, ST) can stimulate developmental milestones
(2) Causes
(a) Genetic syndromes
(b) Prematurity
(c) Perinatal infections/toxin exposures (fetal alcohol syndrome)/hypoxia
(d) Hypoxia during delivery
(e) Vision impairments
(f) Hearing impairments
(g) Lead exposure developmental delays & 󰁙 in I.Q.
ii) Screening tools
(1) Ages & Stages, Bayley Infant Screener, Infant development inventory, Denver Developmental Screening
(2) Parents’ Evaluation of DevelopmentUsed often, CDC Developmental MilestonesFREE
(3) *Learn the Signs. Act Early*
iii) Screening and services
(1) Gross motor skills: movements that use the large muscles in the arms, legs, torso and feet (standing, walking,
running, jumping) PT
(2) Fine motor skills: movements that use the small muscles of the fingers, toes, wrists, lips & tongue (grabbing using
thumb and index finger, hand to mouth, eating) OT
(3) Oral/motor skills: language & communication, eating ST
(4) Social/emotional (eye contact, smiles, interaction) SE
(5) Cognitive (learning, thinking, problem solving) SE
(6) EIP (Early Intervention Program) provides PT, OT, ST and SE teacher
(a) PT: Physical Therapy; OT: Occupational Therapy; SP: Speech Therapy; SE: Special Education
iv) Developmental milestones
(1) 12 months: crawls, pulls to stand, stands alone, can sit down from standing position, puts block in a cup, can turn
pages in a book, says 1 word other than mama and dada understands simple commands
(a) social: shy with strangers, cry when parents leave, shows fear, hands you book to read, repeats sounds to get
attention, helps with getting dress, play peak a boo
(b) language: respond to simple request, shake head for no, say mama and dada, tries to say words you say
(c) cognitive: finds hidden things, copies gestures, use thing correctly like brush and cup, bangs together items,
poke with index finger, follow direction like pick up toy
(d) movement: get into sitting position without help, pull up to stand, may take steps holding on, stand alone
(2) 18 months

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Week 7: Well child continues
(a) Walks up and down stairs holding on, runs, builds tower of 2-3 cubes, says 15 or more words, scribbles, self
feeds (fingers), follows one step commands, points to 6 body parts
(3) 2 years:
(a) Walks up and downstairs without help, can kick a ball forward, builds tower 6 cubes, feeds doll, says about
50 words or more, uses 2 word phrases, uses pronouns “I”, “me”, brush teeth with help, helps dress , uses
spoon, speech is 50% intelligible
(4) 3 years: -- tricycleQ was if they are 4 what is it a concern that they cannot doit was ride tricycle, not that they
can’t write their name or draw 10 body parts
(a) Pedals tricycle, broad jump, 3 to 4-word sentences, knows 2 actions, speech 75% understandable, build tower
of 10 cubes, thumb wiggle, imitates horizontal line, wash and dry hands, put on T shirt
(5) 4 years:
(a) Hops, speech all understandable with complete sentences, follows 3 step commands, copy cross, draw person
2-4 parts, brush teeth no help, dress no help, can count 4 objects
(b) social: enjoy new things, play mom & dad, creative, prefer to play with kids, cooperates with children
(c) language: knows to use he/she, sing itsy bitsy spider, tell story, can say first and last name
(d) cognitive: name color and numbers, understand counting, time, same and different, use scissors
(e) movement: hop and stand on one foot, catch bounced ball, pour, cut, and mash food
(6) 5 years:
(a) social: want to please friends, wants to copy friends, agree with rules, sing dance, act, aware of gender, tell
what’s real and pretend, show independence
(b) language: speak clearly, tell simple story with full sentences, use future tense, say name and address
(c) cognitive: count 10 things, draw person, print some letters & No., copy triangle knows about money & food
(d) movement: do somersault, use fork and spoon, go to toilet on their own, swing and climbs, hop, maybe skip,
stand on one foot for 10 seconds or longer
v) CT: A 2-year-old patient walks on his tiptoes, has repetitive speech and little eye contact.
(1) Tiptoes (sensation) and only repeating what is said to them or what they hear (repetitive speech) or doesn’t have
history of expressive language could be Autism
e) Nutritional assessment
i) Toddlers
(1) Need fewer calories per day than infants
ii) Preschoolers
(1) Need 90 cal/kg: average 1800 cal/day
(2) 3 meals and 2-3 snacks per day
iii) Avoid juices, sodas
iv) NO > 2 cups of milk per day
v) Food jags (eats only a few foods)
vi) No force feeding
vii) Mealtime should be a pleasant experience
viii) CT: Sophia only likes to drink milk. What’s the concerns?
(1) Too much milk!
(2) Ca++ interferes with iron absorption, so the child is at risk for iron deficiency
ix) How to communicate this to parents?
(1) Maybe 1 cup of milk with breakfast & 1 with dinner, and water for the rest of the time.
f) Physical assessment
i) Allow “warm-uptime prior to touching child
(1) Allow toddler to sit on caregiver’s lap
ii) Remove only clothing needed for each part of assessment
iii) Proceed from LEAST intrusive to MOST intrusive
iv) Give choices when possible
v) Primary dentition (20 teeth) completed by 30 months# teeth + 6 = # months old the child is.
g) Anticipatory guidance
i) Safety!
ii) Sleep pattern
(1) 8-13 hours of sleep each day
(2) Naps: 16-20 months the morning nap is eliminated
(a) Change to one long afternoon nap (1-3 hours)
(3) Nightmares
(a) Occur during early sleep
(4) Night terrors
(a) Occur during the second half of sleep
(b) Due to active imagination and ↑ dream state
(c) ↑ nightmares can be related to stress or anxiety

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Week 7: Well child continues
iii) Oral health
(1) Dental caries in primary teeth has ↑ for children 2-5 years of age due to juice
(2) Preventive care
(a) Brush twice daily (soft brush, pea sized fluoride toothpaste)
(b) Limit sweet drinks and snacks Visit the dentist every 6 months
(c) Visit the dentist every 6 months
iv) Mental health
(1) Temper Tantrums- their way of communicating
(a) Common in toddlers
(b) Screaming, crying, kicking episodes
(c) Do NOT give attention to it as long as safe but be sure remain calm as the parent
(d) Toddlers way of expressing anger
(e) Should ↓ with age
(2) Tantrum tips
(a) Help avoid tantrum with distraction at early signs
(b) Separate child from others (avoids attention getting)
(c) Keep child safe
(d) Remain calm (be a role model)
(e) Do not give in (if you stop crying I’ll give you candy)
(f) Reward improvement of behavior control (it was good that you were able to calm down on your own)
(3) Tantrums communicate
(a) “I want” something
(b) This is their form of communication
(c) Happens when they are tired/hungry or when they are in a place they do not want to be.
v) Play toddler
(1) Parallel play
(2) Imitation
(3) Push-pull toys, balls, riding toys, finger paint, crayons, puzzles with large pieces, blocks
vi) Toilet training
(1) Signs that child is ready…
(a) Diaper is dry for > 2 hours
(b) Child is able to pull pants on and off
(c) Imitates parent/sibling in the bathroom
(d) Is able to follow instructions
(e) Shows interest toileting activities
(2) Most children are ready to begin toilet training at around 2 to 2 ½ years old.
(3) How to begin…
(a) Have child select their own “big boy” or “big girl” underwear
(b) Place a potty chair in the bathroom specifically for the child
(c) Child should be placed on the chair at regular intervals
(d) Reward and praise successes
(e) If child does not cooperate, wait a few weeks and try again
(i) Stress can cause a delay
vii) Lead levels
(1) NY requirements
(a) Lead levels must be drawn on every child at 1 and 2 years of age
(b) Older if child eats paint chips, plaster or soil, have a sibling with a high lead level
(2) Lead toxicity
(a) Children get lead exposure by swallowing or breathing in lead
(b) Lead is found in dust from lead paint
(c) Lead paint was banned in 1978
(d) Lead poisoning can cause growth problems, behavior problems and difficulty learning
(3) If child lives in a home built before 1978
(a) Wash children’s hands and toys often
(b) Mop floors and use damp cloth to clean windowsills (often)
(c) Repair any peeling paint
(d) Be careful that children do not eat or play with paint chips, plaster, dust or dirt
(4) Other sources of lead
(a) Water keep water running for 1 minute before use
(b) Use only cold water for drinking, cooking and preparing infant formula
(c) Use lead-free dishes and pots (seen in pottery from Latin America, Middle East and India)
(5) Lead Levels (>10 is bad)
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