Nurs 629 Exam 2 Questions & Answers

Infant assessment and development - Answer ■ Proportional changes: weight, height, head, nervous system, chest ● Weight increases 6-8lbs, up to 20lbs in the 1st year of life ■ Posterior fontanelle closes by 2 months of life ■ Eye alignment ● Some children get cross eyed at times, but usually resolve close to 4 months ■ Red reflex should be symmetrical ■ The abdominal muscles do not close until 3 years of life ■ For boys: ● Both testicles are descended by 6 months ● Note any hydrocele ■ For girls: ● Assess for labial adhesions ■ Musculoskeletal ● Leg fold symmetry ● Hip abduction ○ To make sure there are no hip clicks. ○ Barlow maneuver and Ortolani maneuver will assess for hip click ● Foot shape and flexibility ■ Skin: rashes ● Common - infantile eczema ● Lesions ● Bruising or burns ○ Mongolian spots are normal ■ Feeding difficulties ● Regurgitation and spitting-up ○ Acid reflux is prevalent d/t sphincters are not mature ○ Encourage parents to break up feeding after ~15mL. burp the child and then return to feeding ○ Spitting up can be large amount and it is normal for it to come out of the nose ● Colic ○ Common during newborn period, usually resolves by 6 months of life Toddler development - Answer ■ Toddler ● Weight gain 4-6lbs per year ● Height: 3 inches per year ● Visual acuity 20/40 ● Brain growth is 75% completed ● Respiratory tract is rapidly developing closer to that of an adult, but still anatomically is much smaller. ● Immune system is weakened, increased risk for any kind of complications ● Measurements: height, weight, head circumference up until 2 years of age ● Physical exam ○ HEENT ■ Anterior fontanel - make sure it is getting smaller and closing ● It usually closes by 18 months - 2 years ■ Screen for strabismus ■ Look for tooth eruption and/or dental decay ● If by 18 months they do not have a first tooth eruption, order x-ray ○ Musculoskeletal ■ Assess for hip dysplasia, gait, out-toeing, bowlegged ○ Neurological ■ Deep tendon reflex ■ Babinski Preschool development and assessment - Answer ● Weight gain 5 lbs/year ● Height 2-3 inches/year ● Head circumference, no needed since the anterior fontanelle should have closed 18 months - 2 years ● Screening: vision and hearing School age children development/ assessment - Answer ■ Slow but steady growth ● Height: increases 2 in/year ● Weight: 4 ½ - 6 ½ lbs/year ● Skeletal lengthening & fat diminution ● Strength increases yet muscles remain functionally immature ● Start to lose those primary teeth and develop their permanent teeth ● GI system, cardiovascular system becomes that of an adult ● Bladder capacity increases ● Immune system improves ● Bones become hard and they are not as pliable as it was in the early ages ● Prepubescent ● Vital signs: approaching adult values by the end of the school age ○ Blood pressure ○ Vision screening ○ Hearing screening Adolescence development and assessment - Answer ■ Extremities grow faster than trunk and head ■ Facial proportions change ● Nose and chin enlarge first ■ Figure changes ● Pelvis enlarges in females ● Shoulders enlarge in male ■ Subcutaneous fat increases ■ Increased function of sweat glands ■ Increased function of sebaceous glands ■ Puberty begins ● Girls: 9-13 years ● Boys: 11-14 years ■ Girls ● Breast enlargement begins 8-13 years ● Axillary hair develops 11-13 years ● Pubic hair develops 10-12 years ● Menarche begins 10-16 years ■ Boys ● Genital enlargement begins 9-13 years ● Axillary hair begins 12-14 years ● Facial hair develops 11-14 years ● Pubic hair develops 12-15 years ■ Physical Exam ● Vitals, height & weight with BMI ● Head to toe examinations ○ Acne ○ Athletic teens may have lower heart rate ○ Changes related to puberty - including Tanner staging Neonate milestones and red flags - Answer Milestones Strong reflexes. Minimum of 6-8 bowel movements per day. Urinates 8 times a day Red flags Jaundice at birth (hemolysis). High-pitched cry. Irritable. "Floppy" (hypotonic). Poor reflexes 3 month old mile stones and red flags - Answer Milestones Smiles. Able to coo. Makes gurgling sounds. Can hold head up. Starts to recognize parents. Crawls. Red flags Inability to hold head up. Avoids eye contact. Floppy. 6 month old milestones and red flags - Answer Milestones Sits up without support. Rolls in both directions (front to back, back to front). Says single-syllable sounds "ba, da, ma." Tries to get things out of reach by "raking" (uses palms to reach). Red flags Lack of babbling. Does not laugh. Inability to turn head past midline (180 degrees). 9 month old milestones and red flags - Answer Milestones Pincer grasp (fine motor). Plays "pat a cake" and "peek-a-boo." Says "good-bye." May be afraid of strangers (can be clingy). Can stand holding on. Red flags Infantile reflexes strong. Persistence of primitive reflexes (startle, fencing, etc.). does not babble. Does not bear weight on legs with support. Unable to site with help. 1 year milestones and red flags - Answer Milestones Supports own weight. Walks with hands held. Parallel play. Separation anxiety. Can "climb" stairs by crawling up or down. Starts to cruise (moves from one piece of furniture to the other for support). Red flags Unable to support own weight. Lack of babbling. No response to smiles, poor eye contact, loss of previously learned skills (autism). 2 years milestones and red flags - Answer Milestones Walks. Runs. Climbs stair up and down on own by holding onto handrails. Speech mostly understood by family. Follows two or three step instructions. Copies a line. Red flags Unable to speak meaningful two-word "sentences." Does not understand simple commands. Loss of speech, social skills, previously learned behaviors and/or does not say words by 16 months (autism). 3 years old milestones and red flags - Answer Milestones Speaks 3-4 words sentences; understood by strangers. Copies a circle with a crayon or pencil. Rides tricycle. Builds towers of more than 6 blocks. Runs and climbs easily. Red flags Speech hard to understand or unclear speech. Unable to understand simple commands. Fall down often. Does not speak in sentences. No eye contact. Losses skills he or she once had. 4 year old milestones and red flags - Answer Milestones Draw a cross. Draws person with three body parts. Plays "Mom: and "Dad." Hops and stands on one foot up to 2 seconds. Cooperates with other children. Names some colors and some numbers. Red flags Unable to speak in full sentences. Inability to skip, run, hop. Cannot put on clothes without help. Unable to play with other kids. Unable to follow three-part commands. 5 year old milestones and red flags - Answer Milestones Can draw a person with six body parts. Counts 10 or more things. Is aware of gender. Speaks clearly. Red flags Unusually withdrawn. Not active. Trouble focusing on one activity for more than 5 minutes. Tanner stage 1 girls - Answer -Preadolescent, no pubic hair, other than fine hair similar to abdomen -No breast dev. Tanner stage 2 girls - Answer -sparse growth of long slightly pigmented, downy, straight, or slightly curly pubic hair -small area of glandular tissue w/ surrounding areola that begins to widen around age 10-11 Tanner stage 3 girls - Answer Breast enlargement without separate nipple contour Pubic hair fills out but is straight ● Age 13-14 Tanner stage 4 girls - Answer Areola and nipple projects as secondary mound Pubic hair is more coarse - no triangle yet ● Age 14-15 Tanner stage 5 girls - Answer -breasts reach final adult size, areola returns to contour of surrounding breast, with projecting central papilla -pubic hair distribution similar to adults, covering pubis medial thighs -15+ Tanner stage 1 boys - Answer preadolescent no pubic hair Tanner stage 2 boys - Answer -Sparse growth of long, slightly pigmented pubic hair at penis base -Penis slightly enlarging or no enlargement -Testes and scrotum larger, reddened, and altered in texture -Age 11-13 Tanner stage 3 boys - Answer -darker, coarser, curlier pubic hair spreading across pubis -penis enlarging in length -testes scrotum further enlarging -Age 13-14 Tanner stage 4 boys - Answer -pubic hair is curse and more curly, but not quite adult-like -enlarged penile length -enlargement of scrotum and increased pigmentation -Age 14-15 Tanner stage 5 boys - Answer Adult genitalia Age 15-16