Hesi - Maternity Review. Study Guide.

Erickson … Psycho-Social Development • 0-1 yr (Newborn) … Trust vs. Mistrust • 1-3 yrs (Toddler)… Autonomy vs. Doubt and Shame … Fear intrusive procedures - Security objects good (Blankies, stuffed animals) • 3-6 yrs (Pre-school) … Initiative vs. Guilt … Fear mutilation – Band-Aids good • 6-12 yrs (School Age) … Industry vs. Inferiority… Games good, Peers important … Fear loss of control of their bodies • 12-19 yrs (Adolescent) … Identity vs. Role Confusion … Fear Body Image Distortion • 20-35 yrs (Early Adulthood) … Intimacy vs. Isolation • 35-65 yrs (Middle Adulthood) … Generativity vs. Stagnation • Over 65 (Older Adulthood) … Integrity vs. Despair Piaget … Cognitive Development • Sensorimotor Stage (0-2) … Learns about reality and object permanence • Preoperational Stage (2-7) … Concrete thinking • Concrete Operational Stage (7-11) … Abstract thinking • Formal Operational Stage (11-adult) … Abstract and logical thinking Freud … Psycho-Sexual Development • Oral Stage (Birth -1 year) … Self gratification, Id is in control and running wild • Anal Stage (1-3) … Control and pleasure wrt retention and pooping – Toilet training in this stage • Phallic Stage (3-6) … Pleasure with genitals, Oedipus complex, SuperEgo develops • Latency Stage (6-12) … Sex urges channeled to culturally acceptable level, Growth of Ego • Genital Stage (12 up) … Gratification and satisfying sexual relations, Ego rules Kohlberg … Moral Development • Moral development is sequential but people do not aromatically go from one stage to the next as they mature • Level 1 = Pre-conventional … Reward vs. Punishment Orientation • Level 2 = Conventional Morality … Conforms to rules to please others • Level 3 = Post- Conventional … Rights, Principles and Conscience (Best for All is a concern) Bench Marks • Birth wt doubles at 6 months and triples at 12 months • Birth length increases by 50% at 12 months and doubles at 4 years • Post fontanel closes by 8 wks • Ant fontanel closes by 12-18 months • Moro reflex disappears at 4 months • Steady head control achieved at 4 months • Turns over at 5-6 months • Hand to hand transfers at 7 months • Sits unsupported at 8 months • Crawls at 10 months • Walks at 10-12 months • Cooing at 2 months • Monosyllabic Babbling at 3-6 months, Links syllables 6-9 mo • Mama, Dada + a few words at 9-12 months • Throws a ball overhand at 18 months • Daytime toilet training at 18 mo - 2 years • 2-3 word sentences at 2 years • 50% of adult Ht at 2 years • Birth Length doubles at 4 years • Uses scissors at 4 years • Ties shoes at 5 years • Girls’ growth spurt as early at 10 years … Boys catch up ~ Age 14 • Girls finish growing at ~15 … Boys ~ 17 Nursing implications for toddlers (1-3 years)  Temper tantrums are common and normal behavior  Give simple brief instructions of procedures  Forced separation from parents is their biggest threat  Security or transitional objects should be encouraged  Expect regression (bed wetting)  Autonomy should be provided with choices Nursing implications for the preschool child (3-6 years)  Child stands erect with a more slender posture  Thinking is egocentric & concrete  A child learns sexual identity and masturbation is normal  Imaginary playmates & fears are common  Explain the child did not cause the illness and painful procedures are not punishments  Therapeutic medical play with the equipment  They need to be prepared for procedures and understand what is going to be “fixed”  Pictures and dolls can be used Nursing implications for the school age child (6-12)  Maintaining school activities and social relationships with peers is important  They learn by verbal explanations, pictures, books, and handling equipment  Privacy & modesty are important and should be maintained Nursing implications for the adolescent (12-19 years)  They can problem solve & use abstract thinking  Time when they form their own identity  Rebelling against the family is common  Teaching should include time with out the parents & if parents are present all questions should be directed toward the adolescent  The age for making own medical decisions ranges from 7-14 years  The major concern is body changing and any procedure that will alter their appearances Age Appropriate Toys Infants birth to 1 year (solitary play)  Mobiles  Rattles  Squeaking toys  Picture books  Balls  Colored blocks Toddlers (1-3 years) (parallel play)  Boards and mallets  Push-pull toys  Toy phones  Stuffed animals  Story books with pictures Preschoolers (3-6 years) (associative play)  Coloring books  Puzzles  Cutting and pasting  Dolls  Building blocks  Clay School Age (6-12 years) (corporative play)  Board & card games  Hobbies and/or video games  Puzzles Immunizations (Hector Rayes did have pretty popular muscles varying high /school )  Hep B (3) o Contraindicated in persons with anaphylaxis to backers yeast  RV Rotovirus (3) o IS a LIVE vaccine o Most common cause for diarrhea in infants & children  Dtap (diphtheria, tentanus, pertussis (5) o Administer separate site o Not given to kids past there 7th birthday o Contraindicated in kids with seizures or encephalopathy  HIB Hameophilus Influenza type B (4) o Protects against epiglotitis, bacterial meningitis, & septic arthritis o Given IM o No contraindications  PCN Pneumococal (4) o Used to protect against disease caused by bacteria, streptococcus  IPV Inactivated polio virus (4) o (OPV) Oral polio vaccine is a live vaccine that was given in 2000, OPV can not be given to kids with HIV o IPV is a dead vaccine o Given sub-q or IM in a separate site o Contraindicated in people with an allergy to neomycin or streptomycin  MMR Measles, mumps, rubella (2) o Contraindicated in those allergic to eggs, neomycin, have immunodefiencies, or pregnant o Is a LIVE vaccine o Can be given to people with HIV & breast feeding mothers o Only injection Given Sub-q not IM o Child may develop a rash 2 weeks after administration  Varicella (2) o Protects against chicken-pox o Can not be given in children with HIV o Give MMR & varcella on the same day or within 30 days but in separate sites  Hep A (2)  Tdap (x1 q 10 years , between 11-12)  HPV (between 11-12) adminster the 2nd dose 1-2 months after the 1st & the 3rd dose 6 months after the 1st  MCV4 Meningococcal (between 11-12)  Influenza (IIV;LAIV) Flu- is given at 6 months of age then annually o Is a LIVE vaccine o Contraindicated in persons with an allergy to eggs The common cold is NOT an contraindication for immunizations Avoid Live Virus vaccines while taking prednisone (MMR, Flu, Varicella, RV Rotavirus, & Oral Polio Vaccine, Poliovirus the IPV is a dead vaccine) Hepatitis Hepatitis: -ends in a VOWEL, comes from the BOWEL (Hep A) Hepatitis B=Blood and Bodily fluids Hepatitis C is j