HESI – Pediatrics Review

HESI – Pediatrics Review Growth and Development Description: Growth and development follow an orderly yet individual pattern. Nurses should assess growth and the emergence of developmental skills in all pediatric clients. Knowledge of cognitive abilities allows a nurse to adapt teaching to the level of the child. Knowledge of appropriate toys and interests of children at different ages enables the nurse to use play to facilitate the child's development and minimize problems caused by the hospitalization. I. Infant (Birth to 1 Year) A. Developmental milestones 1. Birth weight doubles by 6 months, triples by 12 months. 2. Birth length increases by 50 at 12 months. 3. Posterior fontanel closes by 8 weeks. 4. Social smile occurs at 2 months. 5. Head turns to locate sounds at 3 months. 6. Moro reflex disappears around 4 months. 7. Steady head control is achieved at 4 months. 8. Rolls from abdomen to back and back to abdomen at 5 to 6 months. 9. Plays peek–a–boo after 6 months. 10. Transfers objects from hand to hand at 7 months. 11. Develops stranger anxiety at 7 to 9 months. 12. Sits unsupported at 8 months. 13. Crawls at 10 months. 14. Fine pincer grasp appears at 10 to 12 months. 15. Waves bye-bye at 10 months. 16. Walks with assistance at 10 to 12 months. 17. Says a few words in addition to "mama" or "dada" at 12 months. 18. Explores environment by motor and oral means. B. Erickson's theory: Developing a sense of trust (trust versus mistrust) C. Nursing implications 1. During hospitalization, the infant's emerging skills may disappear. 2. If the parents are not able to be with the infant the baby may be inconsolable due to separation anxiety. 3. The nurse should plan to have the parents be part of the infant's care and should encourage them to do so. 4. Respect the infant's schedule at home by assessing and implementing components as possible. 5. Preparation and teaching should be directed to the family. However, the nurse should always speak to the infant and console the infant, especially while performing painful or stressful procedures. 6. Toys for hospitalized infants include mobiles rattles, squeaking toys, picture books, balls, colored blocks, and activity boxes. II. Toddler (1 to 3 Years) A. Developmental milestones 1. Birth weight quadruples by 30 months. 2. Achieves 50 of adult height by 2 years. 3. Growth velocity slows. 4. Appears to be bowlegged and potbellied. 5. All primary teeth (20) are present. 6. Anterior fontanel closes by 12 to 18 months. 7. Throws a ball overhand at 18 months. 8. Kicks a ball at 24 months. 9. Feeds self with spoon and cup at 2 years. 10. Daytime toilet training can usually be started around 2 years. 11. Two– to three–word sentences are spoken by 2 years. 12. Three– to four–word sentences are spoken by 3 years. 13. Own first and last name can be stated by 2 1/2 to 3 years. 14. Temper tantrums are common. B. Erikson's theory: Developing a sense of autonomy (autonomy versus doubt and shame) C. Nursing implications 1. Give simple, brief explanations before procedures, keeping in mind that a l-year-old does not benefit from the same explanation as that given to a 3–year–old. 2. During hospitalization, enforced separation from parents is the greatest threat to the toddler's psychological and emotional integrity. 3. Security objects or favorite toys from home should be provided for a toddler. 4. Teach parents to explain their plans to the child (e.g., "I will be back after your nap"). 5. Respect the child's routine and implement when possible. 6. Expect regression (e.g., bed–wetting). 7. Toys for the hospitalized toddler include board and mallet, push-pull toys, toy telephones, stuffed animals, and storybooks with pictures, depending on the reason for hospitalization. 8. Toddlers benefit from being taken to the hospital playroom when able, because mobility is very important