PEDS HESI HINTS, UPDATED

PEDS HESI HINTS, UPDATED-Growth and Development - Client safety is the hallmark of nursing. The fundamental components of nursing practice include nursing process integrated w/ caring, communication, and spirituality, teaching, and learning as well as documentation of the integration of each of these elements - Erikson (Psychosocial) – TM,AS,IG,II,IRC,II -TMASIGIIIRCII o Trust vs mistrust (birth-1 year) ▪ Having parents hold their child while in the hospital is an excellent means of building the trust relationship o Autonomy vs shame and doubt (1-3 year) o Initiative vs guilt (3-6 year) o Industry vs inferiority (6-12 year) ▪ Academic performance  sense of industry = completing hw, staying on track w/ classmates o Identity vs role confusion (12-18) o Intimacy vs isolation (18+) - Piaget (cognitive) - SPCF o Sensorimotor period (birth-2 year) o Preoperational thought (2-4 year) o Concrete operation (7-11 year) o Formal operation (11-15 year) - Kohlberg (moral) NE,PO,IH&CR, GBGG &LO, SC & PP & UP) o Infancy - Naiveté and egocentricism o Toddler - Punish-obedience orientation o Early childhood - Instrumental hedonism and concrete reciprocity o Middle - childhood Good boy or good girl orientation, Law and order orientation o Adolescence - Social contract orientation, Personal principle orientation, Universal principle orientation - Denver developmental test o Evaluates children from 1mo-6 years: gross motor skills, fine motor skills, language development, and personal/social development - Infant (birth  1 year) o Birth weight DOUBLES by 6 months, TRIPLES, by 12 months (if baby was born 9lbs, by 6 months, they would be 12lbs and by 1 y/o they would be 18lbs) ▪ Newborns can lose up to 10% of their weight w/o concern, but should regain their birth weight by 2 weeks of age o Newborn vaccine: Hep B  birth-2 months (usually given prior to discharge) o Birth length INCREASES by 50%/doubles by 12 months o Posterior fontanel closes in 2-3 months, anterior fontanel closes in 12-18 months o Heart rate: 110-160 (birth-1mo) o Anticipatory guidance ▪ Separation anxiety (begins around 6 months to 30 months): if parents are not able to be w/ the infant (ex: hospitalization), baby may be inconsolable ▪ Aspiration is a common cause if injury/death at this age – often find small things on the floor and put them in their mouths (older siblings often responsible for leaving around small objects) o Nutrition ▪ Infants should be started on vegetables prior to fruits. The sweetness of fruits may inhibit infants from taking vegetables ▪ Full term infants have iron stores that last approx. 4-6 months ▪ Premature infants have iron stores form the mother that last approx. 2 months, so it is important to introduce an iron supplement by 2 months of age o Hospitalization/nursing implications ▪ Emerging skills may disappear ▪ Plan & encourage to have parents as part of infant’s care • Infants are more secure when in proximity to the parents – the parent’s lap = excellent place to assess the child ▪ Prep and teach family, but speak & console infant (esp. during pain/stress) ▪ Toys: mobiles, rattles, squeaking toys, picture books, balls, colored blocks, and activity boxes (ex: musical rattle  infants have short attention span and enjoy auditory/visual stimulation ▪ The nurse should not deliver more than 1mL/injection to a 6mo old ▪ Medications should never be mixed in a large amount of food/formula b/c you can’t be sure child will take the entire feeding ▪ Formula decreases the absorption of iron - Knowledge of normal growth and development Is used to evaluate interventions and therapy o Ex: what behavior would indicate that thyroid hormone therapy for a 4 month old is effective? (what milestones are accomplished at 4 months?) o Head control – milestone is met? indicates replacement therapy is adequate for growth - Toddler (1-3 years) o Birth weight QUADRUPLES by 30 months, achieves 50% of adult height by 2 y/o o Varicella vaccine o Anticipatory guidance ▪ Engage in parallel play  play alongside child, but rarely engage in activities w/ the other child ▪ Freud/Erickson  toilet training is the essential event that must be mastered by the toddler ▪ Very egocentric, do not consider needs of others (children) o Hospitalization/Nursing implications ▪ Simple explanations right before procedures (1 y/o vs 3 y/o explanations differ) ▪ Enforced separation from parents (hospitalization) = greatest threat to toddler’s physiological/emotional integrity (teach parents to tell child they’ll be back!) ▪ Common stressors of the hospitalized toddler • Interrupted routine, sleep pattern disturbances, fear of being hurt ▪ Very important to maintain a child’s home routine when parents are present and when not – increase child’s sense of security and decrease anxiety ▪ Provide security objects/favorite toys from home ▪ Respect & implement routine as much as possible ▪ REGRESSION (aka bedwetting) ▪ Toys: board and mallet, push-pull, toy phones, stuffed animals, storybooks w/pictures – playroom if able (mobility is important to development) ▪ Very basic explanations ▪ Toddlers learning to name body parts/concerned about their bodies ▪ Autonomy: provide guided choices when appropriate, allow to participate in actions of which they are capable - Preschool (3-6 years) o Gains 5lbs/year and grows 2.5 to 3 inches o Posture: erect, more slender o Vision: 22/20 o Respirations: 20-30bpm o Runs, jumps, skips, hops, establishes handedness, and learns colors and shapes. o 3 y/o: tricycle o Falls: common injury o 4 y/o: use scissors  also has aggressiveness o 5 y/o: ties shoelaces  aggressiveness becomes independence) o Learns sexual identity (curiosity, masturbation – common) o Imaginary playmates and fears = common o Literal thinkers (ex: child’s parents say Grandpa is in heaven, so she will think they are in heaven when they are at his funeral) o Implications/hospitalization ▪ Emphasize understanding of child’s egocentricity • Believe abuse/illness is their fault and should be reminded they are not bad people ▪ Explain they did not cause illness and pain/procedures are not punishment ▪ Answer child’s questions at child’s level (simple words they understand) • What is/what is not going to be “fixed” • Concrete/Simple explanations/basic pictures = helpful • Understand time in relation to events (ex: nap time) • Let child handle equipment/models of the equipment ▪ Therapeutic play/medical play  helpful for child to act out their experiences • Enjoy games, good way to elicit their assistance/cooperation during a procedure ▪ Fear of mutilation = common • Bandaid – helpful in restoring body integrity • Common response is to cry/protest during an immunization ▪ Toys: coloring books, puzzles, cutting and pasting, dolls, building blocks, clay and toys that allow the preschooler to workout hospitalization procedures - Use facts and principles related to growth and development in planning teaching interventions o Ex: what task could a 5 y/o w/ diabetes expect to accomplish by him or herself? o Let the child choose injection site, gives them a sense of control - Knowledge of normal growth and developmental milestones are important in the delivery and care of an infant. If there appears to be a discrepancy in the infant’s development, it’ll warrant HCP to further investigate possible cause of delay - School-age (6-12 y/o) o Normal for girls to grow taller/gain more weight at this time