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NR 322-Exam 1: Review of Knowledge Principles of Growth & Development Growth and development follow a specific pattern:
1. Cephalocaudal: (head to tail) the process by which development proceeds from head downward through the body towards the feet 2. Proximodistal: (near to far) the process by which development proceeds from the center of the body outward to the extremities. 3. *Know your milestones 4. Stages & age ranges A. Newborn---------first 28 days of life B. Infant--------------birth-1year C. Toddler ----------1-3 years D. Preschool-------3-6 years E. School-age-----6-12 years F. Adolescent----12-19 years
Newborn (First 28 days of life) Trust vs. Mistrust Oral Stage
Growth and Development 1. General appearance: newborn’s head is one-quarter of the body length; the child is top heavy with short lower extremities. 2. Weight: 6 to 8 lbs. gains to 7 oz. weekly for the first 6 months 3. Height: 20 in.; grows 1 in. monthly for the first 6 months 4. Head circumference: 33 to 35 cm; head circumference is greater than chest circumference; posterior fontanel closes in 2 to 3 months and anterior fontanel closes by 12 to 18 months Reflexes (present at birth) 1. Moro: startle reflex elicited by loud noise or sudden change in position (strongest during first 2 mos. but disappears after 3-4 mos.)
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2. Tonic Neck: elicited when side infant lies supine and head is turned to one side the infant will assume a “fencing position” and legs are opposite direction (disappears by age 3-4 mos.) 3. Gag, cough, blink, pupillary: protective reflexes (persist throughout life) 4. Grasp: the infant’s hands and feet will grasp when the hand or foot is stimulated. (Palmar grasp lessens after age 3 mos. And plantar grasp lessens by 8 mos. of age) 5. Rooting: elicited when side of mouth is touched, causing the child to turn to that side (disappear at about 3-4 mos. but may persist for up to 12 mos.) 6. Babinski: fanning of the toes when sole of foot is stroked upward (disappears after age 1 yr.) Gross Motor: 1. Head Lag if prone on pillow, but able to move mon Fine Motor: 1. Hand predominantly closed at 1 month Sensory Development: 1. Hearing and touch well developed at birth Nutrition: 1. Breast Milk- best option for infant nutrition up to 1 year of age, micronutrients that are bioavailable (nutrients are available in quantities and qualities which makes it easy to digest as a newborn. Breast milk has a variety of immunologic properties that is found exclusively in human milk. Human milk has been shown to be affect to protect the newborn against respiratory tract infections and decreasing the incidence of hospital admission for respiratory tract illness, GI infections caused by enterococci, Otis media, allergies, atopy and type 2 diabetes 2. Formula (iron-fortified) closely resembles the nutritional content of human milk, recommended for the first 1st 6 months. No additional fluid required for the 1st 4 months of life after 6 month fluoridated water can be given especially of breast feeding ends. Honey should be avoided in the first 6 months because of risk of botulism Safety:
1. Infants up to 20 lbs. should be restrained in rear-facing car seat in the middle of the back seat of the car. 2. Keep side rails of crib 3. Never leave infant unattended on table, bed, bathtubs 4. Check temperature of bath water, formula, foods 5. Avoids giving bottles at naps or bedtime (may cause dental caries)
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6. Teach injury prevention: a) Aspiration of foreign objects b) Suffocation (plastic bags, strangulation) c) Falls d) Poisoning e) Burns (electric cords, wall outlets, radiators, pots and pans on stoves) f) Drowning Play: 1. 2. 3. 4. 5. 6. 7.
Provide black/white contrast or patterns for premature and newborn infants Hang mobile 8 to 10 inches from infants face Rocking and cuddling Music boxes, singing, tape players, soft voices Moving legs and arms while listening and singing Place unbreakable mirror in front of crib for infant to focus on their face Vocalization provide pleasure (smiling, cooing, laughing)
Immunization: 1. Hepatitis B: 1st (0-2 months) 2. Vitamin K 3. Erythromycin to eyes (maybe)
1. Newborn screenings & assessment; hearing (to assess in early hearing problems), vision( if premature or O2 requirements) A. History and physical B. Denver Development: to detect a potential development problem in young children, used to confirm suspicion of development delay as well as monitor children at risk for delay (start at birth to 6 year of age) C. Growth Chart (HC, Hgt and Wgt) D. Metabolic screening (PKU) E. Hearing acuity: Reaction to loud noise: moro reflex and blinking eye F. Visual acuity: observing infants ability to fixate and follow objects VS: start with respiration if baby is quiet, the pulse, temperature 2. Thermoregulation /newborn care: Wear hat on head, keep swaddled whenever possible, skin to skin, keep away from windows. 3. Primitive reflexes (when do they disappear): Start to disappear at 3 to 4 months 4. Nutrition: Breast milk ideal, but fortified formula 5. Immunizations (how administered):Vastus Laterus 6. Activity and play: Mobiles and cuddling 7. Safety & injury prevention: Never leave unattained when awake 8. What is normal for a newborn?