Human Growth and Development Quiz Two Notes
Human Growth and Development Quiz Two Notes NURS 1430
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This 21 page Class Notes was uploaded by Aliyah Becker on Sunday January 31, 2016. The Class Notes belongs to NURS 1430 at Saint Louis University taught by Dr. Nina Westhus and Janice Palmer in Fall 2015. Since its upload, it has received 29 views. For similar materials see Human Growth and Development in Nursing and Health Sciences at Saint Louis University.
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Date Created: 01/31/16
Neonate and Infant Neonate Birth to 4 weeks Primary Needs First Week of Life Food Sleep Warmth Nurturing Security Neonate/Infant Size and Appearance Weight Average: 7 ½ pounds o Average Male: 7.8 pounds o Average Female: 7.5 pounds Double their weight = 56 months Triple their weight = one year Weight Lose 10% of their body weight o Loss of fluids o Gain weight ~5 day o Back to birth weight by 10 15 day Length Average 20 inches (~53 centimeters) ~1 inch per month (1 year) ~1 ½ times birth length (1 year) o (~30”) Head and Chest Circumference Head Circumference = 12.5 – 15.5 inches Chest Circumference = 1 inch less than head circumference at birth Body Mass Index Relationships between height and weight Charts are age and gender specific Growth charts = most important tool for assessing somatic growth Proportions Head o ¼ body length o Receding chin Easier to nurse o Gain weight ~5 day th th o Back to birth weight by 10 15 day Changes in Proportions of the Human Body during Growth Later growth Head is smaller in relation to rest of body Physiologic Cardiovascular System Heartbeat = fast and irregular Blood Pressure = does not stabilize until 10 days of age Respiratory Birth trauma anoxia or hypoxia Immature = 1/10 air sac adult st Obligatory nose breathers 1 few months Irregular respiratory rate at birth o Increase respiratory rate at birth 3040 breaths per minute o Decrease respiratory rate over first year 2030 breaths per minute Gastrointestinal System Meconium = first stool Matures somewhat after 23 months o Chew, hold, and spit out food Extrusion reflex Stomach capacity increases 23 months sucking reflex replaced by voluntary swallowing Peristalsis slows down and reverses less by 8 months Stools more formed Baby spits up less Colic Teeth erupt ~ 6 months – begin cleaning 2 months = 2 stools 4 months predictable interval between feeding and bowel movement Breast fed = soft semiliquid, light yellow Formula = brown and formed Liver not functionally mature until 1 year Urinary System Structural components present at birth Ureters short Bladder close to abdominal wall Immature renal function until 2 years 1 void within 24 hours Bladder empties when stretched 15 mL Thus, may have 20 voids per day Immune System Phagocytosis = mature Inflammatory response = inefficient, unable to localize infection Antibody production = from mom then develops from exposure Red Blood Cells, Hg, and White Blood Cells High at birth Red blood cells and Hg decrease after 23 months Red blood cells and Hg gradually increase erythropoiesis begins Maternal Iron stores present 56 months May have Iron deficiency anemia = 6 months White Blood Cells high at birth o Decline to adult levels by 1 year Muscular / Skeletal Tissue Birth = muscle tissue wellformed Growth = increase in size As size increases, strength increases (growth hormone, thyroxine, insulin) Need continual stimulation to developstull function and strength Skeletal system = ossification over 1 year Endocrine System Functionally immature Child susceptible to stress o Affects Fluid and electrolyte imbalance Glucose concentration Amino acid metabolism o 1 18 months pituitary gland, adrenal cortex, and pancreas do not function well together Eccrine (sweat glands) Ineffective thermal regulation Inability to shiver and perspire Thermal regulation develops during infancy Skin Structures = present – function immature Epidermal layers permeable = greater fluid loss Sebaceous glands very active o Milia, cradle cap o Decrease activity during infancy Apgar Scoring System Physical status of newborn At 1 and 5 minutes o Heart rate o Respirations o Muscle ton o Reflex irritability o Color Brazelton Neonatal Behavioral Assessment Scale Neurological and behavioral test to measure neonate’s responses to the environment o Motor organization o Reflexes o State changes o Attention and interactive capacities o Central nervous system instability Neonatal Screening Correctable Medical Conditions PKU Galactosemia Hypothyroidism States of Arousal Infants physiological and behavioral status at a given moment in the periodic daily cycle of wakefulness, sleep and activity Indeterminate State Transition from one state to another Sleep Sleep patterns are unique to each infant Newborns sleep 1620 hours o Range 1021 hours 1 month year olds sleep longer at night 6 week year olds may sleep 6 hours at night 4 months closer to adultlike sleep patterns Ex: Kipsigis culture in Africa o Sleep with mom, feed on demand o Rarely sleep longer than 3 hour stretch Sleep pattern changes to coincide with day and night Naps become shorter until eliminated (morning nap eliminated first) 78 months sleep 8 hours, without awakening 1 year = 1214 hours a night, 14 hours a day Location Consistent place Full size crib when active Crib slats (2 ½ inches apart) Crib pad Tightly fitting mattress Light covers Night Waking Wait a few minutes Pat child and speak softly Continued crying = unmet needs Shared Sleeping Variations across cultures o Share bed with mom o Sleep in crib Same room as parents or separate room US crib, separate room o Mayan culture, Guatemala sleep same bed mom until sibling born, then with older sib Some Child Experts Promote breast feeding Respond to babies cries quickly Detect potential dangerous breathing pauses Early Physical Development Is extensive 1 of 2 periods of rapid physical growth Principles of Development: Cephalocaudal Growth occurs from top down Head disproportionately large Principles of Development: Proximodistal Growth occurs from center of body and moves outward extremities Limbs grow faster than hands and feet Upper arms and legs forearms and forelegs hands and feet fingers and toes Whole hand as unit before several fingers Physical Characteristics: Neonate Fontanels Witch’s milk o Swollen breasts boys and girls Blood tinged vaginal discharge of girls Swollen genitals Neonate: Skin Thin Delicate Usually mottled Pink to reddish – ruddy when cries Acrocyanosis = bluish color of hands and feet Lanugo = Vernix Caseosa = Neonate: Physiologic Jaundice Appears 3 – 4 day Excess number of red blood cell’s present in fetal life = No longer needed = hemolysis = high levels of bilirubin (bile pigment) in bloodstream Skin and eyeballs look yellow Nutrition Breast of bottle Emotional linkage Nutritional Needs Feeding time is crucial o Attachment o Infant and mom/primary caregiver learn about each other o Infant learns about environment Nutrition: Breastfeeding AAP recommends birth to 6 months (exclusively), breast milk for one year Substances pass into milk and to baby Human Milk Considered Ideal Sterile Digestible Economical Contains necessary nutrients Commercial Formulas All similar Manufacturers trying to make breast milk Fe fortified formula (exclusively 6 months) o Cow’s milk o Soy protein Supplemental Fe by 4 months Need to be heated Never heat in microwave o Oropharyngeal and esophageal burns o Plastic liners can explode after removal from microwave NEVER o Prop bottle Aspirate formula Choke Babybottle mouth Tooth decay Second Half of First Year Fe enriched solid foods Fruit juices Cow’s Milk Unsuitable less than 6 months of age 23 times more protein Some of which casein o Large, difficulttodigest curd Poor source of Vitamin C, D, and Fe Infant No lowfat (2%) milk No skim milk Will not gain weight Need fat content Breast or Bottle 50 calorie / number of weight per day Breast milk 1 ounce = 22 calories Bottle (formula) milk 1 ounce = ~24 calories Water 100150 mL / kg body weight Do not substitute fruit juice 70% infant’s body weight o Vulnerable fluid loss o H2O in ECF o Easily lost when ill Dehydration Intoxication Weaning Often initiated 6 months Usually complete by end of first year Readiness o Muscle coordination increases o Teeth erupt o Resists being held close Bedtime feeding hardest to give up Maxillary central incisors = night time feed, no CHO’s tooth decay Influences Endowment o Genetic influences Environment o Nutrition o Living conditions Healthy Infant Assess steady weight gain Normal development Healthy Thumb Sucking and Pacifier Do not shame It is okay for the first 2 years Sensory and Motor Development Use upper body before lower body See objects before can control trunk Learn to do things with hands before can crawl or walk Infants Novel stimuli Patterned stimuli of less complexity Black and white patterns = bull’s eye, concentric circles Faces Environment Modifies endowment Plasticity = modifiability or molding of the brain through experience o Enables learning o Can lead to damage if harmful effects Maternal stress Toxins / drugs Malnutrition Sensory impoverishment (integration disorder) Problems Obesity High blood pressure Behavior characteristics express neuromuscular maturity Infant Reflexes Primitive Postural Locomotor Assessment of Infant Reflexes Rooting Sucking Moro or startle Palmar / plantar grasp Tonic neck or fencing Orienting Attending Babinski Walking Swimming Sense of Touch (Haptic System) Myelinated at birth More fully developed at birth than other senses All body parts sensitive to touch at birth st 1 sense to develop Temperature, pain, pressure, vibration Pain May develop 3 trimester Circumcision Prolonged or severe pain = longterm harm Smell and Taste Newborns o Prefer pleasant odor o Prefer sweet taste to sour or bitter Sweetened water for pain o Turn head toward milk source Bottle or breast Sense of Hearing Functional before birth 3 day olds can tell new speech sounds from ones they have already heard Hearing Early recognition of voices and language heard in womb may lay foundation for relationships 1 month can distinguish sounds as close as ‘ba’ and ‘pa’ Hearing Screening Key to language development NIH recommends hearing screening all infants first 3 months Auditory Neuron Myelination Not complete until 4 years old Sight / Vision Myelination o Begins at birth o Continues first five months of life o Not complete until age 4 Vision o Sense least well developed at birth Visual Pathways: Newborns Initial vision blurred Fixation = directs both eyes limited time (418 seconds) Tracking = visually follows large moving objects Conjugation = moves eyes together Accommodation = Visual Pathways: One Month Can distinguish mom from stranger o Infant needs eye contact o Needs opportunity to see human face Neonate and Infant: Motor and Cognitive Development Milestones Achievements that develop systematically Simple skills Combine simple to complex Grasping, crawling, walking Need room to move Freedom to see what they can do Opportunities for exploration and practice Denver Developmental Screening Test (DDST) To chart normal progress between the ages of 1 month – 6 years To identify children who are not developing normally Gross motor skills = physical skills that involve large muscles o Rolling over, catching a ball Fine motor skills = physical skills that involve the small muscles and eyehand coordination o Grasping a rattle, copying a circle Language development o Definitions of words Personality and social development o Smiling spontaneously, dressing without help DDST II o Revised norms Head Control Birth = lift head from prone Birth – 1 month = turn head side to side while lying on back 2 months = weight on forearms elevates head Lying chest down = lift head enough to turn head 2 – 3 months = lift head higher and higher, may lose balance and roll over on backs; hold chest up 4 months = keep head erect while being held or supported in sitting position Hand Control Birth = grasping reflex o Palm of hand stroked = hand closes tightly 3 ½ months = grasp object of moderate size (rattle) Then transfer from one hand to the other Then hold, but not pick up, small objects Thumb opposition to finger (prehension) 7 months 7 – 11 months = pick up tiny object (pea), pincer grasp Locomotion 3 months roll over deliberately o Front to back, then back to front 3 – 4 months = sits with support 3 – 6 months = pulls self to sitting position Kicks vigorously Begins to hitch (scoot) backwards while sitting 6 months = sit without support 6 months = rolls over completely 8 ½ months = assume sitting position without help 6 – 10 months (usually 8 – 9 months) = creeping or crawling, selflocomotion (cognitive and psychosocial ramifications) 7 months = stand with helping hand or furniture 4 months later = let go and stand alone 10 – 11 months = cruising 11 ½ months = standalone well 12 months = first unaided step 1 year + = walks well Walkers Delay motor development Dangerous AAP ban Motor Development and Perception Sensory and motor activity seem well coordinated o Visual guidance Use of the eyes to guide movements of the hands or other parts of the body Ex: locate rattle by sound o Other senses help Ecological Theory of Perception Sensory and motor activity seem well coordinated o Visual cliff Learning to learn o Approach a slope, back off Visual Cliff Do infants perceive death? 6 month old babies would approach ledge but avoided drop Demonstrated depth perception Thelan’s Dynamic Systems Theory Infants develop motor skills o Maturation and o Coordination of multiple systems of action within a changing environment Cultural Influences May influence the pace of early development Cognitive Development: Piaget First comprehensive theory of cognitive development based on systematic observation of infant’s behavior Infant: Cognitive Development Piaget was describing o Most advanced level of performance for each stage, early in the stage a baby is only beginning to acquire the abilities described Age ranges given are approximate. What is imp. is the sequence of stages Piaget’s stages o One way of describing and explaining infant cognitive development Piaget: Adaptation How children handle familiar information Two processes o Assimilation: Incorporating new information into existing schemes o Accommodation: changing structures to include new information These steps are balanced through equilibration Sensory and Motor Behaviors Earliest aspects of intellectual development Necessary for later intellectual development Infant Cognitive Development Sensorimotor Period o First 2 years of life o Awareness of the world is limited to what can be known through Sensory awareness and Motor acts Cognitive Development: Sensorimotor Development 1. Reflex stage 2. Primary circular reactions 3. Secondary circular reactions 4. Coordination of schema Infant Cognitive Development Period 1 (0 – 1 month) Reflex Stage o Covers neonatal period to goal oriented toddler o From behavior that is entirely reflexive o Stimuli assimilated into mental images Through reflex behavior Through human contact o Infant stimulated o Reflexes respond o New behaviors appear o Distinguish between objects Period 2 (1 – 4 months) Primary Circular Reactions o First differentiations Reflexive behavior Appears to be modified o Primary Circular Reactions Stimulus creates response Gratifying behavior is repeated Beginning intention of behavior is seen (reproduces behavior previously done) Smile at familiar faces Sucks thumb and mouths hand repeatedly Anticipates routines (diapering) Hand mouth coordination Habituation Can’t be explaining by reflexes alone Eye coordination Follows moving objects with eyes Coordination between hearing and vision Moves head in direction of sounds Period 3 (4 – 8 months) Secondary Circular Reactions o Reproduction of interesting events o Secondary circular reactions Learns to initiate and recognize new experiences Repeats pleasurable experiences Intentional behavior is seen Memory traces being established Repeats or prolongs interesting events Coordination vision and tactile senses Grasps and manipulates objects she can reach Now can distinguish self from objects Handeye coordination Goaldirected (oriented) behavior Period 4 (8 – 12 months) Coordination of Secondary Schema Reactions o Reproduction of interesting events o Combines behaviors to achieve goals o Coordination of secondary schema Clear acts of intelligence and experimentation Activities to attain goals Someone else causes activity Searches for and retrieves toy that disappeared from view Objects are recognized from several perspectives Intentionality Behavior still lacks intention Does not initiate behaviors directed at certain ends Affects Two kinds of feelings appear o Pleasure, pleasantness, unpleasantness o Needs and interests associated with actions Language Development Crying Cooing = soft murmur or hum contentment, 23 months Babbling = incoherent sounds made by playing with sounds, 23 – 8 months Squealing and grunting Lalling = movement of tongue with crying and vocalization, “mmm” Sucking sounds Gestures 1 year = 6 words Neonate and Infant Psychosocial Development Foundations of Psychosocial Development Personality development is intertwined with social relationships Crying Differentiate patterns of crying o Hunger o Angry o Pain o Frustration Smiling / Laughing 1 – 3 months = smiles and comforting person 3 – 6 months = smiles at person deliberately during interaction, displays joy, frustration, and rage 6 months = giggles 6 – 9 months = engages is social play 9 – 12 months = increasingly sociable Play Play with self o Hands, feet, rolling Toys Objects in mouth, heft through air Unrestricted play areas Temperament Disposition o Easy children o Difficult children o Slow to warm up to children Infant in the Family Mothers role Fathers role Getting to Know Newborn Progression o Examine baby with eyes o Eye contact with the baby o Touch extremities with fingers o Enfold baby into arms Infant – Parent Attachment Emotional tie between two persons Close reciprocal relationship Involves contact and proximity Behavior between caregivers and infants Bonding No scientific evidence Stranger Anxiety Stranger approaches, infant wants to be held or cuddled by mother or primary caretaker Able to distinguish one adult from another – fears unfamiliar Fear or avoidance (wariness) of stranger people and places Occurs at 6 months Intensifies at 9 months Lessens at 12 months Less when baby held by caretaker when stranger appears Separation Anxiety 7 – 8 months Distress when familiar caregiver leaves Do not want to leave parent (primary caretaker) Tries to prolong bedtime Parents have to be firm Infant Mortality Unintentional injury / death o Suffocation o MVT – occupant o Fires / burns o Poisoning o Falls Birth defects Preterm birth (birth before 37 weeks gestation) and low birth weight Sudden Infant Death Syndrome (SIDS) Maternal complications of pregnancy Injuries (ex: suffocation) American Academy of Pediatrics SIDS o Back to sleep o Firm surface o Mom = smokes tobacco or uses cocaine Parents roll over on infant o Increased stress in cosleeping Immunizations Rates of infectious diseases plummeted in US o Due to immunization Hesitant to immunize Too many vaccines o Multiple vaccines fortify immune system List of Immunizations Hepatitis B (HepB) = at birth and 1 – 2 months and > 24 weeks Diphtheria Tetanus Pertussis (DTap) = 2, 4, 6 months Hib = 2, 4, 6 months and > 1215 months Polio (IPV) = 2, 4 months and between 6 and 18 months Measles, Mumps, Rubella (MMR) = between 12 and 18 months Varicella = > 12 and 18 months Pneumococcal (PCV) – 2, 4, 6 months and > 12 – 15 months Influenza = > 6 months and annually in children with certain risk factors Hep A = > 12 months Immunizations About 90% all children today are vaccinated Some regions are better vaccinated than other No causal connection between vaccines and autism or other disorders Psychosocial Developmental Task: Erikson = Trust vs. Mistrust Confidence, optimism Reliance on self and others World can satisfy needs Sense of hope Accepts self Routine o Ease of feeding o Depth of sleep Trust Relaxation of bowels Overall contentment Cooperates and helps with activities o Ex: dressing Tries new activities with encouragement Fostered by prompt, loving, and consistent response to infant’s distress and needs Positive responses to happy contented behavior Sociable and responsive Positive attitude Mistrust Sense of not feeling satisfied emotionally or physically Inability to believe in or rely on others or self Deaths from Injuries 90% of injury deaths in infancy due to: o Suffocation o Motor vehicle accidents o Drowning o Residential fires or burns Child’s Concept of Death Influenced by o Age o Cognitive development o Nationality o Religion o Lifelimiting illness o Personal experiences with death o Family members explanation and attitudes surrounding death Infants and Toddlers Preverbal children’s view of death is a mystery Cognitively o No concept of death o Toddlers Egocentricity of toddlers Vague separation of fact and fantasy make it impossible to comprehend absence of life Perceive events inly in terms of their own frame of reference: living Reactions to Dying Separation from parents Alteration to routines Regression o Speech, toilet training, eating, drinking, crying, clinging, physical illness) Perceive seriousness of condition from parents reaction o Anxiety, sadness, depression, anger Young children are unaware of reason for such emotions o Find Barents behavior disturbing or upsetting Help parents deal with feelings Allows them to have emotional reserve to meet needs of children Encourage parents to stay in hospital as much as possible and to participate in child’s care o Helps adjustment to situation of serious fatal illness Provide child with physical comfort, consistent providers, routines, and familiar objects Family Developmental Tasks Crisis Life will never be the same Rework o Selfconcept o Philosophy of life o Communication o Routine in light of babies activity o Rework role with other family members and relatives Infant Developmental Tasks Manage changing body Understand and master environment Develop beginning symbol or language system Direct emotional expression to indicate needs and wishes Physiologic equilibrium Dependent, but separate person A live vs. inanimate object Familiar vs. unfamiliar Feeling of and desire for affection Adjust to expectations of others
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