PEDIA-FINAL 1st year topic in BS Nursing pptx

Pediatric, 1st year topic in nursing

1. PEDIA INGRED MAE D. GUINGUE, SN PRESENTER

2. STAGES OF FETAL DEVELOPMENT Pre-embryonic Stage – starts at first two weeks, beginning with fertilization) Embryonic – 3 to 8 weeks Fetal – 8 weeks to birth

3. TERMS USED TO DESCRIBE FETAL GROWTH Ovum – from ovulation to fertilization. Zygote - from fertilization to implantation. Embryo – from implantation to 5-8 weeks. Fetus – 5 to 8 weeks until term Conceptus – developing embryo and placental structures throughout pregnancy. Age of viability – The earliest stage at which features survive if they are born is generally accepted as 24 weeks or at the point a fetus weighs more than 500-600g.

4. ASSESSMENT OF GESTATIONAL AGE Newborns are used to be term if they are born between 37 and 42 weeks of gestation.

5. CLINICAL CRITERIA FOR GESTATIONAL AGE FINDING 0-36 weeks 37-38 weeks 39 and over Sole Creases Anterior transverse crease only Occasional creases in anterior two-thirds Sole covered with creases Breast Nodule Diameter (millimetre) 2 4 7 Scalp Hair Fine and Fuzzy Fine and Fuzzy Coarse and Silky Ear Lobe Pliable; No Cartilage Some Cartilage Stiffed by thick cartilage Testes and Scrotum Testes in lower canal; scrotum small; few rugae Intermediate Testes pendulous, scrotum full; extensive rugae

6. THE EMBRYONIC AND FETAL STRUCTURES THE DECIDUA OR UTERINE LINING CHORIONIC VILLI THE PLACENTA THE AMNIOTIC MEMBRANES THE AMNIIOTIC FLUID THE UMBILICAL CORD

7. THE BIRTH As soon as the head of the fetus is prominent (approximately 8cm. a cross) at the vaginal opening, one technique to help the fetus achieve extension and allow the smallest head diameter to present is for the provider to perform Ritgen Maneuver . A child is considered born when the whole body is born.

8. CUTTING AND CLAMPING THE CORD This is part of the stimulus that initiates a first breath or marks the newborn’s most important transition into the outside world, the establishment of independent respirations. Delaying cutting “physiologic clamping” until pulsation ceases. Before cutting the cord is clamped with two hemostats placed 8 to 10 in. from the infant’s umbilicus. The cord consists of two arteries and one vein (AVA)

9. INTRODUCING THE INFANT After the cord is cut, it is time for the new parents to spend quality time with their newborn . Most newborns receive prophylactic eye ointment against the possibility of a chlamydia infection.

10. PROFILE OF A NEWBORN

11. THE PROFILE OF A NEWBORN VITAL STATISTICS – measurement of a newborn THE AVERAGE NEWBORN Head Circumference: 34 – 35 cm. Temperature: 97.6F – 98.6F Chest Circumference: 32-33 cm. Heart Rate: 120-140 beats/min Respirations: 30-60 breaths/min Weight: 2.5 – 3.4 kg. Length: 46-54 cm.

12. VITAL SIGNS TEMPERATURE – the majority of heat loss occurs because of separate mechanisms: Convection – is the flow of heat from the newborn’s body surface to cooler surrounding air. Radiation – the transfer of body heat to a cooler solid object not in contact with the baby. Conduction – the transfer of body heat to a cooler solid object in contact with the baby. Evaporation – loss of heat through conversion of a liquid to a vapor .

13. VITAL SIGNS Cold Stress - a term that describes excessive heat loss that leads to hypothermia and results in the utilization of compen - satory mechanisms to maintain the neonate’s body tempera- ture (Fig. 15-6). Cold stress occurs when there is: ■ A decrease in environmental temperatures → a decrease in the neonate’s body temperature → an increase in respiratory rate, heart rate → an increase in oxygen consumption , a depletion of glucose, and a decrease in surfactant → respiratory distress

14. VITAL SIGNS PULSE – the heart rate of a fetus in utero averages 110 to 160 beats per minute. Within one hour of birth, as the newborn settles down to sleep, the heart rate stabilizes to an average of 120 to 160 beats per minute. During crying, the rate may rise again to 180 beats per minute and during sleep, the rate can decrease as low as 85 beats per minute but usually ranges from 90 to 110 beats per minute. A newborns heart rate is best determined by listening for an apical heart beat for a full minute.

15. VITAL SIGNS RESPIRATION In the first few minutes of life newborns have high respiratory rate around 90 breaths per minute. As respiratory activity is established and maintained over the next hour, this rate will settle to an average of 30 to 60 breaths per minute. Respiratory depth, rate, and rhythm are likely to be irregular and short episodes of apnea (10 secs . and without cyanosis), sometimes called “periodic respirations”

16. VITAL SIGNS BLOOD PRESSURE Newborn is approximately 80/46mmHg at birth. By the 10 th day it rises to about 100/50mmHg and remains at that level fo the infant year. Blood pressure in newborns is somewhat inaccurate due to the size of their arms. Hemodynamic monitoring is used when continuous assessment is required.

17. PHYSIOLOGIC FUNCTIONS

18. CARDIOVASCULAR SYSTEM Changes in cardiovascular system are necessary after birth because lungs are now responsible for oxygenating blood that was formerly oxygenated by the placenta. As soon as the umbilical cord is clamped, fetal cardiovascular shunts begin. BLOOD VALUES A newborn’s blood volume is 80 to 110 mL per kilogram of body weight or about 300 mL total. Once proper lung oxygenation has been established, the need for a high red cell count diminishes, so within a matter of days, red blood cells begin to be destroyed. BLOOD COAGULATION Vitamin K, synthesized through the action of intestinal flora, is responsible for the formation of factor VII ( proconvertin , factor IX (plasma thrombop lastin component) and factor X (Stuart- Prower factor) in the clotting sequence.

19. CARDIOVASCULAR SYSTEM

20. RESPIRATORY SYSTEM A first breath is a major undertaking because it requires a tremendous amount of pressure for a newborn to be able to inflate alveoli for the first time. Some fluid present in the lungs from intrauterine life makes a newborn’s breath possible because fluid eases surface tension on alveolar walls and allows alveoli to inflate more easily than if the lung walls were dry. The rest of the fluid is quickly absorbed by lung blood vessels and lymphatics after the first breath. A baby born by caesarean birth does not have much lung fluid expelled at birth as one born vaginally and so typically has more difficulty establishing respiration because excessive fluid blocks air exchange space. Preterm newborn alveoli may collapse each time they exhale (because of the lack of pulmonary surfactant). As a result, they also have difficulty establishing effective residual capacity and respirations .

21. GATROINTESTINAL SYSTEM Gastrointestinal tract is usually sterile at birth, bacteria may be cultured from the tract in most babies within 5 hrs. of birth and from all babies at 24 hrs. of life. Most of these bacteria enter the tract through the newborn’s mouth from airborne sources. The accumulation of bacteria is helpful because bacteria in the gastrointestinal tract are necessary for digestion through probiotics and for the synthesis of vitamin K. STOOLS – first stool of a newborn is usually passed within 24hrs. of birth. Meconium – a sticky, tarlike, blackish-green, odourless material formed from mucus, vernix , lanugo, hormones and carbohydrates that accumulated in the bowel during intrauterine life. Transitional Stool – bowel contents appear both loose and green; bowel movements may resemble diarrhea to some parents.

22. URINARY SYSTEM The average newborn voids within 24 hrs. of birth. A newborn who does not take in much fluid for the first 24hrs. may void later than this, but the 24hr. point is a general rule. Newborns who do not void within this time need to be assessed for the possibility of urethral stenosis or absent kidneys or ureters. The kidneys of newborns do not concentrate urine well, making newborn urine usually light colored and odorless . A single voiding in a newborn is only about 15 mL and may be easily missed in an absorbent diaper. The first voiding may be pink or dusty because of uric acid crystals that were formed in the bladder in utero.

23. IMMUNE SYSTEM Newborns have limited immunologic protection at birth because they are not able to produce antibodies until about 2 months. Newborns are however, born with passive antibodies passed to them from their birthing parent that crossed the placenta. Newborns are routinely administered Hepatitis B Vaccine before they leave their birth setting to promote antibody formation. Without antibody protection, Herpes Simplex Type 2 infections can become systemic or create a rapidly fatal form of the disease in newborn .

24. NEUROMUSCULAR SYSTEM Term newborns demonstrate neuromuscular function by moving their extremities, attempting to control head movement, exhibiting a strong cry, and demonstrating newborn reflexes. Newborn reflexes can be tested with consistency by using a number of simple maneuvers : The Blink Reflex The Rooting Reflex The Sucking Reflex The Swallowing Reflex The Extrusion Reflex The Palmar Grasp Reflex The Step-in-Place Reflex The Placing Reflex The Plantar Grasp Reflex The Tonic Neck Reflex The Moro Reflex The Babinski Reflex The Magnet Reflex The Crossed Extension Reflex The Trunk Incurvation Reflex The Landau Reflex The Deep Tendon Reflexes

25. THE SENSES

26. NORMAL ADJUSTMENT TO EXTRAUTERINE LIFE PERIODS OF REACTIVITY

27. ASSESSMENT FIRST PERIOD (FIRST 15-30 min.) RESTING PERIOD (30-120 mins .) SECOND PERIOD (2-6 hrs.) Color Acrocyanosis is present Color begins to stabilize. Quick color changes occur with movement or crying Temperature 100.6 F or 38.1 C 99 F or 37.2 C 99.8 F OR 37.6 C Heart Rate Rapid , as much as 180 beats per minute while crying Slows, to 120-140 beats per minute Wide swings in rate occur with activity but stabilize at 120-140 beats per minute Respirations Irregular breathing; 30-90 breaths per minute while crying. Breathing slows to 30-50 breaths per minute. Breathing rate becomes irregular with activity but stabilizes at 30-60 beats per minute. Activity Alert; watching Sleeping Awakening Ability to respond to stimulation Vigorous Reaction Difficult to arouse Becoming responsive again Mucus Visible in mouth Small amount present while sleeping Mouth full of mucus, possibly causing gagging Bowel Sounds Can be heard after first 15 minutes. Present Often passage of first meconium stool.

28. ESSENTIAL INTRAPARTAL NEWBORN CARE

29. 1. Call out time of birth and sex of the baby. 2. Deliver the baby onto the dry cloth draped over the mother ‘s abdomen or arms 3. Start drying baby within 5 seconds after birth: Wipe eyes, face, head, trunk, back, arms and legs thoroughly. Check breathing while drying. Remove wet cloth to start skin-to-skin contact Cover the baby with dry cloth and head with bonnet. Do not do routine suctioning. STEPS IN ESSENTIAL NEWBORN CARE

30. 4. After 30seconds: If the baby is gasping or not breathing, clamp and cut the cord and start ventilation. If the baby is not gasping and breathing well. Continue skin-to-skin contact on mother’s abdomen or chest. 5 . After 1 full minute inject oxytocin 10 iu IM after informing the mother (as per doctor’s order). Then remove soiled set of gloves, if you are lone birth attendant. STEPS IN ESSENTIAL NEWBORN CARE

31. ASSESSMENT OF WELL-BEING APGAR SCORING Less than 4 indicates serious danger in respiratory or cardiovascular failure; newborn need resuscitation. 4-6 indicates a guarded condition; newborn may need cleaning of the airway and supplementary oxygen. 7-10 indicates infant scored as high as 70-90% of all infants at 1 and 5 mins . or is just adjusting well to extrauterine life.

32. APGAR SCORING Taken three times at 1 min. after birth, 5 mins . after birth and 10 minutes after birth. SIGN 1 2 Appearance (Skin Color ) Cyanotic or Bluish Acrocyanotic (trunk-pink, extremities-blue) Pink or completely pink Pulse Absent Less than 100 beats per minute More than 100 beats per minute Grimace (Reflex Irritability) Absent or No Response Grimace Vigorous (cry, sneeze, coughs) Activity (Muscle Tone) Limp Some tone or Minimal Flexion Active or Full Flexion Respiration (Respiratory Effort) Not Breathing Slow Irregular Breathing Good Crying

33. Newborns are used to be term if they are born between 37 and 42 weeks of gestation. MATURITY RATING

34. Newborns are used to be term if they are born between 37 and 42 weeks of gestation. NEUROMUSCULAR MATURITY ASSESSMENT CRITERIA

35. APPEARANCE OF A NEWBORN

36. APPEARANCE OF A NEWBORN

37. APPEARANCE OF A NEWBORN

38. APPEARANCE OF A NEWBORN

39. APPEARANCE OF A NEWBORN

40. BIRTHING ROOM ESSENTIALS FOR NEWBORN CARE 1. Separate area for newborn care 2. Radiant heat table or warmed bassinet 3. Warm, soft blanket 4. Equipment for: - Oxygen administration - Resuscitation - Suction - Eye care - Identification - Weighing Gentle Newborn Handling : 1. Handle newborns gently at birth 2. Avoid rough handling (e.g., holding by heels, spanking) 3. Use gentle stimulation (e.g., rubbing back) to promote breathing

41. Infant Abduction Infant identification is important because a newborn may be handed to the wrong parent or be switched or abducted from a healthcare facility. The typical profile of someone who might abduct a newborn is one who has recently lost a pregnancy or had an infant stillborn. IDENTIFICATION BANDING One mainstream form of identification used with newborns is a plastic bracelet or umbilical cord clamp with a permanent lock that requires cutting to be removed

42. BIRTH RECORD DOCUMENTATION Time of birth Time the infant breastfed Whether respirations were spontaneous or aided Apgar score at 1 minute and at 5 minutes of life Whether eye prophylaxis was given Whether vitamin K was administered General condition of the infant Number of vessels in the umbilical cord Whether cultures were taken Whether the infant voided Whether infant passed a stool BIRTH REGISTRATION The primary care provider who supervised a newborn's birth has the responsibility to be certain that a birth registration is filed with the Bureau of Vital Statistics for the state in which the infant was born. The infant's name, the birthing parent's name, the nonbirthing parent's name (if the birthing parent chooses to include this), and the birth date and place are re- corded.

43. NURSING CARE FOR NEWBORN IN THE POSTPARTAL PERIOD NEWBORN CARE

44. 1. Critical management procedures Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions. Maintain a written breastfeeding policy that is routinely communicated to all healthcare staff. Establish ongoing monitoring and data-management systems. 2 . Ensure that all staff have sufficient knowledge, competence , and skills to support breastfeeding. Key Clinical Practices 3 . Discuss the importance and management of breastfeeding with pregnant people and their families . 4. Facilitate immediate and uninterrupted skin-to-skin contact and support parents to initiate breastfeeding as soon as possible after birth. INITIAL FEEDING

45. 5 . Support parents to initiate and maintain breastfeeding and manage common difficulties. 6 . Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated. 7 . Enable parents and their infants to remain together and to practice rooming-in 24 hours a day. 8 . Support parents to recognize and respond to their infants ' cues for feeding. 9 . Counsel parents on the use and risks of feeding bottles, teats, and pacifiers. 10 . Coordinate discharge so that parents and their infants have timely access to ongoing support and care (WHO & UNICEF, 2018 INITIAL FEEDING

46. Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an infant younger than 1 year of age. Although the specific cause of SIDS cannot be explained, these interventions have been shown to decrease the incidence of the syndrome: placing the infant on the back to sleep using a firm sleep surface Breastfeeding room sharing and possibly bed sharing if it means that a parent is not falling asleep with an infant in their arms routine immunizations avoidance of soft bedding avoidance of overheating avoidance of exposure to tobacco smoke, alcohol , and illicit drugs S upervised "tummy time" when infant is awake (AAP Task Force on Sudden Infant Death Syndrome, 2016) SLEEPING POSITION

47. Preventing diaper dermatitis, or diaper rash, is a practice parents need to start from the very beginning with their newborns . Advise parents to change diapers frequently and, with each diaper change, wash the area with clear water and dry well. Nurses can recommend that parents routinely apply zinc oxide or petrolatum-based ointments to prevent or treat diaper dermatitis DIAPER AREA CARE

48. Newborns born in a hospital or birthing center are routinely screened for more than 30 metabolic or inherited disorders by a screening technique that requires a small blood sample obtained by a heel stick and then dropped onto special filter paper. Ideally , a baby should have received formula or breast milk for 24 hours before the blood is obtained for best result. METABOLIC SCREENING TESTS

49. Newborns born in a hospital or a birthing center usually receive a first vaccination against hepatitis B within 12 hours of birth; a second dose will then be administered at 1 month and a third one at 6 months. Infants whose parents are positive for the hepatitis B surface antigen ( HBsAg ) also receive hepatitis B immune globulin (HBIG) at birth (AAP, 2018 ). Newborns are at risk for bleeding disorders during the first week of life because their gastrointestinal tract is sterile at birth and therefore they are unable to produce vitamin K, a vitamin necessary for blood coagulation. A single dose of 0.5 to 1.0 mg of vitamin K administered IM within the first hour of life helps prevent such problems ( Stachowiak & Furman, 2020). HEPATITIS B VACCINATION AND VITAMIN K ADMINISTRATION

50. Circumcision is the surgical removal of the foreskin of the penis . CIRCUMCISION

51. Benefits to Babies who are breastfed have a lower risk of: • Asthma • Obesity • Type 1 diabetes • Severe lower respiratory disease • Acute otitis media (ear infections) • Sudden infant death syndrome (SIDS) • Gastrointestinal infections ( diarrhea /vomiting) • Necrotizing enterocolitis (NEC) for preterm infants external icon NUTRITIONAL HEALTH BENEFITS OF BREASTFEEDING

52. CALORIES Requirment : 100-120 kcal/kg/day Importance: Calories are essential for maintaining body functions, growth, and development. Breastmilk and infant formula should meet these caloric needs effectively. PROTEIN Requirment : Approximately 2.2 grams per kg per day Importance: Protein is essential for tissue growth, repair and immune function. Breastmilk provides high-quality, easily digestible proteins, including whey and casein, which support growth and development. FATS Requirment : 40-50% of total caloric intake Importance: Fats are vital for brain development, hormone production, and energy. Breast milk contains DHA ( docosahexaenoic acid) and ARA ( arachidonic acid), which are crucial for brain and eye development. NUTRITIONAL NEEDS OF A NEWBORN

53. CARBOHYDRATES • Lactose, the disaccharide found in human milk and added to commercial formulas, appears to be the most easily digested of the carbohydrates. Lactose also improves calcium absorption and aids in nitrogen retention. It produces stools consisting predominantly of gram-positive rather than gram-negative bacteria and therefore decreases the possibility of gastrointestinal illness FLUID • It is important to maintain a sufficient fluid intake in newborns because their metabolic rate is so high (and metabolism requires water ). A newborn needs 150 to 200 ml/kg (2.5 to 3.0 os / lb ) of water intake every 24 hours (adults require 2,400 ml. per day or less than 1 oz / lh ). This requirement can be supplied completely by breastfeeding or formula feeding. Fruit juice is not recommended for infants younger than 6 months because it supplies no protein and. if not pasteurized, can carry infectious organisms. NUTRITIONAL NEEDS OF A NEWBORN

54. MINERALS • A number of minerals are particularly important to early growth. CALCIUM • Calcium is important to the newborn because a newborn's skeleton grows very rapidly. Because milk is high in calcium, t etany resulting from a low calcium level seldom occurs in infants who suck well, regardless of whether they are fed human milk or commercial formula (U.S. Department of Agriculture , 2021 ). IRON • A full-term newborn 137 or more weeks gestational age) whose parent had adequate iron intake during pregnancy will be born with iron stores that, theoretically, will last for the first 3 months of life, until the newborn begins to produce adult hemoglobin. NUTRITIONAL NEEDS OF A NEWBORN

55. FLOURIDE • Fluoride is essential for building sound teeth and for preventing tooth decay. Because t eeth are already set in their primary form during pregnancy, it is important for breastfeeding individuals to drink fluoridated water during pregnancy. VITAMINS • Although both human milk and commercial formulas contain sufficient vitamins for growth, the AAP now recommends that breastfed newborns be given a supplement of 400 IU per day of vitamin D, beginning in the first few days of life. Newborns who are fully or partially formula fed also benefit from a daily 400 IU of vitamin D supplement (US Department of Agriculture, 2021). BREASTFEEDING • it is universally agreed that human milk is the preferred food for newborns because it provides numerous health benefit to both the parent and the infant, it remains the ideal nutritional food for infants through the first year of life. NUTRITIONAL NEEDS OF A NEWBORN

56. SKIN TO SKIN CONTACT • defined as placing the undressed infant on their parent's chest against their skin. When placed in this position, the infant will root toward the nipple and initiate a latch. This may be more successful following an un medicated birth of a full-term infant . PUMPING WITH A HOSPITAL-GRADE PUMP OR MANUAL EXPRESSION • an alternative method to provide human milk to a newborn who is unable to latch or if the parent and baby are separated. Skin-to-skin contact, also termed chest-to-chest contact, can be provided by the non-birthing parent as well to promote infant bonding . BREAST FEEDING TECHNIQUES

57. LATCH BREASTFEEDING CHARTING SYSTEM The system assigns a numerical score of 0, 1, or 2 to five key components of breastfeeding; 10 is a perfect score, meaning breastfeeding is performed independently. The LATCH score is a useful tool to identify those who might benefit from additional skilled support to encourage them to continue exclusive breastfeeding . A quick rule of thumb to estimate how much an infant will drink at a feeding is to add two or three to the infant's age in months. After initially taking 0.5 to 1 oz for the first 2 days, a newborn (0 age) will take 2 to 3 oz each feeding; a 3-month-old child, 5 to 6 oz ; and a 6-month-old child, 8 oz.

58. NEONATES AND INFANTS HEALTH PROMOTION GUIDELINES NEWBORN-28 DAYS

59. Immunizations diphtheria , tetanus, acellular pertussis ( DTaP ), inactivated poliovirus vaccine (IPV), pneumococcal (PVC), Haemophilus influenzae type B (HIB), hepatitis B ( HepB ), hepatitis A ( HepA ), rotavirus, and influenza vaccines as recommended. Varicella and measles-mumps-rubella (MMR) are not given before 12 months of age. Flouride Supplements Fluoride supplements for infants over 6 months of age if there is inadequate water fluoridation (less than 0.3 parts per million) Screening for tuberculosis Screening for metabolic conditions including phenylketonuria (PKU) Prompt attention for illnesses Appropriate skin hygiene and clothing PROTECTIVE MEASURES

60. NUTRITION Exclusive breast-feeding to 6 months Solid foods between 4 and 6 months Need for iron supplements at 4 to 6 months Continued breast-feeding to age 12 months Breast-feeding and bottle- feeding techniques Formula preparation Feeding schedule (every 2 to 3hrs.) SAFETY Importance of supervision Car seat, crib with a firm mattress, playpen, bath, and home environment safety measures No stuffed animals, pillows, or blankets in the crib Position the infant on the back for sleep INFANT SAFETY AND NUTRITION

61. Babies and young children are at high risk of choking because they: have less practice controlling food in their mouths, do not always chew food into small enough pieces, have small airways, explore the world by putting small objects into their mouths. It is prevented by always supervising young babies and children when they are eating Children explore their environment as part of their normal, natural development. They learn about new things by playing with them trying to open containers, mimicking what they see siblings or adults do and by putting things in their mouth. Swallowing a poisonous substance, spilling it on the skin, spraying or splashing it in the eye or inhaling it can all lead to poisoning. It is prevented by storing medicines, chemicals and cleaners up in a locked cupboard. CHOKING AND CHEMICAL INTOXICATION

62. TODDLER HEALTH PROMOTION GUIDELINES 1 TO 3 YEARS OLD Toddlers in the hospital often find the experience upsetting, in part because it disrupts their comfort of their routine and separates them from their caregiver

63. Starts begin around 1 year and ends around 3 years of age. Physical growth slows after infant stage, but the child continues to develop rapidly in many days. Visual acuity improves, and binocular vision is develop Most body systems are matured Heart and respiratory rates are slow The gastrointestinal system has matured and the toddler can tolerate a variety of food. By 12 to 13 mos. Of age children usually begins to ambulate Nutrition is often concern for parent's. Picky eaters toddler's often become PHYSICAL, PSYCHOSOCIAL, AND COGNITIVE DEVELOPMENT OF TODDLER

64. Two behaviors typical of toddlers in this stage, negativism and ritualism Frustration is often exhbited in the form of tantrums Toddlers in the hospital often find the experience upsetting, in part because it disrupts their comfort of their routine and separates them from their caregiver PHYSICAL, PSYCHOSOCIAL, AND COGNITIVE DEVELOPMENT OF TODDLER

65. DEVELOPMENTAL ASSESSMENT GUIDELINES

66. Immunizations : continuing DTaP IPV Pneumococcal MMR, Varicella Haemophilus influenzae type B H epatitis B H epatitis A I nfluenza , and meningococcal vaccines as recommended Screenings for tuberculosis and lead poisoning HEALTH EXAMINATIONS AND PROTECTIVE MEASURES At 15 and 18 months and then as recommended by the primary care provider Dental visits starting at age 3 or earlier

67. TODDLER SAFETY Importance of constant supervision and teaching child to obey commands Home environment safety measures (e.g., lock medicine cabinet) Outdoor safety measures (e.g., close supervision near water and on sidewalks) Appropriate toys Eliminate toxins in environment (e.g., tobacco, pesticides, herbicides, mercury, lead, arsenic in playground materials) Use smoke and carbon monoxide (CO) detectors in home Importance of nutritious meals and snacks Teaching simple mealtime manners Dental Care

68. ELIMINATION , REST, SLEEPAND PLAY Toilet training techniques Dealing with sleep disturbances Providing adequate space and a variety of activities Encouraging regular, vigorous physical activity Toys that allow "acting on" behaviors and provide motor and sensory stimulation timulation

69. SCHEDULE OF CHILDHOOD IMMUNIZATIONS

70. IMMUNIZATIONS 1. BCG - initial dose given at birth or any time after birth (0-1 year) a. Initial dose 0.05 ml ID R/L deltoid as protection from possibility of infection from other family members. b. Booster dose at school entry (Grade 1) 0.1 ml ID R/L deltoid given to all grade school pupils regardless of the presence or absence of a BCG scar. 2. Measles - single dose given at 9-12 months a. 0.5 ml SQ at inner aspect of upper arm, thigh b. At least 80% of measles may be prevented

71. IMMUNIZATIONS 3 . DPT - diphtheria, pertussis, tetanus a. 3 doses given as early as 6 weeks after birth with at least 4 weeks interval in between doses b. 0.5 ml IM at vastus lateralis , gluteus 4. OPV - oral polio vaccine a. 3 doses given as early as 6 weeks after birth with at least 4 weeks interval in between doses b. 2-3 drops by mouth c. Extent of protection is increased the earlier the OPV is given .

72. IMMUNIZATIONS 5 . Hepatitis B - similar in schedule with OPV and DPT a. 3 doses given as early as 6 weeks after birth with at least 4 weeks interval in between doses b. 0.5 ml IM at vastus lateralis , gluteus c. Early start with Hep B vaccine reduces chances of being infected and becoming a carrier

73. GROWTH AND DEVELOPMENTAL THEORISTS

74. JEAN PIAGET'S COGNITIVE DEVELOPMENT THEORY Main Concept: Children construct knowledge through active learning and experience. Stages (0-18 years): Sensorimotor (0-2 years): Learning through senses and motor activities. Preoperational (2-7 years): Symbolic thinking, egocentrism. Concrete Operational (7-11 years): Logical thinking, problem-solving. Formal Operational (11-18 years): Abstract thinking, reasoning.

75. LAWRENCE KOHLBERG'S MORAL DEVELOPMENT THEORY Main Concept: Moral reasoning develops through stages. Stages (0-18 years): Pre-Conventional (0-9 years): Obedience, punishment avoidance. Conventional (9-15 years): Conformity, social norms. Post-Conventional (15-18 years): Principled, moral reasoning.

76. ERIK ERIKSON'S PSYCHOSOCIAL DEVELOPMENT THEORY Main Concept: Development is shaped by social interactions and crises. - Stages (0-65 years): 1. Trust vs. Mistrust (0-1 year): Trust, attachment. 2. Autonomy vs. Shame (1-3 years): Independence, self-control. 3. Initiative vs. Guilt (3-6 years): Exploration, responsibility. 4. Industry vs. Inferiority (6-12 years): Competence, self-esteem. 5. Identity vs. Role Confusion (12-18 years): Self-discovery, identity.

77. ERIK ERIKSON'S PSYCHOSOCIAL DEVELOPMENT THEORY Main Concept: Development is shaped by social interactions and crises. - Stages (0-65 years): 6 . Intimacy vs. Isolation (18-40 years): Relationships, intimacy. 7 . Generativity vs. Stagnation (40-65 years): Contribution, legacy. 8 . Integrity vs. Despair (65+ years): Reflection, acceptance.

78. THANK YOU! REFERENCES: MATERNAL AND CHILD HEALTH NURSING BOOK, FUNDAMENTALS OF NURSING PPTS AND COMMUNITY HEALTH NUNRSING MODULES