• The family is the basic unit of the society
•  Come in many different forms and sizes
• Represent racial, ethnic, cultural, and socioeconomic diversity.
• Children grow both individually and as part of a family.

• Vital Statistics- These are numerical recordings of significant "events" that affect the population's general health state and serve as a basis for determining the appropriateness of health care.

1. Four phases of Health Care- can be envisioned as a framework in which nurses care for families during their childbearing and childrearing years through four phases of health care, employing nursing method, nursing theory, and evidence-based practice.
2. Statistical terms used to report Maternal and Child
   Health- Declining live births, increased births attended by health professionals, >50% born to unwed mothers, more babies born to adolescent mothers, infant mortality remains unchanged, and relatively low maternal mortality ratio.

• Neurologic system - first 2 years
• Lymphatic system - infancy and childhood
• Reproductive system - puberty
• Musculoskeletal system - childhood

• Psychosexual Development – developing instincts or sensual pleasure (Freud)
• Psychosocial Development – personality development (Erickson)
• Moral Development – know right from wrong and apply in real-life situations (Kohlberg)
• Cognitive Development – learn or understand from experience, to acquire and retain knowledge to respond to new situation and solve problems (Piaget)

Personality Traits
☆ Negativism
☆ Ritualistic Behavior
☆ Slowness in carrying out requests/ambivalence
☆ Temper Tantrums

• Diagnosis

• Planning 

• Implementation

• Evaluation

TAKE NOTE !!!
☆ The child should be permitted to explore the surroundings with the primary caregiver's encouragement throughout the critical stage of AUTONOMY vs. SHAME and DOUBT.

National Health Goals

• Increase the number of states with legislation requiring bicycle riders under the age of 15 to 50 from a starting point of ten.
• Reduce infectious diarrhea among children in licensed child care centers by at least 25%.
• Increase the percentage of children aged 4 and younger who utilize kid car restraints from 92 percent to 100 percent.

• Socialization - Grandparents, siblings, and preschool teachers are now important others (but parents remain the most important).

• Imitation - replicate the activities that kids see their parents doing at home the best.
• Fantasy - remind kids that they are still recognizable.
• Oedipus and Electra Complexes - each child competes with the same-sex parent for the other parent's affection and attention.
• Gender Roles - need to be exposed to an adult of the other gender in order to become familiar with the roles of the opposite gender
• Socialization - much more time is spent with other kids their age.

• According to Piaget, cognitive development is still preoperational at three years.
• Begin a second phase of thought known as intuitional thought. 
• Centering - lack the ability to perceive themselves through the eyes of others or to put themselves in the shoes of others

• Determine what is correct and what is incorrect depending on
• Conscience

1. Automobile accidents
2. Poisoning and falls
3. Minor illnesses, such as colds, ear infections, and flu symptoms

1. Fear of the Dark -reassure they are safe
2. Fear of Mutilation - need good explanations of the limits of health care procedures
3. Fear of castration
4. Fear of Separation or Abandonment - most effective, “Mommy will pick you up from preschool after you have had your snack”

1. Telling Tall Tales - parents should be warned not to encourage this type of storytelling, but rather to assist their children in distinguishing between fact and fantasy.
2. Imaginary Friends - discussing their imagined acquaintance, they must distinguish between fact and imagination
3. Difficulty Sharing - assure parents that sharing is a challenging concept to grasp and that, like most things, it takes practice for toddlers to understand and develop.
4. Regression - greatest strategy to assist a child stop this behavior is to remove the stress.
5. Sibling Rivalry - feel secure and promote self-esteem, by supplying them with a private drawer or box for their things 

1. Thumbsucking
2. Food likes and dislikes
3. Enuresis – bed-wetting
4. Encopresis - fecal incontinence or soiling
5. Bruxism - grinding the teeth at night

• child’s weight and height
• assess a child for general appearance (alert, happy, active, healthy)
• teeth for presence of cavities
• symmetrical gait
• frequent upper respiratory infections

• health-seeking behaviors related to  developmental expectations
• readiness for enhanced parenting related to parent’s
  pride in child
• risk for poisoning related to maturational age of
  child

• accident prevention 
• opportunities for adventurous activities or messy play

• role playing a mood or attitude you would like a child to learn
• suggest preschoolers participate by listening to their heart or coloring the table paper

• When crossing roadways, a child emphasizes the significance of holding his or her parent's hand.
• By the next appointment, the mother says that she has prepared her 4-year-old for the arrival of the new baby.

• Annual average weight gain - 3 to 5 lb (1.3 to 2.2 kg) 
• Increase in height - 1 to 2 in (2.5 to 5 cm)
• Posture - slims down, becomes more agile and graceful
• Immunoglobulins IgG and IgA - reach adult levels & lymphatic tissue continues to grow up until about age 9
• Pulse rate - ↓ to 70 - 80 beats/minute
• Blood pressure - ↑  about 112/60 mm Hg
• Maturation of respiratory system - ↑ oxygen–carbon dioxide exchange

• Malocclusion - a deviation from the normal with teeth alignment 
• Scoliosis - may become apparent for the first time in late childhood

• girls: occurs between 12 & 18 years
• boys: between 14 and 20 years

New Concepts Learned
Decentering - to put oneself in other people's shoes
Accommodation - to change one's mental processes to fit the situation
Conservation - to recognize that a change in shape is a good thing
Class Inclusion - to recognize that objects might belong to multiple categories

☆ Keys to health: PEDS
Proper nutrition
Exercise
Dental hygiene
Sleep

1. School Phobias - school refusal or school avoidance, sign of a separation anxiety. Possible reasons could be being the target of a bully
2. Stealing - wants items for himself. Possible reason could be financial means

• PERIOD BETWEEN 13 AND 18 OR 20 YEARS
• TRANSITION BETWEEN CHILDHOOD AND YOUNG ADULTHOOD
• PHYSIOLOGIC, PSYCHOLOGICAL, AND SOCIOLOGIC CHANGES

1. GROW BOTH RAPIDLY AND MATURE DRAMATICALLY
2. INCLUDE FACTORS SUCH AS OCCUPATIONAL HAZARDS OR THE EFFECTS OF JOB, FAMILY, AND FINANCIAL STRESS ON AN ADOLESCENT

1. Apocrine sweat glands
2. Heart and lungs increase in size more slowly 
3. PR: 70 beats per minute
4. RR: 20 breaths per minute
5. BP: 120/70 mm Hg than the rest of the body

Major milestone: Onset of puberty at 9 to 12 years of age
and the cessation of body growth at 16-20 years of age

• AGE 14: cannot work non-agricultural jobs unless employed by parents 
• AGE 15: may spend a great deal of time in their room
• AGE 16: no hours limit
• AGE 18: no hours limit

• Developmental Task: Identity Versus Role Confusion
• Establishing a value system or what kind of person they want to be

• Strongly correlated with the sense of trust, the first developmental task in infancy

• Early teenagers may feel more self doubt than self confidence
• Adolescents watch adults carefully during this period, searching for good role models with whom they can identify

• Adolescents start to show interest in learning about other cultures and beliefs 
• They can be responsible for self-care because they view this as a standard of an adult behavior

1. PROMOTING ADOLESCENT SAFETY
2. DROWNING IS ANOTHER CHIEF ACCIDENT
3. HOMICIDE AND SUICIDE
4. ATHLETIC INJURIES

• ↑ NUMBER OF CALORIES
• ↑ CALCIUM PLUS PHYSICAL EXERCISE
• LARGE AMOUNTS OF IRON

1. VEGETARIAN DIETS
2. GLYCOGEN LOADING

• ADEQUATE SLEEP
• DRESS AND HYGIENE
• EXERCISE
• CARE OF TEETH

• HYPERTENSION
• POOR POSTURE
• BODY PIERCING AND TATTOOS
• FATIGUE
• ACNE
• OBESITY

• INCREASING EXPOSURE TO AND ACCEPTANCE OF PREMARITAL SEXUAL RELATIONS IN SOCIETY, MORE ADOLESCENTS THAN EVER 
• DIFFICULTY TELLING THEIR PARENTS ABOUT THEIR PERCEIVED SEXUAL ORIENTATION

1. PRESCRIPTION AND OVER-THE-COUNTER DRUGS
2. TOBACCO
3. ALCOHOL
4. PERFORMANCE-ENHANCING DRUG ABUSE
5. MARIJUANA
6. AMPHETAMINES
7. COCAINE
8. OPIATES

• HEALTH HISTORY SEPARATELY FROM PARENTS TO PROMOTE INDEPENDENCE AND RESPONSIBILITY FOR SELF-CARE

• HEALTH-SEEKING BEHAVIORS RELATED TO NORMAL 
• LOW SELF-ESTEEM RELATED TO FACIAL ACNE
• RISK FOR INJURY RELATED TO PEER PRESSURE TO USE ALCOHOL AND DRUGS

• ESTABLISHING A CONTRACT
• RESPECT THE FACT THEY HAVE A STRONG DESIRE TO EXERT INDEPENDENCE OR DO THINGS THEIR OWN WAY

• EVALUATE HOW AN INTERVENTION APPEARS FROM AN ADOLESCENT’S STANDPOINT BEFORE BEGINNING TEACHING

• PARENTS STATE THEY FEEL MORE CONFIDENT ABOUT THEIR ABILITY TO PARENT AN ADOLESCENT
• CLIENT STATES HE HAS NOT CONSUMED ALCOHOL IN 2 WEEKS

• the musculoskeletal system is well developed and coordinated
• period when athletic endeavors reach their peak

• basic developmental task is establishing intimacy 
• sense of intimacy versus isolation

• use formal operations, characterized by the ability to think abstractly and employ logic

• mastered the previous stages of Kohlberg’s theory of moral
• development enter the post-conventional level
• able to separate self from the expectations and rules of others

• reflective period sometime after 18 years of age
• individual focuses on reality

1. injury and violence
2. suicide
3. hypertension
4. substance abuse
5. sexually transmitted infections (STIs)
6. eating disorders
7. certain malignancies

• At 40, most adults can function as effectively as they did in their 20s
• At 40-65, many physical changes take place

• Generativity versus Stagnation
• Generativity: the concern for establishing and guiding the next generation
• Marriage partners have more time for companionship and recreation

• include reaction time, memory, perception, learning, problem solving, and creativity
• life experiences of middle-aged individuals will be reflected in their cognitive performance

• can move beyond the conventional level to the post-conventional level
• extensive experience of personal moral choice and responsibility is required before people can reach the post-conventional level

• not all adults progress through Fowler’s stages to the fifth, called the paradoxical-consolidative stage
• can view “truth” from a number of viewpoints

1. injuries
2. cancer
3. cardiovascular disease
4. obesity
5. alcoholism
6. mental health alternations

How to encourage pre-natal care?
E-ducate
E-mphasize the importance
E-nsure privacy & comfort
E-ngage & involve

• 1-7: once/month
• 8-9: twice/month
• 10: weekly
• Post-term: twice/week

• Naegel's rule: standard method used to predict length of pregnancy

• GTAPL/GTPALM: Gravida, term, pre-term, aborted, living children, and multiple pregnancies

• Weight & Vital signs: 30-35 lbs.
• Eyes: (-)BOV, (-)swelling of eyelids
• Nasal stuffiness: (+,-)
• Melasma/Chloasma: (+,-)
• Fissures on the lips: (-)
• Dental caries: (-)
• Gingival hyperplasia: (-)
• Swelling (+)
• Slight enlargement of thyroid
• Breast tenderness, darkening & protrusion of tubercle; production of colostrum
• Slight Inc in HR (70-80); Palpitations may be present
• Slight INC in RR
• Enlarged, firm, globular abdomen

• Lordosis, back pain (+)
• Hemorrhoids  (+)
• Palmar Erythema  (+)
• LE varicosity & edema (+)
• Waddling gait (+)
• Vagina: purple in color, (-) signs of vaginal infection, (-) vesicles/ulcerations
• Rectocele/cystocele (-)
• Cervix purple in color, tender: (+) edema, (-) inflammation, (-) vesicles/lesions/ulcerations

1. measurement of fundal heights & fht
2. pelvic examination
3. PAPanicolau smear
4. pelvic measurement

1. Bartholomew's rule: fundus reaches typical measurement
2. Mcdonald's rule: measure cm -> SYMPHYSIS PUBIS = week of gestation

1. Fetal movement
2. Fetal heart tone

1. True conjugate: 10.5cm-11 cm
2. Diagonal conjugate: >12.5 cm
3. Ischial tuberosity: 11 cm

1. Blood studies: cbc, vdrl, HIV screening
2. Urinalysis: (+) albumin/protein/glucose/urine
3. Tuberculin screening: PPD/tuberculin skin test

• Vaginal bleeding
• Chills & fever
• Increase/decrease Fetal movement
• Sudden Escape of clear fluid from the vagina
• Pregnancy-induced HTN
• Abdominal/chest pain
• Persistent vomiting

• Complete Blood Count: (1)hemoglobin or hematocrit and red cell index: (+)anemia, (2)white blood cell count: (+)infection, (3)platelet count: estimate clotting ability
• Genetic screen: for common ethnically inherited diseases
• Serologic test for syphilis 
• Blood typing (including Rh factor)
• Indirect Coombs’ test
• Antibody titers for rubella and hepatitis B
• HIV screening