Four core values of nursing
- Health promotion
- Health prevention
- Palliative care
- Disease alleviation
Nursing process
- ADPIE
Prioritizing Care (ABC)
- Airways
- Breathing
- Circulation
Developmental Stages
- 0-6 months
Turn their head toward sounds and movement
Gradually holds own head up
Watch an adult’s face when feeding
Smile at familiar faces and voices
Reach up to hold feet when lying on their backs
Look and reach for objects
Hold and shake a rattle
Put everything in their mouth (common disease is diarrhea)
Sit up with support
Mainly milk feeds (recommend for 2 years), begins weaning (pureed food – 6 months)
- 6-12 months
Begins to sit unsupported
Roll over from their tummy to their back (put in a crib, side rails up)
Begin to crawl or bum shuffle
Pull up on furniture to reach a standing position
Raises arms to be lifted
Turns and look up when they hear their name
Pass objects from hand to hand
Look for things that have been hidden or dropped (object permanence)
Reaches hand towards source of food
May start to get first teeth
Eats lumps in food, introduce finger food and feeder cup
- 1-2 years old
Begin to walk
Begin to feed themselves
Push and pull toys while walking
Wave goodbye
Paint or make noises to indicate wants
Smile at familiar faces and voices
Hold and shake a rattle
Shake head for ‘no’
Uses thumb and first two fingers to grip (development of motor and fine skills)
Bangs object together
Crawl upstairs
Begins to show preference for one hand
Builds tower of few bricks
- 2-3 years old
Throws
Kicks ball
Builds larger brick tower
Uses pencil to make marks and circular scribbles
Runs safety on whole foot
Climbs confidently and pulls self up onto equipment
Walks up or down stairs holding onto a rail, two feet to a step
Feeds self competently with spoon
Drinks without spilling
Communicates needs for potty or toilet
Full set of 20 milk teeth
- 4-5 years old
Pedals
Uses scissors
Holds a pencil and can draw people/houses
Hops
Kicks with aim
Catches ball
Copy shapes and write some letters
Goes to the toilet independently
Dresses independently
Shows preference for dominant hand
Shows good control of large and small movements
Recognize own body needs; hunger, tired
- 6-7 years old
Skips
Rides bicycle
Jumps from height
Climbs confidently
Writes
Threads needle
Can do buttons, show laces
Loses milk teeth
- 8-12 years old
Enjoys team games such as football, netball, etc.,
Able to swim
Show increased body awareness
Show increased awareness of own physical skills
Perfecting and refining fine motor skills e.g., fluid handwriting, writing speed increases
Girls may begin to show signs of puberty
Girls tend to be taller than boys
REMEMBER…EVERY CHILD IS UNIQUE AND DEVELOPS AT THEIR OWN PACE
Psychoanalytical Stages of Development (Sigmund Freud
- ORAL stage – birth to 18 months
- ANAL stage – 18 months to 3 years
- PHALLIC stage – 3 years to 6 years
- LATENT stage – 6 years to puberty
- GENITAL stage – Puberty
ORAL STAGE
- Erogenous zone – MOUTH
- Gratifying activities – nursing-eating, as well mouth movement like sucking
- Developmental task – self from non-self and development of TRUST
- Interaction with the environment – primary socialization – breast is the source of food and
drink and also love
- Controlled by the ID therefore immediate gratification
- Insufficient or forceful feeding result in FIXATION
- Symptoms of fixation: smoking, nail biting, constant chewing, overeating, drinking, sarcasm
(“biting personality”) and verbal hostility
- Pathology – DEPENDENT personality
ANAL STAGE
- Erogenous zone – ANUS
- Gratifying activities – bowel movement and the withholding of such movement
- Developmental task – to control and postpone the urge, to work out ambivalence attitudes
- Anlage of the superego
- Interaction with the environment – dyadic relationship. The major event is toilet training
- Anal fixation:
ANAL - EXPULSIVE personality
ANAL – RETENTIVE personality
- Pathology – OBSESSIVE COMPULSIVE PERSONALITY
PHALLIC STAGE
- Erogenous zone – GENITAL
- Gratifying activities – masturbation and genital fondling
- Superego developing
- Developmental task – resolution of “Oedipus complex”
- Interaction with the environment – triadic relationships. The key event is the child’s
attraction of the parent of opposite sex, together with the envy and fear of the same-sex
parent
- “OEDIPUS COMPLEX”
The male child’s attachment to the mother. Child becomes rivals with his father and sees
him as competition for the mother’s affection. Then, experience intense fear of
punishment from the father for their desire for the mother
“CASTRATION ANXIETY”
- “ELECTRA COMPLEX”
Girls unconscious sexual desire for the father. It involves “penis envy” that is according
to Freud, the girl believes that she once had a penis but that it was removed
- Phallic fixation: sexual deviances, weak or confused sexual identity
LATENCY STAGE
- No erogenous zone
- Quiescent stage
- Stabilization of superego – ego-ideal
- Interaction with the environment – same sex peer relationships, sexual instinct is
submerged in the unconscious
GENITAL STAGE
- Erogenous zone – GENITAL
- Gratifying activities – MASTURBATION AND HETEROSEXUAL RELATIONSHIP
- Reshaping of the superego
- Developmental task – consolidation of sexual identity, control of drives, greater
independence
- Interaction with the environment – marked by renewed sexual interest and desire and the
pursuit of relationships
Erickson’s Psychosocial Stages of Development by Erik Erickson
- Infancy (0-1 year) – Trust vs. Mistrust
- Toddler (1-3 years) – Autonomy vs. Shame and Doubt
- Preschool (3-6 years) – Initiative vs. Guilt
- School (6-12 years) – Industry vs. Inferiority
- Adolescent (12-18 years) – Identity vs Role Diffusion
TRUST vs MISTRUST
- Corresponds to the oral psychosexual stage
- TRUST shown by ease of feeding, depth of sleep, availability of mother or caretaker
- Depends on the consistency and sameness of experiences provided by the caretaker
- Second to 6 months: teething and biting move infant from getting to taking
- Weaning leads to nostalgia for lost paradise
- If basic trust is strong, child maintains hopeful attitude, develops self-confidence
- Oral zone associated with mode of being satisfied
- Virtue of HOPE
- Psychopathology: DYSTHYMIA
AUTONOMY vs SHAME AND DOUBT
- Corresponds to muscular-anal stage
- Biologically includes learning to walk, feed self, talk
- Need for outer control, firmness of caretaker before development of AUTONOMY
- SHAME occurs when the child is overly is self- conscious through negative exposure and
punishment
- Self-doubt can evolve if parents overly shame child, eg., elimination
- Anal zone associated with mode of holding on and letting go
- Virtue: WILL
- Psychopathology: OBSESSIVE COMPULSIVE personality, PARANOID personality
INITIATIVE VS GUILT
- Corresponds to phallic psychosexual stage
- INITIATIVE arises in relation to tasks for the sake of activity, both motor and intellectual
- GUILT may arise over goals contemplated (especially aggressive goals)
- Desire to mimic adult world; involvement of oedipal struggle leads to resolution through
social role identification
- Sibling rivalry frequent
- Phallic zone associated with mode of competition and aggression
- Virtue: PURPOSE
- Psychopathology: ANXIETY DISORDERS, PSYCHOSOMATIC, PHOBIAS
INDUSTRY vs INFERIORITY
- Corresponds to the latency psychosexual stage
- Child is busy building, creating, accomplishing
- Receives systematic instruction of fundamentals of technology
- Dangers of sense of inadequacy and inferiority if child despairs of tools, skills and status
among peers
- Socially decisive age
- No dominant zone or mode
- Virtue: COMPETENCE
- Psychopathology: low self-esteem, inferiority can lead to depression or work as main focus
in life in expense of intimacy
IDENTITY vs ROLE CONFUSION
- Struggle to develop ego identity (sense of inner sameness and continuity)
- Preoccupation with appearance, hero worship, ideology
- Group identity (with peers) develop
- Danger of role confusion, doubts about sexual and vocational identity
- Psychosexual moratorium, stage between morality learned by the child and the ethics
developed by the adult
- No dominant zone or mode
- Virtue: FIDELITY
- Psychopathology: CONDUCT DISORDER, DISRUPTIVE BEHAVIOR, GENDER IDENTITY
DISORDER, PSYCHOTIC DISORDER
INTIMACY vs ISOLATION
- Tasks are to LOVE and to WORK
- INTIMACY is characterized by self-abandonment, mutuality of sexual orgasm, intense
friendship, attachment that are life-long
- ISOLATION is marked by separation from others and view that others are dangerous
- General sense of productivity in this stage
- No dominant zone or mode
- Virtue: LOVE
- Psychopathology: SOCIAL ISOLATION, SUSPICIOUS character, DEPRESSION
GENERATIVITY vs STAGNATION
- GENERATIVITY includes raising children, guiding new generation, creativity, altruism
- STAGNATION not prevented by having children; parent must provide nurturance and love
- Self-concern, isolation and absence of intimacy are characteristic of stagnation
- No dominant zone or mode
- Virtue: Care
- Psychopathology: prone to DEPRESSION, substance use like alcohol
INTEGRITY vs DESPAIR
- INTEGRITY is a sense of satisfaction that life has been productive and worthwhile
- DESPAIR is a loss of hope that produces misanthropy and disgust
- Persons in the state of despair is fearful of death
- An acceptance of one's place in the life cycle is characteristic of integrity
- Virtue: WISDOM
- Psychopathology: psychosomatic, hypochondriac and depression, increase suicide
Piaget’s Theory of Cognitive Development
- Sensorimotor Reflexes (0 – 2 years) – Reliance on reflexes to interact with environment
- Pre-operational/Pre- conceptual (3 - 5 years) – Increase use of language; unable to put self
in another's place; does not understand relationship of size, weight, volume
- Intuitive (5 - 7 years) – Magical thinking; egocentric; tendency to center attention on one
feature
- Concrete Operations (8 – 13 years) – Inductive reasoning (specific to general); conservation
-ability to understand things are essentially the same even though its shape and
arrangement are altered
- Formal Operations (13 – 16 years) - Capable of introspection, deductive reasoning; able to
formulate hypothesis
Gross Motor Skills
- 2 months – Holds head up
- 3 months – Holds head and chest up when prone
- 4 months – Rolls front to back
- 5 - 6 months – Rolls back to front
- 6 months – Holds head steady when sitting
- 6 - 8 months – Sits unsupported
- 12 months – Stands
Fine motor skills
- Social development
- 2 month – smlle
- 3 month – breast milk,
- 6 month – stranger anxiety
- 9 months – waves bye bye
- 12 months comes when called speaks one word
- 15 months jargon babbles
- 18 month copies parents
- 2 yr. two words
- Circle by 3 years
- Cross by 4
- Square by 5
- Triangle by 6
Pediatrics feeding and play
- 0-1 yo breast milk
- 4-6 mo iron fortified
- 6-8 mon yellow veggie
- Play
- Infants solitary play
- Toddler parallel play
- Preschool associative or cooperative play
- School-age competitive play
Infant Play Activities
- Birth - 3 months – Visual and auditory stimuli
- 3 - 6 months – Noise-making objects and soft toys
- 6 -9 months – Teething toys and social interaction
- 9 - 12 months – Large blocks, toy that pop apart, and push and pull toys
Play Activities & Separation Anxiety
- Birth -3 mo visual & auditory – Separation Anxiety
- 3-6 months noisemaking objects and soft toys – Parents at hospital are toddler
- 6-9 months teething toys and social interaction, stack, build cause they sitting up - Begins
9 months and peaks at 18 months
- 9-12 months push pull, popcorn popping, large blocks pull apart- Isolation washable toys
