Chapter 25: Growth and Development of the Newborn and Infant

1. Jesus is the first-born son of Roberto and Marie Valez. The parents are very excited about the birth of their new son. They have brought Jesus into their nurse practitioner today for his first examination 3 days after his birth. Jesus was 7 lbs 2 oz at birth and 19 in. His Apgar scores were 8 and 9. There were no complications with his mother’s pregnancy or his delivery. Jesus’ parents have noticed that he has lost some weight since coming home. Marie is breastfeeding Jesus and is concerned that she is doing something wrong. They also have several questions about Jesus.  (Learning Objectives 1 and 4)

a. What can the nurse practitioner tell Marie regarding her concerns about Jesus’ weight loss?

b. What questions should the nurse practitioner ask regarding Jesus’ nutrition, and what information can he or she offer to Marie regarding breastfeeding?

c. What anticipatory guidance can the nurse practitioner offer to Roberto and Marie regarding Jesus’ growth and development over the next several weeks?

2. Steve Shell has brought in his 9-month-daughter Emily for her wellness examination and immunizations. Steve is a single father raising his daughter after Emily’s mother was killed in a motor vehicle accident (MVA). Steve is doing a great job of raising Emily by himself, but he still has some concerns about his abilities as a father. He has several questions for the nurse practitioner. The nurse practitioner’s examination of Emily is unremarkable and she is growing and developing as expected. (Learning Objectives 6 and 7)

a. What should the nurse practitioner include when teaching Steve about promoting healthy eating habits and appropriate sleep and rest?

b. What can the nurse practitioner offer Steve regarding promoting appropriate discipline with Emily?

c. Since Steve is a single parent and sole income earner, he is required to place Emily in day care while he is at work. Steve is concerned about the effects of day care on Emily’s development. What can the nurse practitioner teach Steve about child care?

Chapter 26: Growth and Development of the Toddler

1. Bill and Ted are a domestic couple that have brought in their 30-month-old daughter, Victoria, complaining of a runny nose, cough, and low-grade fever. Bill and Ted adopted Victoria at birth. The biological mother was a teenager who chose to give her child up for adoption and Bill and Ted provided financial support to ensure that she received the appropriate prenatal care. Her pregnancy and delivery were unremarkable. She has had no contact with Victoria or her fathers since the birth. The nurse practitioner determined that the symptoms are attributed to an upper respiratory tract infection (URI) or common cold and recommended that it be treated symptomatically. While in the office, Bill and Ted have some questions regarding Victoria’s behavior. They explain that she has become more defiant, repeatedly responding to their questions or commands with “no” or temper tantrums. Neither Bill nor Ted has been a parent before adopting Victoria and they are concerned that they are to blame for her behavior.  (Learning Objectives 1, 5, and 12)

a. What can the nurse teach Bill and Ted about the psychosocial or cognitive development of a toddler that would help them understand Victoria’s behavior?

b. What can the nurse teach Bill and Ted regarding promoting appropriate discipline for  Victoria?

c. What is “temperament” and how would it influence Victoria’s behavior?

2. Tenzin and Dechen have brought in their 24-month-old son, Kim, for his wellness examination and immunizations. Kim is the first child for Tenzin and Dechen, but Dechen is 6 months pregnant with their second child. Tenzin and Dechen are Tibetan refugees who have moved to the United States from India. Kim was born in the United States. Tenzin and Dechen are very focused on Kim’s physical abilities (i.e., motor skills, communication, and sensory skills). They express their desire for Kim to do well in school and be successful in business. (Learning Objectives 3, 4, 7, 11, and 13)

a. What could the nurse share with Kim’s parents regarding the normal motor, communication, and sensory development of a 24-month-old?

b. What can the nurse teach Tenzin and Dechen regarding promoting healthy growth and development in Kim?

c. Kim’s parents are curious about toilet training. How can the nurse teach Kim’s parents about toilet training with a toddler?

Chapter 27: Growth and Development of the Preschooler

1. Donnie has brought his 4-year-old son, Isaac, to the pediatric free clinic for a kindergarten physical. Isaac is the older of two children of Donnie and Mary Smith. Donnie is employed as a farrier but his work does not provide insurance and he has come to a nurse-operated free clinic. Donnie shares that Isaac enjoys spending time with his father when he is working with the horses, but he is concerned that Isaac has an imaginary friend named “Tackle.” On physical examination, Isaac is 39 inches tall and weighs 35 lbs. Donnie is a man of average height (5’9” with a slim build). Donnie is concerned that Isaac may be too small for his age. (Learning Objectives 1)

a. What can the nurse communicate to Isaac’s father about his physical growth?

b. What can the nurse teach Isaac’s father about his cognitive and psychosocial development?

c. What can the nurse teach Isaac’s father about his moral development?

2. Nina is the 5-year-old adopted daughter of Sarah and Tim Johnson. Nina is the Johnsons’ only child. They adopted Nina before her first birthday. The Johnsons have brought Nina to the clinic today to discuss some concerns they have about her development. Nina is attending a public kindergarten. Since beginning school, the Johnsons have noticed that they are catching Nina lying more. They are concerned that this may be a result of attending school. In addition, they are concerned about her verbal development and note that her teacher reported that Nina seems to be stuttering or repeating the term “um” when speaking. She also has some difficulty with “sh” and “th” sounds. When the Johnsons try to discuss these issues with Nina she becomes “very emotional” and retreats to her room. (Learning Objectives 2 and 6)

a. What can the nurse teach the Johnsons about lying in preschool children?

b. What can the nurse teach the Johnsons regarding stuttering and speech development with Nina?

c. What can the nurse teach the Johnsons regarding emotional development in preschool children?