Nursing 109

N109: Foundations in Nursing Practice Study Guide • Lawrence Kohlberg and Carol Gilligan contributed to the field of moral development. • James Fowler developed theories around the individual’s spiritual and faith-based development. Normal development and the work of these theorists are detailed below by the patient’s chronological age. As the nurse works with each age group, it is helpful to know typical developmental expectations for the age while understanding that delays or acceleration may occur. Each stage of development also has specific health problems that may be identified in that age group. The astute nurse will be alert to the problems typically seen in each group. 1.2 Neonates and Infants: Birth to 1 Year Physical Development Size: Weight at birth averages 6-8.5 pounds. It doubles by six months, and triples by one year of age. Length at birth averages 20 inches and increases by about eight inches by one year old. Head circumference at birth averages 14 inches, and chest circumference is about one inch less. The anterior fontanel (soft spot) closes by about 18 months. Vision: Vision is poorly developed at birth but by four months of age, the infant is able to recognize familiar objects and follow moving ones. At six months, the infant can perceive colors and by nine months, can recognize faces. Depth perception does not develop until approximately one year of age. Hearing: Hearing in infants can be checked by making a loud noise; the infant with intact hearing will exhibit a startle reflex (Moro). By nine months, the infant should recognize familiar sounds and by 12 months, should begin to respond to simple commands. Reflexes: • Rooting reflex: The rooting reflex begins when the corner of the baby's mouth is stroked or touched. The baby will turn his head and open his mouth to follow and “root” in the direction of the stroking. This helps the baby find the breast or bottle to begin feeding. • Sucking reflex: Rooting helps the baby become ready to suck. When the area around the baby’s mouth is touched, the baby will begin to suck. This reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. The sucking reflex lasts approximately 10 months. Babies also have a hand-to-mouth reflex that goes with rooting and sucking, which may be seen in the form of sucking on fingers or hands. • Moro reflex: The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound, quick movement, or feels like she is falling. In response, the baby quickly extends out the arms with the fingers fanning out then pulls the arms back in. A baby’s own cry can startle her and begin this reflex. This reflex lasts about four months. • Tonic neck reflex: This happens when a baby’s head is turned to one side while lying supine. The arm and leg on that side stretch out and the opposite arm and leg bend up. This is often called the “fencing” position. The tonic neck reflex lasts about six months.

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