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About Pediatrics
Some Differences
Obvious- body size differences
Treating a child is not like treating a
miniature adult.
Children are minors
Often have to treat the parents and
sometimes, the family, rather than just the
child
Two
8 months
4 years
MVA
Substance abuse
Suicide/homicide
1.
2.
3.
4.
5.
Head circumference
Chest circumference
Abdominal girth
Weight
Length
newborn to 3 months
1 month to 1 year
newborn to 6 months
3 months to 15 months
1.
2.
3.
4.
newborn to 3 months
1 month to 1 year
newborn to 6 months
3 months to 15 months
9 months
12 months
18 months
2-3 years
1.
2.
3.
4.
9 months
12 months
18 months
2-3 years
7 years
9 years
15 years
16 years
1.
2.
3.
4.
7 years
9 years
15 years
16 years
1.
2.
3.
4.
1.
2.
3.
4.
4-6 ounces
8-10 ounces
14-16 ounces
20-24 ounces
1.
2.
3.
4.
4-6 ounces
8-10 ounces
14-16 ounces
20-24 ounces
25 words
50 words
150 words
250 words
1.
2.
3.
4.
25 words
50 words
150 words
250 words
1.
2.
3.
4.
1.
2.
3.
4.
0.25 mL
0.5 mL
0.05 mL
1 mL
1.
2.
3.
4.
0.25 mL
0.5 mL
0.05 mL
1 mL
1.
2.
3.
4.
erythema infectiosum
mumps
infectious mononucleosis
roseola
1.
2.
3.
4.
erythema infectiosum
mumps
infectious mononucleosis
roseola
nasal culture
arterial blood gases
stool or throat culture
magnetic resonance imaging (MRI)
1.
2.
3.
4.
nasal culture
arterial blood gases
stool or throat culture
magnetic resonance imaging (MRI)
1.
2.
3.
4.
Shigella
Salmonella
rotavirus
Giardia
1.
2.
3.
4.
Shigella
Salmonella
rotavirus
Giardia
electrical
radiation
chemical
thermal
1.
2.
3.
4.
electrical
radiation
chemical
thermal
1.
2.
3.
4.
1.
2.
3.
4.
15 months
24 months
18 months
36 months
1.
2.
3.
4.
15 months
24 months
18 months
36 months
10
20
30
40
1.
2.
3.
4.
10
20
30
40
He has an abrasion.
Welcome to Pediatric
Nursing
Resource Materials
ATI
Unit 1 (Ch. 1-11)
Saunders
Chapter 27-28, 39
Rosdahl
Chapter 71-74
PowerPoint 1a
Practice Questions
Applicable Handouts
Quizzes
Topics
WHAT IS A FAMILY?
Two or more people related by blood or marriage
who reside together or
More broadly-two or more individuals who come
together for the purpose of nurturing.
Nuclear
Single-parent
Blended
Extended
Same-sex
Foster
Genogram
A diagram of relationships between family
members; medical history
Parenting
Cultural Awareness
Cultural and religious beliefs have an impact on
the interaction of family members.
(Culture-a style of behavior patterns, beliefs,
and products of human work. i.e. art, music within
a given community or population)
Religion, ethnicity, race, stereotyping, prejudice,
bias, ethnocentrism
Communication, dietary preferences, and dress
are influenced by culture
Differences in language, habits, customs,
attitudes, and beliefs can lead to feelings of
isolation and loneliness in children.
Cultural Competence
Refers to the ability of the nurse to
understand and effectively respond to the
needs of patients and families from different
cultural backgrounds
Nurse needs to understand her own cultural
background and biases
Nurse should be aware of, sensitive to, and
appreciative of cultural differences
Nonverbal behaviors (chart ATI p.11)
Religion/Spiritual/Death rituals
Pain
Nutrition
Communication
Family patterns and gender roles
Repatterning
Using and interpreter
Pediatric Assessment
Examination of the child begins from the first contact. You
should observe the behavior of the child and parent by using
visual cues to make a proper assessment.
Premature Infant
Physical Assessment
Physical Assessment
Hide any threatening equipment prior to the exam
Keep room warm and well lit
Tell the child what to expect as the physical exam is
being performed
Use the parents lap if desired
Allow child and parents to ask questions
Know expected vital signs for each age group
Know expected physical findings/General
appearance
Question
A nurse is caring for a 9-month-old infant.
Rank the following assessments in the
order in which the nurse should perform
them.
____ Axillary temperature
____ Respiratory rate
____ Weight
____ Heart rate
Answer
__4__ Axillary temperature
__1__ Respiratory rate
__3__ Weight
__2__ Heart rate
General appearance
(color, temperature,
texture, moistness, turgor, lesions, CFT, skin folds, hair, nails)
Throat, neck
trachea, ROM)
Chest
Abdomen
masses, )
spinal alignment)
Upper/Lower extremities
hips, feet)
(Behavior,
LOC, Communication, balance and coordination, gait)
Newborn Reflexes
Facial Symmetry
Eyes
Examination of Mouth
Lymph nodes
Heart Rate
Apical is recommended
Count 1 full minute
Listen for irregularities document and report
Apical Pulse
Respiratory Rate
Count 1 full minute
Observe chest and abdomen move
S/S Respiratory Distress include:
Grunting
Nasal Flaring
Retractions
Stridor
Tachypnea
Cyanosis
Examination of Chest
A nurse is checking the vital signs of a 3year-old child during a well-child visit.
Which of the following findings should the
nurse report to the provider?
1.Temperature 37.2 C (98.9 F)
2.Pulse 114/min
3.Respirations 38/min
4.Blood pressure 92/54 mm Hg
A nurse is checking the vital signs of a 3year-old child during a well-child visit.
Which of the following findings should the
nurse report to the provider?
1.Temperature 37.2 C (98.9 F)
2.Pulse 114/min
3.Respirations 38/min
4.Blood pressure 92/54 mm Hg
Examination of Chest
Description
Cause
Fine crackles
Sibilant rhonchi
Musical, squeaking, or
hissing noise heard
during inspiration or
expiration; generally
louder on expiration
Bronchospasm or
anatomic narrowing of
trachea, bronchi, or
bronchioles
Sonorous rhonchi
Coarse, low-pitched
sound like a snore,
heard during inspiration
or expiration; may clear
with coughing
Chest Shape
Blood Pressure
Oral
Temperature
Axillary
Axilla with direct skin contact x 3 min.
Rectal
Only when another method cannot be used
Not in newborns, cancer, diarrhea
Lubricated tip inserted - x 3 min.
Tympanic
Rapid (2 sec), noninvasive, convenient
Temporal
Scan across forehead
Temperature
Position for taking
axillary temperature.
Axillary
96.6 98.0 F
Oral
97.6 98.6 F
Rectal or tympanic
98.6 100.0
F
Head Circumference
Fontanels
Measuring length-height
Common Milestones
Infancy
1 month to 1 year
Early Childhood
Toddler
1-3 years
Preschool
3-6 years
Middle Childhood
School age
6 to 12 years
Late Childhood
Adolescent
13 years to
approximately 18
years
Principles Continued
Development proceeds from the simple to the
complex and from the general to the specific.
Development occurs in a cephalocaudal and
a proximodistal progression.
There are critical periods for growth and
development.
Rates in development vary.
Development continues throughout the
individual's life span.
Growth Pattern
Key Definitions
Growth- increase in size of structure
Development- complexity in thought,
behavior, skill, or function; includes growth;
process that continues over time
Cephalocaudal- head-to-toe progression
of growth and development
Proximodistal- trunk-to-periphery
progression of growth and development
Developmental task -skill or competency
unique to a stage of development
Developmental Tasks
Physical (sit, walk, crawl, motor development,
sensory development)
Psychological (imitation, trust, self-esteem,
socialization)
Cognitive (recognition, following direction,
concepts of time and space, magical
thinking, abstract thought)
Theorist
Type of Development
Stage
Erikson
Psychosocial
Freud
Piaget
Psychosexual
Cognitive
Oral
Sensorimotor
Physical Development
Posterior fontanel closes @ 2-3 mos.
Size tracked by weight, length, head
circumference
Gross motor skills
-Holds head up
-Rolls over (5-6 mos.)
-Holds head steady when sitting (6 mos.)
-Gets to sitting alone; pulls up to standing (9 mos.)
-Stands holding on or alone (12 mos.)
-6 mos. doubles birth weight
Age
Gross
Fine
1 month
Head lag
Grasp reflex
2 months
3 months
4 months
5 months
Grasps
6 months
Holds bottle
7 months
8 months
Sits unsupported
9 months
Pulls to standing
Object in container
Newborn
Age 6 months
Head Control
Hypotonia
Sitting Up
Age 6 months
Age 2 months
Age 8 months
Ambulation
Nine to 12-months
13 month old
Cognitive Development
Initial reflexes replaced by voluntary
movements
-Object permanence (peek-a-boo) 9 months
-Discrimination between persons
-Comprehension of word meanings
Language
-Responds to noises
- ooos and aahs
-Laughs and squeals
-Turns head to sound of rattle
-Pronounces single syllable words
- Begins 2-3 word phrases
Psychosocial Development
Personal-Social
-Bonding with parents during first month
-Regards faces
-Smiles in response to others
-Regards own hands
-Works to reach toys
-Feeds self finger foods
-Waves goodbye/Plays pat-a-cake
-Drinks from a cup with handles
Separation Anxiety-latter half of first year
Stranger Fear
(Encourage parents not to leave infant long periods of time)
Self-concept (separate from parents)By end of first
year
Separation Anxiety
Protest
Despair
Denial or detachment
Encourage and plan to have parents be part
of care
Respect infants usual schedule as much as
possible
Nutrition
Breastfeeding recommended
Iron-fortified formulas
Cows milk NOT recommended
Solids: Introduced ~ 6 mos.
-Iron fortified cereals
-Pureed/strained foods one at a time
-Decrease milk/formula as solids increase
-Weaning when can drink from cup ~ 6mos
Milk, eggs, wheat, citrus fruits, peanuts, peanut
butter, and honey should be delayed until the first
year of life.
Injury Prevention
Suffocation (Plastic bags, balloons, firm crib, back to
sleep)
Infant Seats
Infants should use approved rear-facing car
seats in the back seat, preferably in the middle,
(away from air bags and side impact).
Infants should be in rear facing car seats for the
first year of life and until they weigh 9.1 kg (20
lb).
It is recommended to have infants ride rear
facing until they have reached the weight limit
allowed for the car seat (as long as the top of the
infants head does not extend above the top of
the seat back).
A five-point harness or T-shield should be part of
a convertible restraint.
Type of Development
Erikson
Psychosocial
Stage
Autonomy vs.
shame
Freud
Psychosexual
Anal
Piaget
Cognitive
Sensorimotor
transitions to
preoperational
Physical Development
Anterior fontanel closes by 18 mos. of age
At 12 mos. triples birth weight
30 mos. four times birth weight
15 months
18 months
Assumes a standing
position
Manages spoon
Turns pages in book
2 years
2.5 years
Draws circles
Good hand-finger
coordination
Developmental Skills
Steady gait
Climbing stairs
Jumping, standing on 1 foot for
short periods
Stacking blocks increasingly
higher numbers
Drawing stick figure
Undressing and feeding self
Toilet training
Psychosocial/Moral Development
Independence
Separation anxiety
Egocentric (their point of view)
Reward for good behavior; punishment for bad behavior
Self-Concept/Body Image
See themselves as separate form their parents
Usefulness of various body parts
Gender identity by age 3
Cognitive Development
Age-appropriate Activities
Parallel play
Filling and emptying containers
Playing with blocks
Reading books
Push/Pull toys
Tossing a ball
Nutrition
Picky eaters food jags
Toddlers should consume 24 to 30 oz of milk per day
May switch from drinking whole milk to drinking low-fat
milk (2% fat) at 2 years of age
Juice consumption should be limited to 4 to 6 oz per
day
Appropriate finger foods include ripe bananas; toast
strips; graham crackers; cheese cubes; noodles; and
peeled chunks of apples, pears, or peaches
Foods that are potential choking hazards (nuts,
grapes, hot dogs, peanut butter, raw carrots, tough
meats, popcorn) should be avoided
Child Abuse
Upper respiratory infections, otitis media
Temper tantrums
Toilet training
Discipline (well defined boundaries)
Immunizations:
12-15 mos.
12-23 mos.
15-18 mos.
12-36 mos.
Hep A
DTaP
Flu vaccine
Injury Prevention
Drowning (unattended in bathtub, pool supervision)
Falls (Doors and windows locked, safety gates)
Suffocation (toys with small parts, drawstrings from
Car Seats
Toddlers should be in approved rearfacing car seats in the back seat until they
weigh 9.1 kg (20 lb). Toddlers may then sit
in approved forward-facing car seats in the
back seat. Toddlers may usually remain in
car seats until 4 years of age and/or 40 lb
Red Flags-Toddler
Stages of Development
Theorist
Type of Development
Stage
Erikson
Psychosocial
Freud
Psychosexual
Phallic
Piaget
Cognitive
Preoperational
Cognitive Development
Preconceptual: Judgment, artificialism,
animism, imminent justice
Intuitive: Classification, cause and effect
Language: Vocab continues to increase,
sentences, color identification, likes talking
Time: Concepts of past, present and
future; Comprehension of days of week
Psychosocial/Moral Development
Self-concept/Body image
Guilt
Social acceptability
Mastering skills and feeling good
May regress in times of stress
Greatest fear: Bodily harm
Sex-role identification
Magical thinking
Age-appropriate Activities
Associative play
Playing ball
Puzzles
Riding tricycles
Pretend and dress-up
Role play
Painting
Sewing and beading
Reading books
Nutrition
Typically consumes half the calories of an
adult
Continue to be picky up to age 5
Parents need to ensure balanced nutrition
Child abuse
Otitis media
Accidents (poisoning and drowning)
Sleep disturbances (night terrors)
Vision screening
Immunizations: 4 to 6 years
-DTaP, IVP, MMR, Varicella, flu vaccine
Injury Prevention
Drowning (Pool safety)
Poisoning
Motor vehicles
-Approved car seat
-Booster seat UNTIL adult seat belts fit
correctly
Theorist
Type of Development
Erikson
Psychosocial
Freud
Piaget
Psychosexual
Cognitive
Stage
Industry vs.
Inferiority
Latency
Concrete
operations
Physical Development
Cognitive Development
Concrete thought
Simple analogies
Understands time, days, seasons
Defines many words, understands rules of grammar
Classifies more complex information
Understands emotions
Self-concept/Body Image
Develop healthy self-respect by finding out the areas
they excel
Need encouragement
Solidification of body image
Curiosity about sexuality: sex education
Emphasis on modesty, privacy
Psychosocial Development
Sense of industry achieved through
achievements in learning
Same-sex companions
Most friends are from school
May rival same-sex parent
Nervous behaviors (nail-biting)
Fears of ridicule from peers, teachers
Begins to understand rules, understanding
justice
Age-appropriate Activities
Injury Prevention
Fracture prevention
Avoid trampolines
Teach children to swim
Teach fire safety
Keep firearms locked up
Motor vehicles (car or booster seat until adult seats
fit properly)
School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting, animal
abuse
Stages of Development
Theorist
Type of Development
Erikson
Psychosocial
Stage
Identity vs. Role
confusion
Freud
Psychosexual
Genital
Piaget
Cognitive
Formal
operations
Physical Development
Acne
Females 95% of adult height by 13, Widening
hips
Males 95% of adult height by 15, shoulders
broaden
Male sexual maturation: size testes, pubic hair,
rapid growth of genitalia, axillary hair, downy hair
upper lip, chance in voice
Sleep habits change
Cognitive Development
Psychosocial Development
Develops a sense of personal identity
May become a par of a peer group that influences
behavior
Work habits begin to solidify
Increased interest in the opposite sex
Risky behaviors; often view themselves as invincible
Moral/Self-Concept/Body Image
Rules are not seen as absolutes
Having healthy relationships with peers, family,
teachers
Identifies skill or talent
Participation in sports or hobbies, community
Concerned with lean bodies portrayed in the
media
Comparing pubertal development
Common to have depression or eating disorders
due to poor body image
Adolescent
As teenagers gain independence they begin to
challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early adolescents
Anorexia
Attention deficit
Anger issues
Suicide
Nutrition
Rapid growth; high metabolism: tend to be deficient in
iron, calcium, and vitamins A and C
Eating disorders
Anorexia nervosa
Bulimia
Obesity (diet high in fat without adequate activity)
Scoliosis
Child abuse
Motor vehicles leading cause of death
Homicides 2nd leading cause of death
Substance Abuse
Sexual experimentation, STDs, Pregnancy
Injury Prevention
Adolescent Teaching
Relationships
Sexuality STDs / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons
Functions of Play:
-Physical/Sensorimotor development
(exploration,
joint and muscle, muscle coordination, gross/fine motor skill, kinesthetic
stimulation)
Types of Play
Solitary (Begins in infancy and is common in
toddlers)
Parallel (Involves child playing next to another
child but not with that child-Characteristic of
toddlers, no sharing)
Associative (Interaction with other childrenBegins late toddlerhood and extends through
preschool years)
Cooperative (Organized play of groups, usually
involves a leader
Onlooker (Child is a bystander, observes but
does not join in)
Play
Therapeutic
Guided by health care team to assist child in coping with
hospitalization)
Supervised play with medical equipment to be used with child
Enhances compliance with therapy and nursing care
Provides emotional outlet during stressful periods
Dramatic
An emotional outlet
Provides child with opportunity to act out stressful events
Used by psychologists as a means of communicating
traumatic events
Pediatric Medications
Rights of medication administration:
Client
Medication
Dose
Time
Route
Documentation
Volume
Technique/approach
Documentation
Right to refuse
Right to know
potential side effects
ADMINISTRATION OF MEDICATIONS
Pediatric dosages are based on body weight,
BSA, and maturation of body organs
Neonates and infants have immature kidney
and liver function, alkaline gastric juices, and an
immature blood-barrier
Some med dosages are based on age
Children have gastric acid production and
slower gastric emptying
Pediatric clients are more sensitive to
medications
ORAL MEDICATIONS
Liquids, pills, tablets, and caplets.
Do not mix meds with formula
Preferred route, measured in milliliters
5 mL (1 tsp); 30 mL (1 oz)
Use plastic, needleless syringes, medicine cup
Crush tablets and dissolve
Do not crush enteric-coated or time-released
tablets
Divide tablets only if scored
Administration of Medications
If child has NGT, OGT, or GT give via this route
Flush tubes after med administration
Give suspensions/elixirs when available
Raise or lower tube to control rate of flow (gravity)
Rectal
Substitute for oral (child with nausea and vomiting)
Tylenol, sedatives, morphine, anti-emetics
Cut lengthwise
Subcutaneous/Intradermal
May apply local anesthetic prior to injection
Use 3/8 to 5/8; 26-30 gauge needle
Change needed if used to puncture rubber
top of vial
Inject small volumes (up to 0.5 mL)
SQ 90 angle or 45 angle if minimal SQ
tissue
Intradermal 15 angle to form bleb
INTRAMUSCULAR INJECTIONS
INTRAVENOUS MEDICATIONS
Children are at risk for fluid overload.
All children receiving IV fluids should receive
those fluids through a volumetric infusion pump.
Site assessment includes color of site, tension
of skin, and skin temperature.
Peripheral venous access
Central venous access
Assessment of Pain
Subjective data: quality, intensity, strength,
severity, timing, location, aggravating
factors, associated symptoms
Objective data: Facial expressions,
moaning, crying, decreased attention span
Temporary increase in BP, pulse, RR with
acute pain, then return to normal
See ATI pg. 114-115 for appropriate
routes for pain meds
CHEOPS1 to 5 years
(Childrens Hospital of Eastern Ontario Pain Scale)
NIPS
Non-pharmacologic Measures
Positioning
Breathing and relaxation techniques
Splinting
Calm environment (low noise, lighting)
Ice
Warm blankets
Guided imagery
Distraction (video games, cartoons, video)
Holding, rocking
Sucrose pacifiers for infants during procedures
Help by:
Promoting feelings of self-determination
Allow choices when appropriate
Age-Related Interventions
Interventions should be
based on the
developmental level of the
child
Teach family what to
expect
Encourage parents to stay
during hospital stay
See ATI p. 125
Adolescent
Preschool
School-age
Toddler
Adolescent
Preschool
School-age
Toddler
9 months
12 months
15 months
18 months
9 months
12 months
15 months
18 months
6. An assessment of the skull of a normal 10month-old baby should identify which of the
following?
1. Closure of the posterior fontanel
2. Closure of the anterior fontanel
3. Overlap of cranial bones
4. Ossification of the sutures
6. An assessment of the skull of a normal 10month-old baby should identify which of the
following?
1. Closure of the posterior fontanel
2. Closure of the anterior fontanel
3. Overlap of cranial bones
4. Ossification of the sutures
24 hours
7 days
48 hours
28 days
24 hours
7 days
48 hours
28 days