Pediatric Nursing today and Assessment

Infant Mortality

number of deaths per 1000 live births during first year of life

Neonatal period

Postnatal period

28 days to 1 year

Birth Weight

Major determinant of neonatal death in the United States Lower birth weight = higher mortality

LBW

less than 2500 gm (5.5 lb)

Infant Mortality Risk factors

LBW, Race (Black, Indian, Hawaiian), Congenital anomalies, SIDS, Pregnancy complications, Short or long gestation, Maternal age , Low maternal education

Childhood Mortality

Number of child deaths out of 100,000 living children ages 1-14

Childhood Mortality leading cause

Injuries are leading cause of death in children older than 1 year

Childhood Mortality causes of death

Motor vehicle crashes, Drowning, Burns, Poisoning, Firearms

Leading Causes of Death in Children >5 years

Injury-related causes of death, MVC deaths, Firearm-related injuries, Homicide and malignant neoplasm, Suicide, Suffocation, Drowning, Drug overdose

Childhood morbidity

Prevalence of a specific illness in a population at a particular time

Influences on children morbidity

Family unit they are born in, Schools, Socioeconomic influences, Friends, Mass media, tv, books, Nature vs Nurture

Social group

consists of a system of roles carried out in primary and secondary groups.

strong family unit

clear set of values, rules, and beliefs to pass on to the next generation.

Authoritarian

Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations.

Permissive

Parents exert little or no control over the child’s behaviors and consult the child when making decisions.

Authoritative

Parents direct the child’s behavior by setting rules and explaining the rules for each rule setting.

Passive/ Uninvolved

Parents are uninvolved, indifferent, and emotionally removed.

A Family- Centered Approach

Recognizes the family as the constant in a child’s life – develop partnership. Systems must support, respect, encourage, and enhance the strength and competence of the family. Needs of all family members must be addressed.

A Family- Centered Approach effects

less Anxiety , Children are calmer and better pain management. Shorter Recovery times, Improved Families’ confidence and problem-solving skills. Improved Communication between care team and family. A decrease in costs. Health care resources are used more effectively.

Atraumatic Care

Therapeutic care with interventions to eliminate or minimize physical and psychological distress. Preventing or minimizing physical stressors and separation of the child from the family. Promoting a sense of control.

Atraumatic Care Therapeutic communication

Goal directed, Focused and purposeful

Atraumatic Care Therapeutic play

Provides emotional outlet or coping devices

Atraumatic Care Child education

Helps child understand the reason for the hospitalization/procedures

Tools for Atraumatic Care

EMLA Crème/ Patch, Lidocaine crème, Freezy spray, Medical Play, Using child life therapy, Kid-friendly terminology, Minimize pokes/ sticks

Culture

Differs from race and ethnicity. Focus on providing culturally sensitive and inclusive care. Practice with an open mind, kindness and respect Be aware of your own culture, spirituality, and values!

Cultural Competence

The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.”

Cultural Congruence

The practice of applying evidence-based nursing that is in agreement with the preferred cultural values, beliefs, and practices of the healthcare consumer.

WIC Program

a federal nutrition service that provides healthy food, education, and support to pregnant women, babies, and young children.

How might religious beliefs affect the care of children?

Spirituality, Religion, Birth and death, Diet and food practices, Medical care

Social Determinants of Health

Conditions in which people are born, live, work, and worship in addition to the broader set of forces and systems that shape human environments Includes neighborhoods, economic stability, education, social and community context, and health and healthcare. Impacts health and creates health inequities.

Communication,

eye contact, active listening

Establishing Rapport

Consider your FIRST IMPRESSION!

Interactions

parents first, child second.

Principles of Pediatric Practice

Encourage parent involvement, Choose your words wisely! Keep it SIMPLE!, Keep medical equipment out of sight until necessary. Operate with the principle of LEAST INVASIVE to MOST INVASIVE.

Psychological/ Spiritual Assess with discernment

Visitors, Interaction w. Nurses, Behavior, Reactions to stress, Socioeconomic status, Child life therapist, Family Structure, Church Support, Clergy visits. Religious symbols, General Attitude

Safety Checks when enetering room

Code sheet, Side rails up x3/ Crib rails up x4, Suction, Oxygen flowmeter, ID band, IVF correct and rate. IV site checks.

Growth, Development & Milestones

Zero out scale first! Always weigh laying down , Measure head circumference at the largest point (eyebrow). Developmental milestones can be assessed via different screening tools.

An infant's weight

should double by 5-6 months and triple by 1 year.

An infant's height typically

increases by 1 inch per month during the first year.

Plot height weight and head circumstance on

Growth Charts, should be around 50%

Temperature

Rectal for infants, oral for over 4y, tympatic 6+ months,

Pulse

when calm, for 1 full minute

Respiratory Rate

1 full minute, normal to be irregular

BP

appropriate cuff size, usally only older than 3 unless CV concern, leg works better

Head

Observe the shape of the head and symmetry of the face. Palpate the skull for the presence, size, and shape of the fontanels.

Eyes

PERRLA, Test the vision as appropriate for age or developmental ability. (pictures) Permanent color by 6-12 months

Ears

Pull pinna down and back for children <3 years (otoscopic), Up and back for children >3 years.

Fontanels Anterior

closes between 12-18 months. (diamond)

Fontanels Posterior

closes by 8 weeks of age. (triangle)

Integumentary Color

jaundice and birthmarks

Lesions/scars/bruising

NOT normal….assess for risk of abuse

Sclera

should be white, yellows with jaundice

Skin folds

should be symmetrical

Temp

above 97 or else septic work up

Newborns Lanugo,

Fine, soft unpigmented hair that may appear in babies. Typically disappears within a few weeks to months after birth.

Blue, gray birthmarks

(formally called Mongolian spots) that are more common in Asian, African, and Hispanic infants. They require no treatment.

Respiratory

Airway is smaller and more flexible, Tongue is larger. Chocking risk

Signs of Respiratory Distress

Nasal flaring, retractions on inhalation, Grunting or Head Bobbing

Look for retractions on inhalation

SUPRA , INTER, SUB, Clavicular, Costal, Sternal

Gastrointestinal

Daily weights for <3 years or Anorexic/Bulemic, Diet (breast feeding/formula) Nausea/vomiting/ diarrhea? NG Tubes

Peg Tubes

Mickey Tube (detachable)

Musculoskeletal

play a game with the patient, Ask school-age children what they like to do for fun. Offer activities to do in their room.

Musculoskeletal Assess

muscle tone, Strength, Symmetry, ROM, Posture, Gait, activity level, motor skills

Genitourinary

Every child should have intake and output measured (urine frequency; amount; color/clarity; odor; discomfort upon urination; discharge? catheters?)

Is genitalia normal for age?

Do not assess unless given permission or baby/infant. Circumcision (normally 2 days after birth); Post circumcision care

What age did menses start?

(10-15 years old average)

Neurological

Alertness, Orientation (appropriate to age) (change questions to be apporate to age – ex day vs night), Gross motor/Fine motor abilities, Speech/communication. Seizures or seizure precautions. INFANT REFLEXES

Cardiovascular

peripheral pulses brachial or femoral, Appropriate size BP cuff in room. Inspect the chest; the apical impulse may be visible, yet heaves should not be.

Cardiovascular What we need to know

*Congenital heart disease history? *History of a murmur? *History of high blood pressure or high cholesterol? *Any color changes to the skin or mucosa? *Any difficulty feeding or exertional dyspnea or activity intolerance? *Palpitations or chest pain?

PAIN ASSESSMENT for ages 3-7

FACES (pictures with numbers)

PAIN ASSESSMENT Infant-7 years OR Developmental Delay

FLACC (Face, Legs, Activity, Crying, Consolability

Pediatric Early Warning Score

PEWS Should the child be transferred to a higher level of care? Nurses monitor and assign scores for Behavior, Cardiovascular, Respiratory