Week 1 Nurs 307

Week 1 Objectives

Interpret how the Healthy People 2030 objectives will improve the health and welfare of the pediatric population and their families.

Describe the role of the nurse in the care of the pediatric patient and the expanding family.

Analyze the central role of therapeutic care relationship in providing nursing care to pediatric patients in all care settings and situations.

Evaluate the impact of cultural, ethical, legal, gender, and economic issues related to the health care of pediatric populations and their families.

Healthy People 2030 5 Steps

1. Attain healthy lives, free from preventable diseases and afflictions, and early death

2. Eliminate health inequity and achieve health literacy for all

3. Create great environments that promote great health

4. Promote healthy development and behaviors

5. Engage leaderships key constituents

General Role as a Pediatric Nurse

Promote the health and well-being of the child and family!

Therapeutic Relationships, Health Teaching, Research & EBP, Coordination & Collaboration, Promoter of Family Centered Care, Advocate, Support & Counseling, and Mandated Reporter

Family-Centered Care

Enabling

• create opportunities

Empowerment

• sense of control

• foster strengths & abilities & actions

Family is a constant in child’s life —> taking care of the needs of the family members in relation to the care of the child is key

What is Family?

A family is what an individual considers it to be!

most family’s are consanguineous

Consanguineous, Affinal, Family of Origin

1. Blood Relationships

2. Marital Relationships

3. Family Unit someone is born into

Communal Families, Single-Parent, Homosexual families

Use the term “Household” for better description

Family Stress Theory

Stress = inevitable

Stressors can be expected or unexpected

Explains the reaction of a family to stressful events

Offers guidance for adapting to stress

Developmental Theory

Family = small group that interacts with the larger social system

Emphasis on similarities and consistencies in how families develop and change

Duvall’s family life cycle stages to describe changes a family goes through over time

how the family functions in one stage, directly affects how the family will function in the next stage

Duvall’s Family Life Cycle

Parenting Styles

Authoritarian, Authoritative, Permissive, Ignorant

Authoritarian

Focus on obedience, and punishment, instead of discipline

Authoritative

Create positive relationships, enforcing rules

Permissive

Has rules but does not enforce rules

‘kids will be kids’

Uninvolved

Little to no guidance, nurturing, or attention

Limit Setting & Discipline

establishing rules/guidelines for behavior &

to teach or a set of rules that govern conduct

the action taken to enforce rules after non-compliance

implementing discipline

• consistency, timing, commitment, unity, flexibility, planning, behavior-orientation, privacy, termination

textbook pg 21

Childhood Injuries

Deaths by total (high to low):

1. Motor Vehicle (decreased)

2. Suffocation (increased)

3. Drowning (decreased)

4. Poisoning (decreased)

5. Burns (decreased)

6. Fall (increased!)

The Child in the Community: Nursing Care provided in

• health centers, outpatient clinics

• wellness centers / homeless shelters

• schools, child care centers, homes

The Child in the Community: Nursing Role in these capacities

• direct care

• education and assessing for risks of infection, other health risks

• promoting G/D

• information about community resources for wellness

Influences on Children and Families

Poverty/Homelessness

Stress: positive or negative

Sedentary life / Lifestyle influences

Injury prevention: equipment, etc

Environments: School, family, community, culture

Tattoos/Body Art

Other Influences on Child Health

SOCIAL MEDIA / MASS MEDIA

race/ethnicity

parental education

land of origin and immigration status

religion and spiritual identity and culture

Child Maltreatment

Intentional physical abuse or neglect, emotional abuse or neglect, and sexual abuse

Child Neglect

Most common maltreatment

Failure of a parent to provide for their child’s basic needs

Physical Abuse

Deliberate infliction of physical injury!

each state defines this differently*

Abusive Head Trauma (AHT) — Shaken Baby Syndrome

Emotional abuse/neglect

Abuse through intentional or unintentional emotional hurt

Sexual Abuse

Devastating Type of Maltreatment

Incest, Molestation, Exhibitionism, Child Pornography, Child Prostitution, Pedophilia

Risk Factors for Child Abuse and Neglect

Factors for Physical Abuse

• Poverty

• Violence in Family | Parents were abused as children | Substance Abusers | Social Isolation

• Prematurity/Low Birth weight | Younger than 3 y/o

• Unrelated male primary caretaker

• Child disability or condition that needs big gear

Factors for Sexual Abuse

• Absence of natural father or having a stepfather

• Being a female

• Mother’s employment outside of home

• Poor relationship w/ parent | Relationship with conflict

• Parental substance abuse or social isolation

Nursing Management for Abuse

Protect from further abuse

Support the child and family

Prevent Abuse

Piaget’s Stages of Cognitive Deveopment

Sensorimotor

Pre-operational

Concrete Operational

Formal Operational

Sensorimotor

0-2 Years

Infant explores world through direct sensory and motor contact

Object permanence and separation anxiety develop during this stage

Preoperational

2-6 years

Child uses symbols to represent objects but does not reason logically!

Ability to pretend, and egocentric forms

Concrete Operational

7-12 years

Logical thinking begins about concrete objects

Can add and subtract

Conservation understanding increases

Formal Operational

12 years - Adult

Abstract thinking and hypothetical terms used

Erikson’s Stages of Psychosocial Development

In this stage of development, when needs are met —> consequence is healthy, if not med, it is unhealthy

Trust vs Mistrust

0-1 year

Hope, basic needs being met

Autonomy vs Shame and Doubt

1- 3 years

Will

Develop a sense of independence

Initiative vs Guilt

3 - 6 years

Purpose

Take initiative on some activities, can get guilty

Industry vs Inferiority

7 - 11 years

Competence

Develop self-confidence or sense of inferiority depending on if needs are met

Identity vs Role Confusion

12 - 18 years

Fideltity

Experiment with identity and roles

Intimacy vs Isolation

19 - 29 years

Love

Establish intimacy and relationship with others

Generativity vs Stagnation & Integrity vs Despair

30 - 64 yeras
64+ years

Care and Wisdom

Contribution to sciety and make life have meaning

Atraumatic Care (Stages)

Helping different development stages through trauma care

Atraumatic Care: Infant

Before Procedure

• talk to parents, and keep them involved throughout the whole thing (optional)

During Procedure

• secure and immobilize the infant, safely, parent is not doing it

• Perform quickly

• Parent can hold and rock infant post-procedure

Atraumatic Care: Toddler

Before Procedure

• give explanation right before procedure

• Child did nothing wrong!

During Procedure

• immobilize and secure safely

• stay positive

• Do not give “options” when options are available

• Allow child to cry and scream

• Offer favorite drink or sticker post-procedure

Atraumatic Care: Preschool Child

Before Procedure

• Give simple explanations of procedure, basic drawings good

• With supervision, let child touch and play with equipemtns (if able)

• use adhesive tape, ensure body stays together

During Procedure

• immobilize and secure safely

• stay positive, have child count to 10

• let them cry

• encourage them to cry, offer treats

Atraumatic Care: School-Age Child

Before Procedure:

• clear, thorough explanations are helpful (drawings, pictures, contact w/ equipment)

• Teach deep breathing

• offer a choice reward for post-procedure

After Procedure:

• immobilize if needed, if they can be still let them

• explain what is happening

• use stress-control techinques

• praise them!

Atraumatic Care: Adolescent

Before Procedure:

• give clear explanations orally and in writing

• teach stress-reduction techs

• explore fear and discuss

During Procedure

• Assist in self-control

• Explain outcome and tell when results will be sent

Communication with Parents

Encourage parents to talk

Direct the focus

Listen and have cultural awareness, use silence if needed

be empathic

provide anticipatory guidance

avoid blocks to communication

Communication with Children

Consider the cognitive develpoment stage

play

be creative

Physical Assessment on Children

Review ATI chapter 2

Focus:

• order of assessment

• age-appropriate approaches to various parts

• Gross motor milestones

• Fine motor milestones

• Language development for age

Key Points of the Assessment

Always Ask:

• what’s going on?

• what’s it going to look like?

• how will i intervene?

Assessment is not in order, it is circular!

• Assess, assess, assess!

• Trend assessments: even slight changes make a difference!

Pain Assessment and Management

Age of Child

• Box 5.1 (book)

• Response to pain @ different ages

Pain Rating Scales

• table 5.1 & 5.2 (book)

• NIPS, FLACC, Faces/Wong-Baker

Interventions

• Pharmacological

  • page 123-124 (book)

  • PCA Pump

• Non-pharm/Complimentary

  • page 121

Health Promotion of Peds

Newborn, Infant, Toddler, Preschoolers, School-Age, Adolescent

Newborn: Adjustment to Extrauterine Life

Birth - 1 Month

Resp

• Chemical, thermal, and tactile stimuli help w/ first breath

Circulatory System

• changes to allow blood to flow through lungs

• Closure of stunts! (PFO, PDA)

Thermoregulation

• Quickly dry and place skin to skin w/ mom!

• Warm, dry blankets

Infant Eval @ Birth

• Table 7.1

• APGAR @ 1 and 5

Measurements

• Head: 33-35.5cm

• Weight: 10% loss by day 3 or 4, 2 weeks = return, 6-9 lbs

• Length: 48-53cm

Useful info for Newborn Health Promotion

Box 7.1 - Stool Patterns

Fig 7.6 - Sutures and Fontanels

Table 7.2 - Newborn Reflex

Table 7.3 - Newborn Sleep

Box 7.5 - Successful Breastfeeding

The Infant: Growth

Birth - 12 months

Physical development

• RAPID!

• Weight 2x = 5 months

  • 3x = 12 months

• dentition

  • X months - 6 months = # teeth

• Table 9.1 MILESTONE! (STUDY)

Cognitive Development

• Sensorimotor

• Stimulation from surroundings

• Stranger and Separation anxiety, attachement

Psychosocial Development

• Erikson Trust vs MIstrust

• Solitary Play

Nutrition

• breastfeed/formula, progress to solids 4-6 months

• iron-fortified form

• nutrient-rich foods!

• page 305 — Feeding During the First Year

• H/H and Lead screening @ 12 months

Dental Health

• good feeding practices

• smear of toothpaste (once teeth there)

• dental home by 1 year

Injury

• falls, burns, MVA, drowning, choking, suffocation, strangulation

• Teach injury prevention to parents!

Infant Milestones TABLE 9.1

The Toddler: Growth and Development

1 to 3 years

Physical Development

• rate of growth slows by age 2 weight 4x

• 4-6 lbs/year

• body proportion changes

Cognitive Development

• Preoperational

• Language development

Psychosocial Development

• autonomy vs shame and doubt

• Parallel play!

Nutrition

• may breastfeed

• introduce cow’s milk (WHOLE!) and the limit amount consumed

• picky eaters: QUALITY > QUANTITY

• decrease caloric need

Dentition

• Deciduous teeth good by 3 years

• early childhood caries, by 1 year, should visit a dentist by then

Normal Changes in G&D

• Table 11.1

• Toilet training, sibling rivalry

• temper tantrums, regressions

Injury

• Table 11.2

The preschooler: Growth and Development

3-6 years

Physical Development

• Growth in long bones, becoming more slender

• 4-6 lbs/pyear

Cognitive Development

• Preoperational Stage

  • Table 4-16 (p.89)

Psychosocial Development

• Initiative vs Guilt

• Associative play, dramatic play

Nutrition

• 1-2% milk, teach normal food intake

• decrease snacks

• involve child in prep

Dentition

• Education of good dental habits

• Fluorinated toothpaste can be introduced

Normal Changes in G&D

• Table 12-1

• Preschool and kindergarten experience

Injury

• MVA, pedestrian, drowning, burns, needle sticks, electrical

• Teach prevention

School Age: Growth and Development

6-12 years

Physical Development

• Boys and girls comparable in size/proportions

• slow but steady growth

• females preceding males in height

• prepubescence

• sexual awareness

Cognitive Development

• concrete operational

• conservations of altered forms

Psychosocial Development

• industry vs inferiority

• cooperative play (reliance on rules), team play

• self-esteem, body image, sexuality

Nutrition

• encourage balanced diets

• take note of growth spurts

• prevention/education of DM type 2

Dentition

• loss of deciduous teeth commences

• maintenance of good hygiene and practices

Normal Changes in G&D

• table 14.1

• school experiences

Injury

• MVA/vs bike/vs pedestrian

• firearms, burns, assault

• Table 14.2 & FCC boxes on page 415

The Adolescent: Growth and Development

12 - 18

Physical Development

• puberty/sexual maturity

• box 15.2

  • girls 10, boys 13

Cognitive Development

• formal operational

• abstract thinking, critical thinking

Psychosocial Development

• identity vs role confusion

• sexual confusion

• risk for depression

• substance abuse

Nutrition

• need for well-balanced diet

• limit refined sugars and high fat foods

• assess for any presence of eating disorders

Dentition

• risk for damage from tobacco use and drugs

• need for fluoridated water

• dental care / maintenance

Normal Changes in G&D

• Table 15.1

Injury

• MVA, sporting injuries, drowning, box 15.3

• intentional injury

Vital Signs for Infant (Birth to 1 year)

• T

  • 3 months = 99.5F / 37.5 C

  • 6 monhts = 99.9F / 37.7 C

• P/HR

  • 110 - 160/min (newborn)

  • 90 - 160/min (infant)

• RR

  • 30-60/min @ birth to 4 weeks

  • 25-60/min @ 1 month - 1 year

• BP

  • 85/50 @ 1month - 1 year

  • 64/41 @ Birth to 4 weeks

Vital Signs for Toddler (1 - 3 years)

• T

  • 1 year = 99.9F

  • 3 year = 99.0F

• HR

  • 80 - 140/min

• RR

  • 25-30/min

• BP

  • 85-91/37-49

Vital Signs for Preschool (3 - 6 years)

• T

  • 5 year = 98.6F

• P/HR

  • 70 - 120 min

• RR

  • 20-25/min

• BP

  • 89-98/46/54

Vital Signs for School Age (6 - 12 years)

• T

  • 7 year = 98.2 F

  • 9 -11 year = 98.1 F

• P/HR

  • 60-110/min

• RR

  • 20-25/min

• BP

  • 94-106/55-62

Vital Signs for Adolescents (12 - 18 years)

• T

  • 13 year = 97.9 F

• P/HR

  • 50-100/min

• RR

  • 16-20/min

• BP

  • 120/80

Sexual Maturation in Boys

1- Testicular Enlargement

2 - Pubic Hair Growth

3 - Penile Enlargement

4 - Axillary Hair Growth

5 - Facial Hair growth

6 - Vocal changes

Sexual Maturation in Girls

1- Breast development

2- Pubic Hair Growth (may occur before breasts)

3- Axillary Hair Growth

4- Menstruation