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Goal of pediatric nursing
To improve the quality of health care for children and their families
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What effects the health of children
* Children who live in poverty/homeless/foster care
* Chronic medical conditions
* Obesity
* Type 2 diabetes
* Violence
* Injuries
* Substance abuse
* Mental health problems
* Prematurity
* Lack of health insurance
* Culture and Religion
* Family
* Chronic medical conditions
* Obesity
* Type 2 diabetes
* Violence
* Injuries
* Substance abuse
* Mental health problems
* Prematurity
* Lack of health insurance
* Culture and Religion
* Family
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Childhood Morbidity
* May denote acute illness, chronic disease, or disability
* Difficult to define and measure
* Difficult to define and measure
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Why are children ill?
* Primary illness- common cold\*
* Respiratory illness- 50%
* Infections and parasitic disease- 11%
* Injuries- 15%
* Respiratory illness- 50%
* Infections and parasitic disease- 11%
* Injuries- 15%
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Childhood mortality < 1 year old
* Congenital Anomalies
* Short Gestation
* SIDS
* Unintentional Injuries
* Suffocation
* MVC
* Short Gestation
* SIDS
* Unintentional Injuries
* Suffocation
* MVC
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Childhood mortality 1-4 years old
* Unintentional Injuries
* Drowning
* MVC
* Suffocation
* Pedestrian
* Congenital anomalies
* Homicide
* Malignant neoplasms
* Drowning
* MVC
* Suffocation
* Pedestrian
* Congenital anomalies
* Homicide
* Malignant neoplasms
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Childhood mortality 5-9 years old
* Unintentional injury
* MVC
* Drowning
* Fire/Burn
* Suffocation
* Malignant neoplasms
* Congenital anomaly
* Homicide
* MVC
* Drowning
* Fire/Burn
* Suffocation
* Malignant neoplasms
* Congenital anomaly
* Homicide
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Childhood mortality 10-14 years old
* Unintentional injuries
* MVC
* Drowning
* Fire/Burn
* Suffocation
* Suicide
· Suffocation
* Malignant Neoplasms
* Homicide
* MVC
* Drowning
* Fire/Burn
* Suffocation
* Suicide
· Suffocation
* Malignant Neoplasms
* Homicide
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Childhood mortality 15-19 years old
* Unintentional injuries
* MVC
* Poisoning
* Drowning
* Fall
* Homicide
* Firearm
* Suicide
* Firearm
* MVC
* Poisoning
* Drowning
* Fall
* Homicide
* Firearm
* Suicide
* Firearm
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Pediatric nurse roles
o Therapeutic Relationship
o Family Advocacy and Caring
o Disease Prevention and Health Promotion
o Health Teaching
o Injury Prevention
o Support and Counseling
o Coordination and Collaboration
o Ethical Decision Making
o Family Advocacy and Caring
o Disease Prevention and Health Promotion
o Health Teaching
o Injury Prevention
o Support and Counseling
o Coordination and Collaboration
o Ethical Decision Making
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Family centered care
o Family is a constant present in child’s life
o Enable and empower the family
o Enable and empower the family
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Core concepts of family centered care
* Dignity and respect
* Information sharing
* Participation
* Collaboration
* Information sharing
* Participation
* Collaboration
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Morbidity
Refers to someone being unhealthy
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Mortality
Refers to someone being dead
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Effects of hospitalization of child is dependent on…
* Limited coping mechanisms
* Developmental stage
* Support system
* Temperament
* Age
* Intelligence
* Past experiences
* Developmental stage
* Support system
* Temperament
* Age
* Intelligence
* Past experiences
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Seperation anxiety stages
* Protest
* Despair
* Detachment
* Despair
* Detachment
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Post hospital behaviors
o Initial aloofness
o Dependency behaviors
o Negative behaviors
o Dependency behaviors
o Negative behaviors
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Effects of hospitalization on the parents
o Sense of helplessness
o Questioning the skills of staff
o Accepting the reality of hospitalization
o Needing to have information explained in simple language
o Dealing with fear
o Coping with uncertainty
o Seeking reassurance from caregivers
o Questioning the skills of staff
o Accepting the reality of hospitalization
o Needing to have information explained in simple language
o Dealing with fear
o Coping with uncertainty
o Seeking reassurance from caregivers
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Effect of hospitalization on the siblings
o Loneliness
o Fear
o Worry
o Anger
o Resentment
o Jealousy
o Guilt
o Fear
o Worry
o Anger
o Resentment
o Jealousy
o Guilt
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Effects of hospitalization on child nursing interventions
o Prevent/Minimize separation
o Minimize loss of control
o Move
o Maintain child’s routine
o Encourage Independence
o Minimize fear of bodily injury
o Provide developmentally appropriate activities
o Diversion
o Minimize loss of control
o Move
o Maintain child’s routine
o Encourage Independence
o Minimize fear of bodily injury
o Provide developmentally appropriate activities
o Diversion
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Nursing interventions for families with sick kids
o Support family members
o Provide Information
o Encourage participation
o Prepare for discharge and home
o Virtual visitors
o Provide Information
o Encourage participation
o Prepare for discharge and home
o Virtual visitors
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Impact on parents of child chronic disease
* Shock
* Denial
* Guilt
* Angry
* Stress
* Grief & Chronic sorrow
* Denial
* Guilt
* Angry
* Stress
* Grief & Chronic sorrow
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Techniques to communicate with children
o Allow children time to feel comfortable
o Avoid sudden or rapid advances
o Talk to the parent if child is initially shy
o Communicate through transition objects such as dolls, puppets, and stuffed animals
o Give older children the opportunity to talk without the parents present
o Assume a position that is at eye level with the child
o Speak in a quiet, unhurried, and confident voice
o Avoid sudden or rapid advances
o Talk to the parent if child is initially shy
o Communicate through transition objects such as dolls, puppets, and stuffed animals
o Give older children the opportunity to talk without the parents present
o Assume a position that is at eye level with the child
o Speak in a quiet, unhurried, and confident voice
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Techniques to communicate with parents
o Encouraging to talk
* Use broad, open-ended questions
o Being empathetic
* Ability to put oneself in another’s shoes
o Anticipatory guidance
* A proactive developmentally based counseling technique that focuses on the needs of a child at each stage of life
* Use broad, open-ended questions
o Being empathetic
* Ability to put oneself in another’s shoes
o Anticipatory guidance
* A proactive developmentally based counseling technique that focuses on the needs of a child at each stage of life
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Communication overload
o Long periods of silence
o Wide eyes and fixed facial expression
o Constant fidgeting or attempting to move away
o Nervous habits
o Looking around
o Wide eyes and fixed facial expression
o Constant fidgeting or attempting to move away
o Nervous habits
o Looking around
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Physical assessment - infant
o Nonverbal communication
o Respond to adults’ nonverbal communication
o Sudden movements are frightening
o Receive comfort from the sound of a voice
o Respond to adults’ nonverbal communication
o Sudden movements are frightening
o Receive comfort from the sound of a voice
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Physical assessment infant what to provide
* Safety
* Security
* Involve parents
* Security
* Involve parents
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Physical assessment - toddler
o Have a hard time differentiating what is real versus what is fake
o Take words literally
o Take words literally
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Physical assessment toddler what to provide
* Sitting on parent lap
* Inspect body through play
* Involve parents
* Clothes on
* Inspect body through play
* Involve parents
* Clothes on
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Physical assessment - preschooler
o Very literal terms
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Physical assessment preschooler what to provide
* Sitting on parent lap
* Inspect body through play
* Use play, games
* Clothes on
* Inspect body through play
* Use play, games
* Clothes on
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Physical assessment - school age
o Want explanations and reasons
o Interested in functional aspect of procedures, objects, and activities
o Concerned about body integrity
o Interested in functional aspect of procedures, objects, and activities
o Concerned about body integrity
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Physical assessment school age what to provide
* privacy
* choices
* parents (maybe)
* choices
* parents (maybe)
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Physical assessment - adolescent
o Fluctuate between child and adult thinking and behavior
o Differing coping abilities
o When tension rise, may seek security of childhood (regression)
o Differing coping abilities
o When tension rise, may seek security of childhood (regression)
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Physical assessment adolescent what to provide
* privacy
* choices
* parents (maybe)
* choices
* parents (maybe)
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Growth measurement
o Key element in evaluating health status
o Plot on growth charts
o Head may be smaller with premature closure of sutures
o Plot on growth charts
o Head may be smaller with premature closure of sutures
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Physiologic measurements
o Key element in evaluating physical status
o Compare with normal values for that age and to normal and past values for that patient
o Compare with normal values for that age and to normal and past values for that patient
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RR vitals
First before being disturbed (watch or auscultate)
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HR Vitals
Auscultate apical pulse for fill minute in < 2 years, radial if > 2 years old
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BP Vitals
Ensure proper fitting cuff
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T Vitals
Axillary vs oral vs rectal vs temporal vs ear
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General Appearance
o Cumulative, subjective impression of child’s physical appearance
* Nutritional status
* Behavior
* Personality
* Interactions with parents and nurse
* Posture
* Development
* Speech
* Nutritional status
* Behavior
* Personality
* Interactions with parents and nurse
* Posture
* Development
* Speech
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Skin Assessment
o Inspection and palpation
o Skin is normally smooth, slightly dry, and not oily or clammy
o Symmetrically feel each part of body and compare
o Skin is normally smooth, slightly dry, and not oily or clammy
o Symmetrically feel each part of body and compare
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Skin Assess
* Color
* Texture
* Temp
* Moisture
* Texture
* Temp
* Moisture
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Turgor
Indication of adequate hydration and nutrition
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Lymph nodes Assessment
o Normal- small, nontender movable nodes
o Abnormal- tender, enlarged, warm, erythematous- generally indicates infection or inflammation close to their location
o Abnormal- tender, enlarged, warm, erythematous- generally indicates infection or inflammation close to their location
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Head and neck assess
* Shape and symmetry
* Torticollis
* Head control
* Infants at 4mo it should be erect and midline
* Head posture
* Range of motion
* Torticollis
* Head control
* Infants at 4mo it should be erect and midline
* Head posture
* Range of motion
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Skull Assessment
Posterior fontanel closes by 2nd month of life and anterior fontanel between 12 and 18 months
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Eyes Assessment
o Placement, shape, and symmetry of the eyes
o Eyes should close all the way
o Conjunctiva- pink and glossy
o Sclera- clear
o Cornea- clear and transparent
o Pupil- size, shape and movement
o Red Reflex
o PERRLA- pupils, equal, round, react to light and accommodation
o Begin assessing visual acuity around 2-3 years old
o Accommodation
o Eyes should close all the way
o Conjunctiva- pink and glossy
o Sclera- clear
o Cornea- clear and transparent
o Pupil- size, shape and movement
o Red Reflex
o PERRLA- pupils, equal, round, react to light and accommodation
o Begin assessing visual acuity around 2-3 years old
o Accommodation
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Ears Assessment
o Size, shape, and placement
o Skin
o Hygiene
o Drainage
o Signs of discomfort \\
o Otoscopic examination
* ^^
o Skin
o Hygiene
o Drainage
o Signs of discomfort \\
o Otoscopic examination
* ^^
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Nose/Mouth/Throat Assessment
* Infants are nose breathers- up to 3 months
* Inspect for color, lesions, exudate, and odor
* Infants- milk residue
* Do at end of assessment
* Have child say “eeehh” instead of “aaahh”- flattens out the tongue and don’t have to use a tongue blade
* Inspect for color, lesions, exudate, and odor
* Infants- milk residue
* Do at end of assessment
* Have child say “eeehh” instead of “aaahh”- flattens out the tongue and don’t have to use a tongue blade
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Chest Assessment
o Movement symmetric and coordinated breathing
o Size, shape, symmetry, movement, breast development
o Children
o Size, shape, symmetry, movement, breast development
o Children
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Lungs Assessment
* Observe respiratory movements- rate, rhythm, depth, quality, quality of breath sounds
* Look FIRST!!
* Retractions, nasal flaring, grunting, head bobbing, apnea
* Look FIRST!!
* Retractions, nasal flaring, grunting, head bobbing, apnea
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Absent or dimished breath sounds
Fluid, air, or solid mass in pleural space
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Adventitious sounds
Crackles and wheezes
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Crackles
Passage of air through fluid or moisture
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Wheezes
* Air passes through narrowed passages
* Exudate, inflammation, spasm, tumor
* Exudate, inflammation, spasm, tumor
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Heart Assessment
o Children- thin chest wall- pulsation (precordium) may be visible
o
o
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Heart sounds
Produced by opening and closing of the valves and vibrations of blood against the walls of the heart and vessels
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Abdomen Assessment
o Children- abdomen is cylindric and prominent
o Chest and abdomen muscles are synchronous
o Infants and children- peristaltic waves visible through abdominal wall
o Superficial palpation
o Tenderness, muscle tone, superficial lesions/cysts
o Deep palpation
o Chest and abdomen muscles are synchronous
o Infants and children- peristaltic waves visible through abdominal wall
o Superficial palpation
o Tenderness, muscle tone, superficial lesions/cysts
o Deep palpation
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Male genitalia Assessment
* Compare size with expected sequence of maturation
* Palpate for 2 testes (left scrotum lower than right)
* Hair distribution
* Glans and shaft- swelling, skin lesions, inflammation
* Urethral meatus- location, signs of discharge
* Palpate for 2 testes (left scrotum lower than right)
* Hair distribution
* Glans and shaft- swelling, skin lesions, inflammation
* Urethral meatus- location, signs of discharge
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Female genitalia Assessment
* Limited to inspection and palpation
* Size and location of structures
* Hair distribution
* Inspect for Skin lesions, swelling, inflammation, bruising
* Abnormal vaginal or urethral discharge
* Size and location of structures
* Hair distribution
* Inspect for Skin lesions, swelling, inflammation, bruising
* Abnormal vaginal or urethral discharge
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Spine Assessment
* Inspection
* Curvature of spine, newborn C curve, older children S curve
* Mobility
* Curvature of spine, newborn C curve, older children S curve
* Mobility
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Extremeties Assessment
* Symmetrical
* Length and size
* Range of motion
* Joints move freely, without pain
* Appropriate muscle development for age
* Length and size
* Range of motion
* Joints move freely, without pain
* Appropriate muscle development for age
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Neurological Assessment
* Behavior
* Sensory
* Motor function
* Sensory
* Motor function
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Cerebellar function Assessment
* children and adolescents) balance and coordination
* Finger to nose test
* Heel to shin test
* Romberg test
* Finger to nose test
* Heel to shin test
* Romberg test
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Romberg test
Able to stand with slight swaying while eyes are closed
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Infant reflexes Assessment
* Sucking and rooting reflex (birth- 4 mths)
* Palmar grasp (birth- 3 mths)
* Plantar grasp (birth-8 mths)
* Moro reflex (startle) (birth- 4 mths)
* Tonic neck reflex (birth to 3- 4 mths)
* Babinski reflex (birth- 1 yr)
* Stepping (birth- 4 wks)
* Palmar grasp (birth- 3 mths)
* Plantar grasp (birth-8 mths)
* Moro reflex (startle) (birth- 4 mths)
* Tonic neck reflex (birth to 3- 4 mths)
* Babinski reflex (birth- 1 yr)
* Stepping (birth- 4 wks)
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Types of pain children experience
o Procedure-related
o Operative
o Trauma-associated
o Acute or chronic from illness or injury
o Operative
o Trauma-associated
o Acute or chronic from illness or injury
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Growth
An increase in number and size of cells as they divide and synthesize new proteins; results in increased size and weight of the whole or any of its parts
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Development
A gradual change and expansion; advancement from lower to more advanced stages of complexity; the emerging and expanding of the individual’s capacities through growth, maturation, and learning
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Patterns of growth and development
* Cephalocaudal (from head to tail)
* Proximodistal (from midline to periphery)
* Trends are bilateral and appear symmetric
* Simple to complex
* Proximodistal (from midline to periphery)
* Trends are bilateral and appear symmetric
* Simple to complex
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Factors influencing growth
o Nutrition
o Gender
o Hereditary
o Disease
o Environment
o Gender
o Hereditary
o Disease
o Environment
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Infancy period of growth
* Most rapid
* Birth weight doubles by end of 4-7 months, triples by the end of the first year of life
* Birth weight doubles by end of 4-7 months, triples by the end of the first year of life
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Preschool to puberty period of growth
Rate of growth slows
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Puberty period of growth
Growth accelerates and then plateaus
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post puberty period of growth
* Decline in rate of growth
* Until death
* Until death
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factors influencing development
o Hereditary and environment
o Gender
o Disease
o Prenatal influences
o Socioeconomics
o Relationships
o Stress
o TV
o Gender
o Disease
o Prenatal influences
o Socioeconomics
o Relationships
o Stress
o TV
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Infant (birth to one year) developmental age period
* Rapid motor, cognitive, and social development
* Establish basic trust in the world and foundation for future interpersonal relationships
* Critical 1st month of life
* Major physical adjustment to extrauterine existence and psychologic adjustment of the parent
* Beginning development of gross and fine motor skill
* Establish basic trust in the world and foundation for future interpersonal relationships
* Critical 1st month of life
* Major physical adjustment to extrauterine existence and psychologic adjustment of the parent
* Beginning development of gross and fine motor skill
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Infant (birth to one year) cognitive development
* Sensorimotor stage
* Separation- infants separate themselves from other objects in the environment
* Object permanence- know objects exist when they are hidden
* Recognition of symbols
* Separation- infants separate themselves from other objects in the environment
* Object permanence- know objects exist when they are hidden
* Recognition of symbols
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Infant (birth to one year) psychosocial development
* Trust vs mistrust
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Preschooler (3 to 6 years) developmental age period
* Bodies become more graceful and sturdy
* Gross and fine motor skills continuing to develop
* Gross and fine motor skills continuing to develop
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Preschooler (3 to 6 years) cognitive development
Preoperational
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Preschooler (3 to 6 years) psychosocial development
Initiative vs guilt
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School age (6 to 12 years) developmental age period
* Child directed away from the family group and centered around peer relationships
* Steady advancement in physical, mental, and social development
* Development of self-concept
* Peer groups play important part in social development
* Steady advancement in physical, mental, and social development
* Development of self-concept
* Peer groups play important part in social development
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School age (6 to 12 years) cognitive development
Concrete operational
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School age (6 to 12 years) psychosocial development
Industry vs inferiority
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Adolescent (12 to 20 years) developmental age period
* Biologic and personality maturation accompanied by physical and emotional turmoil
* Redefining of self-concept
* Focus on individual identity, instead of a group identity
* Redefining of self-concept
* Focus on individual identity, instead of a group identity
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Adolescent (12 to 20 years) cognitive development
Formal operational
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Adolescent (12 to 20 years) psychosocial development
Identity vs role confusion
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Play
o Allows children to express feeling and fears
o Should be specific to each child’s stage of development
o Can be used to teach children
o Protection from everyday stressors
o Should be specific to each child’s stage of development
o Can be used to teach children
o Protection from everyday stressors
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Functions of play
o Sensorimotor Development
o Intellectual development
o Socialization
o Creativity
o Self-awareness
o Therapeutic value
o Morality
o Intellectual development
o Socialization
o Creativity
o Self-awareness
o Therapeutic value
o Morality
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Social character of play
Socialization and the type of play changes as the child advances in age
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Play - Onlooker
The child observes others
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Play - Solitary
The child plays alone - infant/wobbler
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Play - Parallel
Plays independently but among others - toddlers
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Play - Associative
Playing together without organization - preschool
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Play - cooperative
Formal play in groups with rules - school age
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Caput succedaneum
Edema of soft scalp tissue
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Cephalhematoma
Hematoma between periosteum and skull bone