Pediatric Nursing Notes

Unit 3: Pediatrics

Objectives
  • Describe principles of family-centered and developmentally appropriate care with the pediatric population (Ch. 2).
  • Discuss principles of safety, cultural sensitivity, and advocacy in the pediatric setting (Ch. 2).
  • Describe the nurse’s role in communicating with children and families, including barriers and communication during emergency care (Ch. 3).
  • Identify strategies for promoting cross-cultural communication (Ch. 4).
  • Discuss considerations for newborns, infants, toddlers, preschoolers, school-age children, and adolescents related to growth and development, safety, and health challenges (Ch. 7-10).
  • Describe pathophysiology, clinical presentation, and nursing care of pediatric clients with health alterations (varied).
  • Recognize congenital and cardiac anomalies and priority nursing actions (OB book, Ch. 17).
Family-Centered Care
  • Families are central to children's well-being; family can be defined in various ways.
  • Family-Centered Strategies:
    • Involve parents in care decisions.
    • Adapt schedules to fit family routines.
    • Implement quiet time to enhance patient comfort.
    • Provide amenities for families, such as fridges and microwaves.
    • Ensure privacy for families.
    • Establish family resource centers and learning councils.
Benefits of Family-Centered Care
  • Enhances learning and decreases stress.
  • Increases adherence to care plans and reduces medical errors.
  • Improves sleep/nutrition and increases satisfaction for patients and families.
Developmentally Appropriate Care
  • Children respond differently to pain than adults, including the ability to describe and localize pain.
  • Use appropriate pain scales (e.g., NPASS, NIPS, FLACC, Faces).
Safety in the Pediatric Setting
  • Adhere to National Patient Safety Goals (NPSGs):
    • Use two patient identifiers, implement security tags.
    • Reduce patient falls and ensure medication safety.
Cultural Sensitivity and Advocacy
  • Cultural sensitivity involves understanding patients' cultural beliefs and ensuring safe accommodations.
  • Advocacy includes prevention, detection, and management of child maltreatment.
Communicating with Children
  • Nurse’s Role:
    • Introduce yourself and ensure privacy in communication.
    • Use play and visual aids in assessments.
    • Recognize communication barriers, especially during emergencies.
Childhood Development Stages
  • Growth and Development Principles:
    • Individualized and influenced by various factors.
  • Patterns of Growth:
    • Cephalocaudal (head to tail) and proximodistal (center to periphery).
Infants (0-1 Year)
  • Regular growth metrics:
    • Weight: Gain 5-7 ounces/week; double by 6 months.
    • Height: Increase 1 inch/month for first 6 months.
  • Fine and Gross Motor Development:
    • Voluntary grasp: 4-5 months.
    • Sit unsupported: 8-9 months, walk alone: 12-15 months.
  • Language Development:
    • First communication is crying, social smile at 2-3 months.
  • Nutrition:
    • Breast-feed exclusively for the first 4 months; introduce solids after 5-6 months.
Toddlers (1-3 Years)
  • Physical Growth:
    • Birth weight quadruples by 2.5 years; growth is step-like.
  • Motor Skills:
    • Uses a fork at 3; by age 2, can build a tower of 6 blocks.
  • Language:
    • Vocabulary up to 50 words by 18 months, 1,100 words by age 3.
Preschoolers (3-5 Years)
  • Physical Growth:
    • Height increases by 2-3 inches/year.
  • Cognitive Development:
    • Understand time and tends to negotiate problem-solving.
  • Safety:
    • Focus on injury prevention strategies, including supervision and safe environments.
School-Age (6-12 Years)
  • Physical Growth:
    • Height increases by 2 inches/year, weight by 2-3 kg/year.
  • Safety:
    • Motor vehicle crashes are leading causes of injury.
Adolescents (13-18 Years)
  • Physical Growth:
    • Significant growth spurt correlating with sexual maturation.
  • Psychosocial Development:
    • Significant reliance on peers; struggle between independence and parental authority.
  • Safety Concerns:
    • High-risk behaviors, including substance use and risk of injury from vehicles or firearms.
Pediatric Medication Administration
  • Safety protocols for medication administration across different age groups to prevent errors.
Respiratory Disorders
  • Bronchiolitis and RSV:
    • Monitor respiratory status, hydrate, and educate caregivers on symptoms.
  • Asthma:
    • Chronic inflammation managed through avoidance of triggers and medications.
Cardiovascular Disorders
  • Kawasaki Disease:
    • Monitor for fever and symptoms; administer IV immunoglobulin.
  • Congenital Cardiac Defects:
    • Recognize symptoms like fatigue and failure to thrive.
Neurologic Disorders
  • Hydrocephalus:
    • Monitor ICP; provide shunt care.
  • Cerebral Palsy:
    • Early intervention and support are vital.
Genetic and Hematologic Disorders
  • Conditions like Trisomy 21 requiring supportive care and monitoring for associated health issues.