Pediatric Nursing Essentials – ATI Engage Lecture Review

Newborns (2 to 28 Days)

• Vital-sign parameters
• Temperature 36.5^{\circ}C−37.5^{\circ}C\;(97.7^{\circ}F−99.3^{\circ}F) – fever > 38^{\circ}C\;(100.4^{\circ}F) requires evaluation.
• Heart rate 109−164\;\text{bpm} (fluctuates with sleep/activity).
• Respiratory rate 30−60\;\text{rpm}; < 10-s periodic apnea typical.
• Pulse ox 95−100\% on room air.
• Blood pressure not routine; average 64/41\;\text{mmHg}.

• Growth trends
• Up to 10\% physiologic weight loss first week; regained by week 2.
• Length ↑ 25\;\text{cm} & head circumference ↑ 12\;\text{cm} in first yr.
• Weight gain ≈ 30\;\text{g day}^{−1} in first 3 mo.

• Head/skull – open anterior (diamond) & posterior (triangle) fontanelles; flat = normal, sunken = dehydration, bulging = infection/ICP.

• System transitions
• Cardiac – closure of ductus arteriosus & foramen ovale within 2 mo ⇒ systemic ↑P, pulmonary flow ↑.
• Respiratory – obligate nose breathers; sneezing clears nares; periodic apnea common.
• Skin variants – acrocyanosis, mottling, milia, erythema toxicum, congenital dermal melanocytosis, salmon patches, physiologic desquamation.
• GI/umbilicus – rounded abdomen; umbilical stump off by 10 d–3 wk; watch for erythema/odor.

• Neuro-motor reflexes – root, suck, Moro, tonic neck, grasp, Babinski, step; absence/asymmetry = neuro investigation.

• Sensory & bonding
• Best vision focus 8−12\;\text{in}; prefers faces/high contrast.
• Recognises maternal voice & sweet smells; skin-to-skin & swaddling ↓ startle reflex.

• Health promotion / safety
• Rear-facing car seat, chest clip armpit level; no bulky coats.
• Back-to-sleep on firm surface; no bed-share; tummy-time while awake.
• Exclusive breastmilk/formula; vitamin D supplement for breastfed.
• Teach shaken-baby avoidance, head support, smoke-free home.

• Common concerns – colic (>3 h/day, >3 d/wk, >3 wk), sleep pattern immaturity, food allergy (cow’s-milk protein); counsel coping & routine-setting.

Infants (1 Month to 1 Year)

• Growth – gain 0.45−0.9\;\text{kg mo}^{−1} first 6 mo, 0.45\;\text{kg mo}^{−1} 6–12 mo; brain, motor & language explode.

• Motor milestones
• Gross – roll 4–6 mo, sit ≈ 6 mo, crawl ≈ 9 mo, walk ≈ 12 mo.
• Fine – raking grasp ≈ 5 mo, pincer grasp ≈ 9–10 mo; transfers block, bottle hold.

• Cognitive / psychosocial
• Object permanence by 9 mo ⇒ separation & stranger anxiety (peaks 6–18 mo).
• Social smile 4–6 wk; laughter 3 mo; reciprocal play fosters trust.
• Language: coo 2 mo, babble 6 mo, single words ≈ 12 mo; labeling objects ↑ vocabulary.

• Feeding
• AAP: exclusive breastmilk to 6 mo; introduce solids (~6\;\text{mo}) every 3-5 d; maintain 100−135\;\text{kcal kg}^{−1}\text{day}^{−1}.
• Do NOT restrict fats (<2 yr); offer iron-fortified formula if not breastfed; vitamin D & iron supplements as indicated.

• Sleep – back-to-sleep; no loose items; total need 12−16\;\text{h day}^{−1} incl. naps; lower crib mattress when sitting.

• Safety – child-proofing (outlets, meds, sharps); rear-facing car seat until 2\;\text{yr}; water-temperature < 49^{\circ}C; supervise around water.

• Key threats – SUID, failure to thrive, food sensitivity; early peanut/egg intro < 12 mo ↓ allergy risk.

Communicable Diseases & Infection Control

• Standard isolation hierarchy
• Airborne (N95, negative pressure): measles, varicella, TB.
• Droplet (mask): pertussis, mumps, pneumonia.
• Contact (gown/gloves): RSV, MRSA, impetigo.
• Protective isolation: immunocompromised—positive pressure, no fresh flowers/produce.

• PPE order – don: gown → mask → goggles → gloves; doff: gloves → goggles → gown → mask.

• Nationally notifiable pediatric infections include COVID-19, diphtheria, meningitis, pertussis, tetanus, varicella, etc.

Snapshot of Core Childhood Diseases

(Provide similar quick tables for meningitis, hepatitis variants, mono, roseola, fifth disease, HFMD, impetigo, conjunctivitis sub-types, stomatitis.)

Immunology & Vaccines

• Antibody classes – IgG (long-term), IgM (first responder), IgA (secretions), IgE (allergy).
• Vaccine science
• Antigens provoke adaptive immunity; attenuated weakened live strains; toxoids (diphtheria, tetanus).
• Schedules: follow CDC; mild illness ≠ contraindication; only absolute contraindication = anaphylaxis to prior dose/component.
• Combination (MMRV), conjugate (Hib, PCV13), monovalent (COVID-19), polyvalent (influenza) formulations.
• Cocooning – immunise close contacts of newborns/immunocompromised to create barrier.

Parasitic Infestations

• Scabies – burrows, nocturnal pruritus; permethrin cream to child & contacts; hot-wash linens.
• Lice – nits at hair shaft; 1 % permethrin shampoo, comb; avoid sharing hats.
• Pinworms – perianal itch at night; tape test a.m.; mebendazole single dose for entire household.
• Giardiasis – greasy diarrhea post-contaminated water; 3-sample stool DFA; metronidazole + hydration.

Chronic Illness & Disability

• Prevalence – 19.4\% U.S. children have special health-care need.
• Developmental impacts by stage (infant: early intervention; toddler: autonomy; preschool: speech delays; school-age: absenteeism; adolescent: transition to self-management).
• Caregiver strain – apply NAPC model (Normalize-Ask-Pause-Connect); respite, financial aid, peer support.
• Interdisciplinary “medical home” – coordinated primary + specialty care; nurses guide education (suctioning, enteral feeds) with teach-back.

Cardiovascular Alterations

• Screenings – BP at every visit > 3 yr; lipid panel age 9–11; pulse ox pre-/post-ductal newborn to screen critical CHD.

• Common pediatric issues
• Hypertension: \ge95^{\text{th}} percentile x3; lifestyle ± ACEI.
• Dyslipidemia: LDL goals <110\;\text{mg dL}^{−1}; statins > 10 yr if severe.
• Congenital defects: VSD, ASD, TOF, coarctation—know murmurs, CHF risk, prostaglandin use, surgical windows.
• Acquired: endocarditis (IV abx 4–6 wk, prophylaxis dental), Kawasaki (IVIG + aspirin w/in 10 d), heart failure pharmacology (diuretics, ACEI, digoxin).

Hematologic System

• RBC disorders – Iron-deficiency anemia (screen 9-12 mo; treat 3−6\;\text{mg kg}^{−1}\text{day}^{−1} elemental iron with vit C), sickle-cell disease (pain crisis hydration, opioids; hydroxyurea; HSCT cure), β-thalassemia (scheduled transfusion + chelation).
• Bone-marrow failure/bleeding – aplastic anemia (ATG, cyclosporine, HSCT), hemophilia A/B (factor VIII/IX infusion), von Willebrand disease (DDAVP, vWF concentrate), ITP (IVIG, steroids), DIC (FFP, cryo + treat cause).
• Oncology basics – ALL vs AML presentations; neutropenia infection precautions.

Immune System Disorders

• Allergies / anaphylaxis – IgE-mediated type I; epinephrine auto-injector 0.01\;\text{mg kg}^{−1} IM up to 0.5\;\text{mg}; antihistamines, steroids adjunct.
• Autoimmune – Juvenile idiopathic arthritis (DMARDs, biologics), systemic lupus erythematosus (sun avoidance, hydroxychloroquine, steroids).
• HIV – vertical transmission screens; ART classes (NRTI, NNRTI, PI, INSTI); monitor CD4, viral load; live vaccines per guidelines.

Neurological Concerns

• Headaches – primary (migraine, tension) vs secondary; identify triggers; abortive OTC NSAIDs early; school 504 plan as needed.
• Head injury – pediatric concussion management (24–48 h relative rest, graded return to play), GCS pedi-scale, shaken-baby red flags (retinal hemorrhage).
• Infections – encephalitis (HSV acyclovir), rabies post-exposure prophylaxis, tetanus TIG + vaccine, botulism antitoxin/BIG.
• Seizure disorders – febrile seizure education; epilepsy classification, EEG, ketogenic diet, vagus nerve stimulator.
• Structural – AVM (risk bleed; surgical ± embolisation), hydrocephalus (VP shunt; monitor for sunset eyes, bulging fontanel).
• SCI & drowning – immobilise spine, maintain oxygenation; educate water safety.

Cancer Highlights

• Brain tumours – gliomas (astrocytoma, ependymoma), medulloblastoma—present with ICP signs (morning headache, vomiting), MRI, surgical debulking ± chemo/radiation.
• Neuroblastoma – adrenal origin, catecholamine metabolites in urine (VMA/HVA), staging guides multimodal therapy (surgery + chemo + stem-cell rescue).

Endocrine Disorders

• Pituitary
• GH deficiency → short stature; nightly rhGH injections until epiphyses close.
• Precocious puberty: GnRH agonist (leuprolide) monthly; delayed puberty eval HPG.
• Diabetes insipidus: central—DDAVP; nephrogenic—thiazide + low Na diet.

• Thyroid
• Congenital hypothyroidism screen (low T4, high TSH); levothyroxine 10−15\;\mu g\,kg^{−1}\,day^{−1}; monitor growth.
• Graves hyperthyroidism: methimazole first-line, beta-blocker symptomatic; possible radio-iodine or thyroidectomy.

• Diabetes mellitus
• Type 1: absolute insulin deficit—basal–bolus or pump; carb counting (1 unit per 15\;\text{g} CHO typical); monitor HbA1c goal < 7.5\% pediatrics. • Type 2: lifestyle + metformin 500−2000\;\text{mg day}^{−1}; consider GLP-1 agonists; screen for comorbidities. • DKA: serum glucose > 200\;\text{mg dL}^{−1}, pH < 7.3, HCO_3 < 15\;\text{mEq L}^{−1}, ketones +; manage with 10−20\;\text{mL kg}^{−1} NS bolus, IV regular insulin 0.1\;\text{u kg}^{−1}\text{hr}^{−1}, replace K⁺ when < 5.5\;\text{mEq L}^{−1}.

Exam Tip Connections
• Link cardiac lesions to risk of endocarditis ⇒ need dental prophylaxis.
• Understand how chronic hypoxia (TOF) leads to polycythemia ⇒ monitor Hct.
• Iron therapy and levothyroxine interact—administer 4 h apart.
• Vaccines in immunocompromised (e.g., high-dose steroids, HIV) – live vaccines contraindicated.
• Ethical emphasis: balance parental autonomy with child’s best interest (e.g., vaccine refusal, blood transfusion in thalassemia).
• Practical: teach caregivers to use growth charts, medication syringes, epinephrine auto-injector practice pens.