NUR244 TOPIC 4 TO 6

🩺 PAEDIATRIC NURSING – COMPLETE EXAM NOTES (NUR244)

πŸ§’ 1. Normal Assessment Findings in the Paediatric Patient

πŸ”Ή Paediatric Assessment Triangle (PAT)

Quick first-impression tool based on Appearance, Work of Breathing, Circulation to Skin

Appearance:

  • Alert, active, good muscle tone, strong cry or normal speech, good eye contact.

Work of Breathing:

  • Normal RR for age, effortless breathing, symmetrical chest movement, no nasal flaring, no tracheal tug or retractions.

Circulation to Skin:

  • Pink, warm, capillary refill ≀2 s, no pallor, mottling, or cyanosis.

πŸ”Ή Primary A–E Assessment – Normal Findings

Step

Normal Finding

A – Airway

Patent, no obstruction or abnormal sounds.

B – Breathing

RR within age norms, clear bilateral air entry, SpOβ‚‚ > 95 %.

C – Circulation

HR and BP within age norms, good pulse, cap refill ≀ 2 s, warm peripheries.

D – Disability

Alert (AVPU = A), pupils equal/reactive, normal tone & movement.

E – Exposure

Temp 36.5–37.5 Β°C, skin intact, no rash, bruising, or dehydration.

⚠ 2. Paediatric Assessment & Detection of Deterioration

πŸ”Ή Early Warning Signs

  • ↑ work of breathing (nasal flaring, recession, grunting, head bobbing)

  • Abnormal RR or HR for age

  • ↓ SpOβ‚‚

  • Cool/mottled skin, delayed cap refill

  • Altered level of consciousness (AVPU change)

  • Poor feeding, vomiting, ↓ urine output

πŸ”Ή Structured Tools

  • PAT – quick triage of appearance/breathing/circulation.

  • AVPU – level of responsiveness (Alert / Voice / Pain / Unresponsive).

  • A–E – full primary assessment, repeat frequently.

πŸ”Ή Example (Bronchiolitis case)

  • RR 55/min, recession, SpOβ‚‚ 91 %, tachycardia, poor feeding β†’ respiratory distress + dehydration risk.

  • Nursing: suction, upright positioning, oxygen therapy, fluids, frequent reassessment.

🦜 3. PARROT Chart (Paediatric Assessment and Response Tool)

πŸ”Ή Purpose

  • Standardised, colour-coded observation chart to recognise & respond early to deterioration.

  • Provides age-specific normal ranges for RR, HR, BP, SpOβ‚‚, Temp, Consciousness.

  • Links each zone to an escalation response pathway.

πŸ”Ή Colour Zones

Colour

Meaning

Action

🟩 Green

Normal for age

Continue routine observations (4–6 hourly).

🟨 Yellow

Mild abnormality

↑ obs frequency; inform nurse-in-charge; consider doctor review.

🟧 Orange

Moderate abnormality

Urgent medical review; ↑ obs to hourly; prepare for interventions.

πŸ”΄ Red

Severe abnormality

Call Rapid Response Team / Code Blue; begin resuscitative measures.

πŸ”Ή How to Use

  1. Select correct age group.

  2. Plot each vital sign.

  3. Escalate per colour zone immediately.

  4. Document actions & review frequency.

  5. Re-check after any intervention.

πŸ”Ή Key Points

  • Detects deterioration early using trends.

  • Parental concern is also a trigger for escalation.

  • Promotes clear communication and team response.

  • Always act on the worst-zone reading.

πŸ”Ή Example

A 2-year-old with RR 60 (orange), HR 160 (orange), SpOβ‚‚ 91 % (red) β†’
Immediate rapid response, oxygen, upright position, notify senior staff, continuous monitoring.

πŸ’’ 4. Paediatric Pain Assessment Tools

Age

Tool

Notes

0–3 yrs

FLACC / COMFORT

Face, Legs, Activity, Cry, Consolability (0–2 each = total /10). Observe behaviour & physiology.

4 yrs +

Revised Faces Pain Scale Β± FLACC

Child points to face that matches pain intensity.

7 yrs +

Numerical (0–10) / Visual Analogue Scale

Child self-rates pain.

Nursing Tips

  • Choose tool per developmental stage.

  • Re-assess after analgesia.

  • Combine observation + parent report + physiological cues.

  • Document tool and score clearly.

🧠 5. Developmental Theory

πŸ”Ή Arnold Gesell – Maturation

  • Growth/development directed by genetics; milestones follow fixed sequence.

  • Environment affects rate but not order.

πŸ”Ή Erik Erikson – Psychosocial Stages

Stage

Age

Task

Nursing Focus

Trust vs Mistrust

0–1 yr

Consistent care builds trust.

Encourage caregiver presence, maintain routine.

Autonomy vs Shame/Doubt

1–3 yrs

Develop independence.

Offer simple choices, allow self-care.

Initiative vs Guilt

3–6 yrs

Assert control via play.

Encourage play & imagination, explain rules.

Industry vs Inferiority

6–11 yrs

Master skills, gain approval.

Provide tasks, praise effort.

Identity vs Role Confusion

12–18 yrs

Establish self-identity.

Respect privacy, support peer relations.

πŸ”Ή Jean Piaget – Cognitive Stages

  1. Sensorimotor (0–2 yrs): learns via senses; object permanence.

  2. Pre-operational (2–7): egocentric, imaginative.

  3. Concrete Operational (7–11): logical, cause & effect.

  4. Formal Operational (11 +): abstract reasoning.

πŸ”Ή Lawrence Kohlberg – Moral Development

  1. Pre-conventional: avoid punishment.

  2. Conventional: seek approval, obey laws.

  3. Post-conventional: internal moral principles.

πŸ‘Ά 6. Developmental Needs of Infants & Young Children in Nursing Care

πŸ”Ή Core Needs

  • Safety, comfort, attachment.

  • Consistent routine.

  • Age-appropriate communication.

  • Play for learning and coping.

  • Pain relief and reassurance.

πŸ”Ή Nursing Strategies

Infants: caregiver nearby, cluster care, soothe with voice/touch, swaddle or sucrose (if ordered).
Toddlers/Preschoolers: offer limited choices, use play & distraction, maintain familiar objects.
School-age: give explanations, involve in self-care, encourage questions.
Adolescents: privacy, independence, peer contact, participation in decisions.

❀ 7. Psychosocial Development of Children & Young People

  • Base nursing on Erikson’s stages:

  • Infants: build trust – respond promptly.

  • Toddlers: autonomy – allow control (feeding, dressing).

  • Preschoolers: initiative – allow play choice, explain boundaries.

  • School-age: industry – encourage schoolwork/self-care.

  • Adolescents: identity – ensure privacy, peer time.

  • Respect cultural differences in child-rearing and health beliefs.

  • Encourage coping: support routines, play, communication, family involvement.

  • Promote independence appropriate to stage (choice, control, participation).

πŸ₯ 8. Impact of Illness & Hospitalisation on Infants & Children

πŸ”Ή Common Reactions

Age

Typical Reactions

Infants

Separation anxiety, irritability, regression, sleep disturbance.

Toddlers

Fear of strangers, loss of control, tantrums, regression.

Preschoolers

Guilt, magical thinking (β€œI caused this”), fear of procedures.

School-age

Boredom, fear of injury, loss of control.

Adolescents

Privacy issues, peer isolation, body-image concerns.

πŸ”Ή Nursing Actions

  • Family-centred care – encourage parental presence.

  • Keep routines & familiar items.

  • Use age-appropriate explanations.

  • Provide play therapy/distraction.

  • Encourage independence where possible.

  • Offer honest information & emotional support.

🌱 9. Basic Principles of Growth & Development

  • Growth: quantitative – increase in size/measure.

  • Development: qualitative – progress in function/skills.

  • Follows predictable cephalocaudal and proximodistal patterns.

  • Sequential and continuous but rate varies.

  • Influenced by genetics + environment.

  • Domains: biophysical, psychosocial, cognitive, moral, spiritual.

  • Track using WHO growth charts.

🌿 10. Factors Influencing Growth & Development

  • Genetics: inherited traits, congenital conditions.

  • Temperament: personality affects interaction/coping.

  • Family environment: emotional security, socioeconomic status.

  • Nutrition: critical for physical & cognitive growth.

  • Health: chronic illness may delay milestones.

  • Culture: child-rearing, discipline, expectations.

  • General environment: housing, pollution, community safety.

🧩 11. Head Injury (Assessment & Nursing Care)

πŸ”Ή Overview

  • Common in children; majority minor but require close observation.

  • Children’s thinner skulls & larger heads increase risk of intracranial injury.

πŸ”Ή Assessment

  • AVPU – quick responsiveness check.

  • GCS / Modified GCS – for detailed neurological evaluation.

  • Watch for deterioration: ↓ GCS, persistent vomiting, unequal pupils, seizures, worsening headache, behavioural changes.

πŸ”Ή Nursing Priorities

  • Maintain airway & oxygenation (jaw-thrust if needed).

  • Monitor vitals & neuro obs frequently.

  • Keep head midline, elevate 30Β°.

  • Avoid sedative analgesics that mask neuro signs.

  • Document baseline & changes.

  • Escalate immediately for any deterioration.

  • Keep NPO if imaging/surgery likely.

  • Reassure and educate family.

🧾 Quick Recap Cheats

  1. PAT = Appearance / Work of Breathing / Circulation

  2. PARROT = Colour-coded chart for early deterioration

  3. FLACC = Face Legs Activity Cry Consolability (0–2 each)

  4. AVPU = Alert / Voice / Pain / Unresponsive

  5. Growth = size | Development = skills

  6. Erikson first 4: Trust β†’ Autonomy β†’ Initiative β†’ Industry

  7. Hospitalisation stress: separation, regression, fear β†’ keep parents close

  8. Head-injury red flags: vomiting, ↓ GCS, unequal pupils, seizures

  9. Always act on colour zones in PARROT – Red = call RRT now