Exam 1 1/2 - Outline

🧒🏻 Intro to Pediatric Nursing Study Guide

🌟 Goal of Pediatric Nursing

• Primary Aim: To improve the quality of health care for children and their families.

• Focus is not just on physical health, but emotional, developmental, and social well-being.

🏥 Evolution of Child Health in the U.S.

1800s

• Abraham Jacobi

  • Known as the Father of Pediatrics.

  • Established milk stations: safe places where mothers could obtain clean milk and basic child care education.

1867

• Lillian Wald

  • Founded the Henry Street Settlement in NYC.

  • Recognized as the founder of Community Health Nursing.

  • Advocated for improved living conditions and healthcare access for children in poverty.

1912

• U.S. Children’s Bureau

  • Created to focus on issues related to child welfare and public health.

  • Eventually became part of the Department of Health and Human Services.

1930

• AAP – American Academy of Pediatrics

  • Formed to provide dedicated standards of care for children.

  • Emphasized the need for pediatricians to focus on prevention, education, and advocacy.

1935

• Title V – Child Welfare Services

  • A federal program to fund maternal and child health services.

  • Supports early intervention, nutrition programs, and preventive health services.

1990s

• FMLA – Family and Medical Leave Act

  • Provides 12 weeks unpaid leave for qualifying employees.

  • Can be used for pregnancy, childbirth, adoption, or caring for a sick family member.

  • Important legislation that supports family roles in childcare and health.

📈 Healthy People 2030

• A national initiative with clear objectives for improving public health over the next decade.

Key Goals for Child Health

• Create a framework for child health promotion programs.

• Focus on prevention of disease and promotion of healthy behaviors early in life.

• Increase quality and length of healthy life.

• Eliminate health disparities among different population groups.

Leading Health Indicators (LHI)

• Specific health outcomes used to measure progress.

• Includes topics like:

  • Infant mortality

  • Vaccination rates

  • Nutrition and physical activity

  • Access to care

🧸 Child Health Promotion & Problems – Pediatric Nursing Notes

🌱 Child Health Promotion

🧍‍♂ What is Health?

• Health = Complete physical, emotional, and social well-being, not just absence of illness.

🎯 What is Health Promotion?

• Reduces health inequalities between different groups.

• Ensures equal access to resources and care.

• Helps all children reach their full health potential.

👶 Development

• Developmental stages are unique, and nursing care must be age-appropriate.

  • Infant: First year shows the most rapid physical growth.

  • Toddler

  • Early Childhood

  • Adolescence

• Ongoing surveillance is essential to detect and intervene early in case of delays or concerns.

🍎 Nutrition

• Breastfeeding offers many benefits (immune protection, bonding, etc.).

• Eating habits are usually formed by age 3.

• Parental teaching is vital to guide healthy food choices.

• Food attitudes (likes/dislikes) begin early in life.

• Barriers:

  • Homelessness and low income = limited access to nutritious meals.

  • Lack of education on healthy eating in some families.

🦷 Oral Health

• Dental caries (cavities) are preventable.

• Start dental hygiene with first tooth eruption.

• Promote early preventive dental care.

• Disparities in oral health exist – focus on early education and access to care.

• Encourage regular brushing, flossing, and dental checkups from infancy.

⚠ Common Child Health Problems

⚖ Obesity & Type 2 Diabetes

• Now at epidemic levels in children.

• Obesity linked to:

  • Cancer, especially colon (associated with high-fat diets).

  • Cardiometabolic issues (e.g., hypertension, insulin resistance).

• Influencing factors:

  • Maternal obesity

  • Low physical activity, screen time, and sedentary lifestyles

🩹 Injuries

• #1 cause of death & disability in children.

• Unintentional injuries are strongly tied to age and development.

  • Infants: Suffocation (unsafe sleep), car seat injuries.

  • Ages 5–9: Bicycle & ATV accidents.

  • Older children: Drowning, burns.

• Motor vehicle accidents remain a major concern.

🔫 Violence

• Includes youth violence, especially among minority populations.

• Exposure through:

  • Home, community, school, and media.

• Nurses play a role in:

  • Risk assessment, safety education.

  • Advocating for gun safety (locked, unloaded, out of reach).

🚬 Adolescent Vaping Epidemic

• E-cigarettes produce aerosols with nicotine & harmful chemicals.

• Rapidly growing concern:

  • 78% of high schoolers report vaping.

  • 48% of middle schoolers report vaping.

• Linked to substance abuse, addiction, and health risks.

🦠 COVID-19 Impact

• Disrupted access to:

  • Free school meals (food insecurity increased).

  • Education and mental health services.

• Increased need to:

  • Support physical and mental health.

  • Ensure access to healthcare, stable housing, and childcare.

  • Promote well-being in disadvantaged families.

🧠 Mental Health in Children

• 1 in 5 children have a mental health issue.

• 80% of chronic mental disorders begin in childhood/adolescence.

• Early signs often appear during adolescence.

• Nurses should:

  • Screen for mental health concerns.

  • Identify symptoms, including suicidal ideation.

  • Connect families to resources and referrals.

  • Offer emotional and social support.

📊 Pediatric Care: Statistics – Mortality & Morbidity

⚰ Mortality vs. Morbidity

🔹 Mortality

• Refers to death or the rate of death.

• Helps identify:

  • Leading causes of death.

  • High-risk age groups.

  • Effectiveness of treatments and prevention efforts.

  • Areas where health counseling is needed.

🔹 Morbidity

• Refers to illness or disease prevalence.

• Shows how many people are affected by non-fatal health conditions.

• Measures the impact of disease on a population's health.

👶 Infant Mortality

📉 Infant Mortality Rate (IMR)

• Defined as:
  → Number of infant deaths (under 1 year of age) per 1,000 live births.

• Key Indicator of a country’s overall health and healthcare system.

📌 Contributing Factors

• Birthweight is the main determinant—low birthweight = higher risk.

• Disparities exist: racial and socioeconomic factors widen the gap in IMR.

🧒 Childhood Mortality

👼 Infants (<1 year)

• Leading causes:

  • Congenital anomalies (birth defects)

  • Prematurity / Low birth weight

  • Sudden Infant Death Syndrome (SIDS)

🧒 Children (>1 year)

• Leading cause:
  → Unintentional injuries (accidents)

  • Examples: falls, car crashes, poisoning, drowning

🔪 Violent Deaths

• Second leading cause of death in adolescents (ages 15–19).

• Children <12 years old: Most often harmed by a family member.

• Firearm-related deaths:

  • Rapidly increasing trend

  • Major concern in pediatric population

💔 Suicide

• Among the top causes of death in children and teens (ages 10–19).

• Indicates a growing mental health crisis.

🤒 Childhood Morbidity

📈 Definition

• Measures illness rates per 1,000 children in a population.

• Assesses the prevalence and impact of disease on daily life.

⚠ Types of Morbidity

1. Acute Illnesses

• Sudden onset, short duration, interferes with daily life.

• Common causes:

  • 50% – Respiratory (e.g., colds, flu)

  • 15% – Injuries (e.g., fractures, burns)

  • 11% – Infectious or parasitic (e.g., Hand, Foot & Mouth disease)

2. Chronic Illnesses

• Long-term, not curable, but manageable.

• Not necessarily terminal.

• Example:

  • Cystic Fibrosis

    • Affects lungs/digestive system

    • Requires lifelong management

🧒 Pediatric Care – Quick Study Notes

🏥 Pediatric Philosophy of Care

👨‍👩‍👧 Family-Centered Care

• Involves the family in care decisions.

• Key principles:

  • Listen

  • Enable

  • Empower

  • Partner

🩺 Atraumatic Care

• Minimizes physical & emotional trauma.

• Key methods:

  • Prevent separation from family.

  • Promote child’s sense of control.

  • Minimize pain/injury.

👩‍⚕ Role of the Pediatric Nurse

• Build therapeutic relationships.

• Be a family advocate.

• Focus on health promotion & disease prevention.

• Teach families and children.

• Prevent injuries.

• Provide support and counseling.

• Coordinate care, collaborate with others.

• Support ethical decision-making.

🔍 Providing Care: Skills & Decision-Making

📚 Evidence-Based Practice (EBP)

• Combines:

  • Patient reports

  • Nurse observation

  • Valid research

• Leads to rational, best practice decisions.

🧠 Clinical Judgment & Reasoning

• Involves rational, disciplined, self-directed thinking.

• Builds from:

  • Knowledge + assessment

  • Real clinical situations

  • Developing outcomes

🧠 Six Essential Cognitive Skills:

1. Interpretation

2. Analysis

3. Evaluation

4. Inference

5. Explanation

6. Self-regulation

🌎 Influences on Pediatric Health Care

👪 Family Types

• Traditional – 2 parents (different sex) + children

• Nuclear – Parents (same sex, etc) & their children

• Blended – Step-families

• Extended – Includes other relatives

🌐 Social & Cultural Influences

• School & peers → Socialization

• Media → Behavioral influence

• Poverty → Health disparities

• Immigration & race/ethnicity

• Religion → Impacts care and beliefs

🌍 Cultural Considerations

• Cultural relativity – View behaviors within cultural context.

• Food customs – Respect cultural diets in care planning.

• Health beliefs – Can affect trust and communication with providers.

📏 Growth & Development

⚖ Proportional Growth – Weight

• 2x birthweight by 6 months

• 3x birthweight by 12 months

• Gain ~5–7 oz/week (0–6 months), slows after 6 months

📏 Height & Head Circumference

• Height:

  • ↑ 1 in/month (0–6 months), slows after

  • ↑ by 50% by 1 year

• Head:

  • Grows rapidly in first year (linked to brain growth)

  • 2 cm/month (0–3 months) → 0.5 cm/month (6–12 months)

👀 Sensory Development

• Vision:

  • Binocular vision by 6 weeks, well-set by 4 months

  • Stranger recognition by 6 months

• Hearing:

  • Present at birth, mature by 2–3 months

🧬 System Maturation

🧍‍♂ Gross Motor Milestones

✋ Fine Motor Milestones

🧠 Psychosocial, Cognitive & Social Development – Pediatric Nursing

🧩 Erikson’s Psychosocial Development

👶 Stage: Trust vs. Mistrust (Infant)

• Age: Birth to 1 year

• Goal: Develop basic trust

• How: Consistent care, feeding, comfort

• If needs are met → trust in self, others, and the world

• If unmet → mistrust, fear, insecurity

🧠 Piaget’s Cognitive Development

🍼 Sensorimotor Stage (Birth–2 years)

• Focus: Infant learns through senses and motor activity

• Key Concepts:

  • Separation: Infant learns they are separate from others.

  • Object permanence (7-9 months): Objects still exist even if hidden (peekaboo!)

  • Mental representation: Can use symbols (e.g., gestures) to think

👶 Substages (1–4):

• Reflexive → Primary circular reactions → Secondary → Coordination of reactions

• Develop skills like imitation, cause-effect, memory

🧒 Social Development

💞 Attachment

• Begins early in life, deepens over time.

• 6 months: Discerns mom from others (visual preference).

• 4–8 months: Separation anxiety begins.

• 6–8 months: Stranger fear starts.

• Disorders:

  • Reactive Attachment Disorder (RAD) from prolonged early separation.

🗣 Language Development

• Starts with crying, then coos, babbles, then syllables → words.

• Stimulated by talking, singing, reading.

🧍 Personal-Social Behavior

• Personal response to surroundings.

• Shaped by external stimuli and caregivers.

🎲 Play in Infancy

Birth to 6 Months

• Solitary/Dependent play

• Shakes rattle (2–3 months)

• Enjoys face-to-face interactions

6 Months to 1 Year

• Sensorimotor play

• More selective with toys and people

• Games: Peek-a-boo, pat-a-cake

• Stranger fear becomes noticeable (6–8 months)

😠 Temperament Types

🧷 Coping with Growth & Development

😢 Separation Anxiety & Stranger Fear

• Normal, shows secure attachment

• Nursing approach:

  • Use transitional objects (blanket/toy)

  • Talk softly, eye-level interaction

  • Avoid sudden or intrusive gestures

⛔ Limit Setting & Discipline

• Begin age-appropriate discipline early

• Time-out: 1 min per year of age

• Focus on safety and positive behaviors

🏡 Childcare Arrangements

• Types: Family, center-based, nanny

• Choose:

  • State-licensed

  • Good health/safety practices

  • Stimulating daily routines

👶 Thumb Sucking & Pacifier Use

• Normal reflex in infancy

• Pacifier use is okay, but:

  • Can affect breastfeeding if introduced too early

  • Must be clean and safe

  • Avoid if associated with frequent ear infections

🦷 Teething

🦷 When?

• First 2 years of life

• Formula: Age in months – 6 = number of teeth

  • E.g., 8 months → ~2 teeth

🔍 Signs & Symptoms

• Drooling

• Sleep disturbance

• Mild fever

• Ear rubbing

• Decreased appetite

🧊 Treatment

• Cool teething rings

• Topical anesthetics (if approved)

• Acetaminophen (last resort, follow dosing guidelines)

👶 Health Promotion of the Infant – Pediatric Nursing

🍼 Nutrition

🇺🇸 AAP Recommendations

• Human milk is preferred for the first 6 months.

• If not breastfeeding, use iron-fortified formula for the entire first year.

  • Infants are at risk for iron-deficiency anemia due to dropping hemoglobin levels.

• No cow’s milk before age 1 → can lead to GI irritation and anemia.

• Whole milk is introduced after 1 year (for calorie & fat needs).

🍽 Introduction of Solids

• Start solids between 4–6 months.

• Begin with iron-rich foods (iron-fortified cereals).

• Introduce one food at a time every few days to detect allergies.

🤱 Breastfeeding Notes

• Reduces allergy (atopy) risk, especially in infants with family history of allergies.

• Cow's milk protein can be transferred through breastmilk → avoid allergenic foods for first 6–8 months if needed.

• May need protein supplementation in some cases.

🍼 Formula Types

💤 Sleep & Activity

• By 3–4 months → sleep 9–11 hours at night

• Total daily sleep ≈ 15 hours

• 1–2 naps/day by end of first year

• Breastfed infants: shorter sleep intervals

• Be aware of common sleep problems: waking, feeding-sleep association

🛑 Injury Prevention

Major Risks:

• Aspiration: Small toys, foods like nuts/grapes

• Suffocation: Unsafe bedding, soft pillows, stuffed toys

• Motor Vehicle Accidents: Use rear-facing car seat until age 2 or max height/weight

• Falls: Never leave infant unattended on surfaces

• Bodily Damage: Sharp objects, pulling objects down

• Drowning: Bathtubs, buckets — constant supervision

• Burns: Hot liquids, bath water, sunburn

• Poisoning: Lock up meds, cleaning supplies, plants

👶 Health Problems of Infants – Pediatric Nursing

🥜 Food Sensitivity & Allergy

🔹 Food Allergy / Hypersensitivity

• Immune response to certain proteins.

• Common allergens:

  • Cow’s milk, peanuts, soy, wheat, corn, tree nuts, shellfish, fish

🔹 Atopy

• Definition: Genetic predisposition to allergic conditions (eczema, asthma, allergic rhinitis)

🔹 Clinical Manifestations

🥛 Cow’s Milk Allergy (CMA)

• Allergy to protein in cow's milk (casein/whey)

🔹 Symptoms:

• May mimic respiratory, GI, or dermatologic issues

🔹 Diagnosis:

• Allergy testing, stool analysis

• Elimination/challenge testing

🔹 Management:

• Eliminate cow's milk

• Reintroduce during challenge to confirm

• Use hydrolyzed formula: Nutramigen, Alimentum

• Soy formula may be used if no soy allergy

🧀 Lactose Intolerance

🔹 Pathophysiology:

• Inability to digest lactose due to lactase enzyme deficiency

🔹 Types:

• Congenital: Rare, genetic

• Primary: Normal decline in lactase with age

• Secondary: Due to GI injury (infection, celiac, etc.)

🔹 Symptoms:

• Bloating, abdominal pain, flatulence, watery diarrhea

🔹 Diagnosis:

• Hydrogen breath test

🔹 Treatment:

• Avoid dairy

• Lactose-free or soy-based formulas

• Lactase enzyme supplements

🍼 Feeding Difficulties

🔹 Types:

• Improper feeding techniques

• Regurgitation/spitting up (normal unless excessive)

• Paroxysmal abdominal pain (Colic)

• Rumination: Chronic regurgitation/re-chewing

😢 Colic

🔹 Definition:

• Crying >3 hours/day, >3 days/week, >3 weeks

• Peaks at 6 weeks, resolves by 3 months

🔹 Symptoms

• Fussy in the evening

• Pulling legs to abdomen, gassy

🔹 Possible Causes:

• Overfeeding or rapid feeding

• Swallowing excess air

• Parental anxiety

• Allergies/sensitivities

🔹 Management:

• Educate caregivers

• Try formula changes

• Burp frequently

• Investigate for organic causes (reflux, allergies)

• Medications rarely needed

📉 Failure to Thrive (FTT)

🔹 Definition:

• Weight <3rd–5th percentile

• Drop of 2+ major percentile lines

• <80% of median weight-for-height

🔹 Types:

• Organic FTT: Medical causes (CF, cardiac, celiac)

• Non-organic FTT: Environmental (neglect, poor feeding, poverty)

• Multifactorial: Combination of both

🔹 Pathophysiology:

• Inadequate intake

• Poor absorption

• Increased metabolism

• Defective utilization

🔹 Risk Factors:

• Family stress

• Poor caregiver knowledge

• Lack of resources

• Cultural feeding practices

🔹 Management Goals:

• Correct nutritional deficiencies

• Provide sufficient calories for catch-up growth

• Educate family on age-appropriate feeding

• Restore optimal body composition

👶 Skin Disorders in Infants

🧷 1. Diaper Dermatitis (Diaper Rash)

• Affects 1/3 of infants, esp. 4–12 months

🔹 Causes:

• Prolonged moisture, urine, stool, friction

• Secondary Candida albicans infection possible

🔹 Symptoms:

• Redness, edema, vesicles

• Beefy red rash with satellite lesions → fungal

🔹 Treatment:

• Barrier creams (zinc oxide)

• Antifungals for candidiasis

• Flanders paste for severe rash

  • Gloves for application (stains skin gray)

🧴 2. Seborrheic Dermatitis (Cradle Cap)

🔹 Patho:

• Chronic inflammatory reaction

• Pityrosporum yeast overgrowth

🔹 Symptoms:

• Thick, greasy, yellowish scales on scalp, behind ears

🔹 Treatment:

• Daily shampoo (baby-safe or medicated)

• Soft brush to loosen scales

🌿 3. Atopic Dermatitis (Eczema)

🔹 Chronic inflammatory skin disorder

• Associated with allergies and asthma

• 75% by 6 months, 80–90% by 5 years

🔹 Triggers:

• Foods, fabrics, weather, soaps, dust

🔹 Forms:

• Infantile: Cheeks, scalp, trunk, extensor limbs

• Childhood

• Adolescent

🔹 Diagnosis:

• Pruritus + 3 of:

  • Lymphadenopathy

  • Red palmar creases

  • Pityriasis alba (light patches on skin)

🔹 Management:

• Hydration (no hot baths)

• Moisturizers

• Avoid harsh soaps, wool

• Topical steroids

• Oral antihistamines (not for infants; Vistaril, Atarax)

• Humidifiers, avoid scratching

💀 SIDS – Sudden Infant Death Syndrome

🔹 Definition:

• Sudden unexplained death of infant <1 year

🔹 Peak Incidence:

• 2–4 months, during sleep

🔹 Risk Factors:

• Maternal smoking, prematurity, low birth weight

• Prolonged QT syndrome

• Male sex

• African-American & Native American infants

• Previous sibling deaths

🔹 Prevention:

• Sleep on back (supine)

• Firm mattress, no soft bedding

• Breastfeeding

• Pacifier during sleep

• Avoid co-sleeping, overheating

• Educate families!

🚨 BRUE – Brief Resolved Unexplained Event

🔹 Definition:

• In infants <1 year, sudden alarming event, then complete recovery

• <1 minute duration

🔹 Features:

• Pallor or cyanosis

• Absent, decreased, or irregular breathing

• Change in tone

• Altered responsiveness

🔹 Workup:

• Detailed history

• Pre-/post-natal factors

• EKG, EEG

🔹 Nursing Management:

• Educate caregivers

• CPR training

• Home apnea monitoring

• Gentle stimulation if recurrence (flick foot, pat back)

• Never shake the infant