Unit 2 Pediatric Nursing

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Unit 2Pediatric Nursing
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Communicating With Infants and Young Children

• Infants respond to sounds and actions.
• Distrust of strangers may last through the first
  3 or 4 years of life.
• Get down on their eye level.
• The perceptions of young children are literal.

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Communicating With School-Age Children

• Interested in knowing what and why
• Simple explanations that help them understand how
  equipment works are important.
• These children will ask more questions if their
  curiosity is not satisfied.

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Communicating With Adolescents

• Young teenagers frequently waver between thinking
  like children and like adults.
• Teens may need to relate information that they do
  not wish others to know, and a discussion about
  confidentiality may ease their concerns.
• The nurse should listen attentively in an
  open-minded, nonjudgmental way.

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Communicating With Family Caregivers

• Keep family caregivers well informed about what
  is happening and being planned for their child.
• Some caregivers are so anxious and apprehensive
  that they communicate their concerns and negative
  reactions to the child rather than provide
  support.

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Health Maintenance

• Routine well-baby or well-child visits are
  recommended throughout childhood.
• Dental caries (cavities) are a major health
  problem in children and adolescents.
• Protection against disease in the form of
  immunizations is available against several
  serious or disabling diseases.

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Pediatric Assessment

• Collecting Subjective Data
• Conducting the Client and Family Interview
• Obtaining a Client History

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Collecting Objective Data

• General Status
• Observing General Appearance
• Noting Psychological Status and Behavior
• Measuring Height and Weight
• Measuring Head Circumference
• Vital Signs

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Providing a Physical Examination

• Head and Neck
• Chest and Lungs
• Abdomen
• Genitalia and Rectum
• Back and Extremities
• Neurologic

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Hospitalized Child

• Pediatric Unit
• Infection Control
• Caregiver Participation
• Child Undergoing Surgery
• Play

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Assisting with Basic Needs

• Nutrition
• Intake Measurement
• Gavage Feeding
• Gastrostomy Feeding
• Safety
• Pain Management
• Oxygenation

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Assisting With Basic Needs

• Elimination
• - Output Measurement
• - Specimen Collection
• Positioning
• - Restraints
• - Transporting
• - Holding
• - Sleeping

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Medication Administration

• Evaluate each child from a developmental point of
  view to administer medications successfully.
• Always calculate the drug dosage to ensure
  administration of the correct dosage.
• Oral medications may be given to infants through
  a nipple, with a medicine dropper, or with an
  oral syringe.
• Medications should not be given in food.

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Infants 28 Days To 1 Year

• Trust Versus Mistrust
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

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Toddler 1 To 3 Years

• Autonomy Versus Shame and Doubt
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

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Preschool Child 3 To 6 Years

• Initiative Versus Guilt
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

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School-age Child 6 To 12 Years

• Industry Versus Inferiority
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

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Preadolescent Ages 10 to 12

• Physical Characteristics
• Preparation for Adolescence

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Adolescent Ages 12 to 18

• Ego Identity Versus Role Confusion
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

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Developmental Disorders

• Autism pervasive developmental disorder
• Down Syndrome trisomy 21
• Fetal Alcohol Syndrome
• Lead Poisoning (Plumbism)

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Mental Retardation

• The most common classification of mental
  retardation is based on IQ.
• Medical Management goal is to keep child in home
  environment

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Nursing Process The Child With Cognitive
Impairment

• Self-Care Deficit Bathing/Hygiene,
  Dressing/Grooming, Feeding, Toileting related to
  cognitive or neuromuscular impairment (or both)
• Impaired Verbal Communication related to impaired
  receptive or expressive skills
• Delayed Growth and Development related to
  physical and mental disability

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The Child With Cognitive Impairment (Continued)

• Compromised Family Coping related to emotional
  stress or grief
• Risk for Social Isolation (family or child)
  related to fear of and embarrassment about the
  childs behavior or appearance

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Attention DeficitHyperactivity Disorder

• Syndrome characterized by degrees of inattention,
  impulsive behavior, and hyperactivity
• Medical Management treatment is
  multidisciplinary
• Stimulants
• Nursing Management
• Build the childs self-esteem, confidence, and
  academic success

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Child Abuse and Neglect

• Dysfunctional family
• State laws require health care personnel to
  report suspected child abuse
• Physical Abuse
• Emotional Abuse and Neglect
• Sexual Abuse
• Nursing Management for the Abused or Neglected
  Child

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Nonorganic Failure to Thrive

• Children who fail to gain weight and show signs
  of delayed development
• Organic failure to thrive result of a disease
  condition
• Nonorganic failure to thrive (NFTT) no apparent
  physical cause
• Medical Management

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Nursing Process The Child With Nonorganic
Failure to Thrive

• Imbalanced Nutrition Less than Body Requirements
  related to inadequate intake of calories
• Risk for Delayed Growth and Development related
  to physical or emotional neglect, lack of
  stimulation and insufficient nurturing
• Impaired Parenting related to lack of knowledge
  and confidence in parenting skills

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Respiratory Disorders

• Acute Bronchiolitis/Respiratory Syncytial Virus
• Croup Syndromes
• Spasmodic Laryngitis
• Acute Laryngotracheobronchitis

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Nursing Process The Child With a Respiratory
Disorder

• Ineffective Airway Clearance related to
  obstruction associated with edema, mucous
  secretions, nasal and chest congestion
• Impaired Gas Exchange related to inflammatory
  process
• Risk for Deficient Fluid Volume related to
  respiratory fluid loss, fever, and difficulty
  swallowing
• Compromised Family Coping related to childs
  respiratory symptoms and illness

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Cystic Fibrosis

• Assessment
• Medical Management
• Pulmonary treatment
• Dietary treatment
• Home care
• Nursing Management

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Sudden Infant Death Syndrome

• Leading cause of infant mortality worldwide
• No single cause has been identified SIDS can
  neither be prevented nor predicted.
• American Academy of Pediatrics recommends that
  infants must be placed in a supine position to
  sleep.
• Referrals should be made to the local chapter of
  the National SIDS Foundation.

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Cardiovascular and Hematopoietic Disorders

• Congenital Heart Disease
• Congenital Heart Defects
• Ventricular Septal Defect
• Atrial Septal Defects
• Patent Ductus Arteriosus
• Coarctation of the Aorta
• Tetralogy of Fallot
• Transposition of the Great Arteries

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Cardiovascular and Hematopoietic Disorders
(Continued)

• Rheumatic Fever
• Kawasaki Disease
• Hemophilia
• Factor VIII Deficiency (Hemophilia A
  Antihemophilic Globulin Deficiency Classic
  Hemophilia)
• Factor IX Deficiency (Hemophilia B Plasma
  Thromboplastin Component Deficiency Christmas
  Disease)

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Neurologic Disorders

• Cerebral Palsy
• Ataxia type
• Rigidity type
• Mixed type
• Hydrocephalus
• Ventriculoperitoneal shunting

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Nursing Process Postoperative Care of a Child
With a Shunt Placement

• Risk for Ineffective Cerebral Tissue Perfusion
  related to IICP
• Risk for Impaired Skin Integrity related to
  pressure from physical immobility
• Risk for Infection related to the shunt
• Risk for Delayed Growth and Development related
  to impaired ability to achieve developmental
  tasks
• Anxiety related to family caregivers fear of
  surgical outcome

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Haemophilus influenzae Meningitis

• Assessment
• Medical Management The child is initially
  isolated and treatment is started using IV
  administration of antibiotics.
• Nursing Management
• Closely monitor the child for signs of IICP.
• Side-lying position with the neck supported and
  head elevated

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Reye Syndrome

• Assessment symptoms appear within 3 to 5 days
  after the initial illness
• Medical Managementimproving respiratory
  function, reducing cerebral edema, and
  controlling hypoglycemia
• Nursing Management
• Accurate intake and output
• Avoid giving aspirin to children

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Spina Bifida

• Failure of the posterior laminae of the vertebrae
  to close as a result of a defect in the neural
  arch, generally in the lumbosacral region
• Surgery is required to close the open defect
• Nursing Management
• Until surgery is performed, the sac must be
  covered with a sterile dressing moistened in a
  warm sterile solution.

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Sensory Disorders

• Cleft Lip and Cleft Palate
• Vision Impairment
• Hearing Impairment

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Gastrointestinal Disorders

• Celiac Syndrome/Gluten-Induced Enteropathy
• Colic
• Diarrhea and Gastroenteritis
• Hernias

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Gastrointestinal Disorders (Continued)

• Congenital Aganglionic Megacolon
• Intussusception
• Pyloric Stenosis
• Type 1 Diabetes Mellitus

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Urinary and Renal Disorders

• Cryptorchidism
• Hydrocele
• Enuresis
• Encopresis
• Exstrophy of the Bladder
• Hypospadias and Epispadias
• Nephrotic Syndrome

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Nursing Process The Child With Nephrotic Syndrome

• Excess Fluid Volume related to fluid accumulation
  in tissues and third spaces
• Risk for Imbalanced Nutrition Less than Body
  Requirements related to anorexia
• Risk for Impaired Skin Integrity related to edema
  
• Fatigue related to edema and disease process
• Risk for Infection related to immunosuppression
• Deficient Caregiver Knowledge related to disease
  process, treatment, and home care

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Urinary and Renal Disorders (Continued)

• Urinary Tract Infections
• Wilms Tumor (Nephroblastoma)

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Musculoskeletal Disorders

• Juvenile Rheumatoid Arthritis
• Hip Dysplasia

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Nursing Process The Child in an Orthopedic
Device or Cast

• Acute Pain related to discomfort of orthopedic
  device or cast
• Risk for Impaired Skin Integrity related to
  pressure of the cast on the skin surface
• Risk for Delayed Growth and Development related
  to restricted mobility secondary to orthopedic
  device or cast
• Deficient Knowledge of family caregivers related
  to home care of the child in the orthopedic
  device or cast

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Musculoskeletal Disorders (Continued)

• Legg-Calvé-Perthes Disease (Coxa Plana)
• Muscular Dystrophy
• Scoliosis
• Talipes Equinovarus

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Integumentary Disorders

• Candidiasis
• Diaper Rash
• Acute Infantile Eczema
• Fungal Infections
• Impetigo
• Parasitic Infections

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Immune Disorders

• Communicable Diseases
• Infectious Mononucleosis