PEDIATRICS
Unit 1
Rev. 2012
History of Child Care
Colonial America
Industrialized America
Dr. Abraham Jacobi –Father of Pediatrics
Pediatric Nursing - Purpose
Prevent disease or injury
Optimal health and development
Treat health problems
Qualities of the Pediatric Nurse
Keen observation skills
Conveys respect and honesty
Communication
Enjoys working with children
Teaches parents & children
Good role model
Special Needs Children
Congenital anomalies
Malignancies
Abnormalities
35% of hospitalized children
Family Centered Care
24 hour visitation
Parental access to health information
Parents involved in decisions
Growth and Development
Are complex processes
Occur in stages
Knowing normal milestones easier to identify delays
Cognitive Impairment
Anticipatory Guidance
Physical Assessment
Use different skills for each age group
Follow head to toe direction
Alter sequence based on developmental needs
See Box 30-3 pg. 948
Physical Growth Parameters
Ht or Length
WT.- Balance scale first
Head Circ.- up to 36 mo.
Temperature
Tympanic-most common for infant or small child
Rect, Axillary & oral acceptable
**Think critically as to why temp is needed**
Heart Rate & Respirations
Resp.- always do first
1 full minute
< 6 yrs – abd breathers
Neonate – nasal breathers
Apical rate up to 5 yrs, for 1 full minute @ apex of heart
Blood Pressure
Sites pg. 951 Fig. 30-3
Correct cuff size- covers 2/3 of upper arm
Explain each step
Perform prior to anxiety provoking procedures
Head to Toe Assessment
Head:
Circ.
Fontanel's
Eyes, nose, mouth
Lungs Box 30-8, pg. 953
Chest
Back
Abd.
Extremities
Renal Function
Anus
Genitalia
Factors Influencing G&D
Nutrition ^ Most important influence on bone & muscle growth
0-6 mo Breast/bottle
6-12 monow add food
> 12 mocows milk O.K.
In hospital serve high quality food when child is hungry
Metabolism/Sleep/Speech
MetabolismFaster than adultsHeal quickly
Sleepless required as they mature
Speechability determined by stage of development
The Hospitalized Child
Pre admission education varies by age
Anticipatory guidance
Be honest to establish trust
Allow parents to stay
Considerations/Communication
Pg. 958,961, Table 30-7
Expect regression
anger and
rejection
Surgery
Age appropriate pre op teaching
Allow to verbalize fears
Pre-op teaching is important
Parent Participation
Review info from physician
Parents may not understand due to anxiety
Listen
Pain Management
Anything that is painful to an adult is painful to a child
Observe for changes in behavior
PEDIATRIC PROCEDURES
Bathing
Before a feeding
Prevent chilling
Only water on face
Feeding/Burping
Breast or Bottle
Burping positions
Solids introduced @ 4-6 mo
Weaning
Bedtime bottle removed last
Safety Devices
Restraints:
Used as a last resort
Remove Q2 hours ot exercise body part
Urine Collection
Urine collection bag
Cath specimen
Voided specimen
Veni & Lumbar Puncture
Venipuncture Position securely
Lumbar puncture Side lying
Oxygen Therapy
Hood
Mist tent
Nasal canula
Mask
Suctioning
No more than 5 seconds
I&O
Weigh all diapers
Medication Administration
6 rights
Calculate safe dose
P.O. is preferred route
Children more susceptible to toxic effects of drugs than adults
Use a syringe to measure exact dose
Aim toward side of mouth
Injections
Vastuslateralis is preferred site until walking
Ventral Gulteal on children who are walking
Ear & Nasal gtts.
< 3 y/o pinna down and back
> 3 y/o pinna up and back
Nasal hyper extend head over edge of bed
Rectal
See box 30-11
Less reliable
Suppository w/ jelly
Enema procedure same as adult
Safety
Prevent accidents
See Table 30-12 for Developmental Safety Hazards & Prevention
Caring for Pediatric Patient with a Cardiovascular Disorder
Congenital Heart Diseases
Congenital Heart Disease
Present at birth
Majority are treated with surgery
5-10% of term neonates
Etiology
Environmental
Genetic
4 Types of CHD
Increased pulm. blood flow
Decreased pulm. blood flow
Obstruction to systemic flow
Mixed blood flow
Clinical Manifestations
Cyanosis
Pallor
Cardiomegly
Murmurs
Additional heart sounds
Digital clubbing
Apical and radial pulse differences
Cardiac murmurs
#1 Increased Pulmonary Blood Flow Defects
PDA Patent DuctusArteriosis
ASD Atrial Septal Defect
VSD Ventricular Septal Defect
PDA
Patent DuctusArteriosis
Blood shunts from aorta to pulmonary artery
“Machine like” murmur
PEDIATRICS
UNIT 2
ASD
Atrial Septal Defect
Opening in atrial septum
Murmur
Atrial Septal Defect
Blood flows from high pressured left atrium to lower pressured right atrium.
VSD
Ventricular Septal Defect
Murmur
50% close spontaneously
Remainder require open heart surgery
Dacron patch or close w/ sutures
The most common congenital heart defect
#2. Decreased Pulm. Blood Flow Defects
1) Pulmonary Stenosis
2) Pulmonary Atresia
3) Tetrology of Fallot (most common)
Tetralogy of Fallot
consists of the following 4 defects:
Pulmonary artery stenosis
Ventruculoseptal defect
R. ventricular hypertrophy
Overriding aorta
Note: The heart works harder because of the pulmonary artery stenosis
Signs & Symptoms
Profound cyanosis
Tet spells
Clubbing of nailbeds
Murmur
dyspnea
Squatting
Poor growth
syncope
Surgical Treatment
Blalock-Taussig Shunt (temporary)
Closure of VSD
Pulmonic Valvotomy
Repair of overriding aorta
#3 Mixed Flow Defect
TGV – transposition of great vessels
S/S: severe cyanosis
Treatment surgical repair a) Palliative b) Complete
#4 OBSTRUCTIVE FLOW DEFECTS
Pulmonary Stenosis
Aortic Stenosis
Coartication of the Aorta
Treatment: surgical repair
Coarctation of the Aorta
Narrowing of the aorta at the site of the ductusarteriosus
Results in increased pressure to head and arms and
Decreased pressure to lower extremities
BP in arms will be higher than in legs
(upper extremity hypertension)
Surgery
Remove the narrowed portion of the aorta and an end to end anastomosis or graft replacement if narrowing is extensive.