PEDIATRICSUNIT 1Rev. 2012

HISTORY OF CHILD CARE

Colonial AmericaIndustrialized AmericaDr. 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 skillsConveys respect and honesty

CommunicationEnjoys working with childrenTeaches parents & childrenGood role model

SPECIAL NEEDS CHILDREN

Congenital anomaliesMalignanciesAbnormalities35% of hospitalized children

FAMILY CENTERED CARE

24 hour visitationParental access to health information

Parents involved in decisions

GROWTH AND DEVELOPMENT

Are complex processesOccur in stagesKnowing normal milestones easier to identify delays

Cognitive ImpairmentAnticipatory 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 childRect, Axillary & oral acceptable**Think critically as to why temp is needed**

HEART RATE & RESPIRATIONS

Resp.- always do first1 full minute< 6 yrs – abd breathersNeonate – nasal breathers

Apical rate up to 5 yrs, for 1 full minute @ apex of heart

BLOOD PRESSURE

Sites pg. 951 Fig. 30-3Correct cuff size- covers 2/3 of upper arm

Explain each stepPerform prior to anxiety provoking procedures

HEAD TO TOE ASSESSMENT

Head:Circ.Fontanel'sEyes, nose, mouth

Lungs Box 30-8, pg. 953

ChestBackAbd.

ExtremitiesRenal FunctionAnusGenitalia

FACTORS INFLUENCING G&D

Nutrition ^ Most important influence on bone & muscle growth

0-6 mo Breast/bottle6-12 monow add food> 12 mo cows 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 30-7Expect regression anger andrejection

SURGERY

Age appropriate pre op teaching

Allow to verbalize fearsPre-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 feedingPrevent chillingOnly water on face

FEEDING/BURPING

Breast or BottleBurping positionsSolids introduced @ 4-6 moWeaningBedtime bottle removed last

SAFETY DEVICES

Restraints:Used as a last resortRemove Q2 hours ot exercise body part

URINE COLLECTION

Urine collection bagCath specimenVoided specimen

VENI & LUMBAR PUNCTURE

Venipuncture Position securely

Lumbar puncture Side lying

OXYGEN THERAPY

HoodMist tentNasal canulaMask

SUCTIONING

No more than 5 seconds

I&O

Weigh all diapers

MEDICATION ADMINISTRATION

6 rightsCalculate safe doseP.O. is preferred routeChildren more susceptible to toxic effects of drugs than adults

Use a syringe to measure exact dose

Aim toward side of mouth

INJECTIONS

Vastus lateralis 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 30-11Less reliableSuppository w/ jellyEnema procedure same as adult

SAFETY

Prevent accidentsSee Table 30-12 for Developmental Safety Hazards & Prevention

CARING FOR PEDIATRIC PATIENT WITH A CARDIOVASCULAR DISORDER

Congenital Heart Diseases

ETIOLOGY

EnvironmentalGenetic

CONGENITAL HEART DISEASE

Present at birthMajority are treated with surgery

5-10% of term neonates

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

http://depts.washington.edu/physdx/heart/demo.html

#1 INCREASED PULMONARY BLOOD FLOW DEFECTS PDA Patent Ductus Arteriosis

ASD Atrial Septal Defect

VSD Ventricular Septal Defect

PDA

Patent Ductus ArteriosisBlood shunts from aorta to pulmonary artery

“Machine like” murmur

PEDIATRICSUNIT 2

ASD

Atrial Septal DefectOpening in atrial septum

Murmur

ATR

IAL S

EP

TA

L D

EFEC

T

Blood flows from high pressured left atrium to lower pressured right atrium.

VSD

Ventricular Septal DefectMurmur50% close spontaneouslyRemainder require open heart surgery

Dacron patch or close w/ sutures

TH

E M

OS

T C

OM

MO

N C

ON

GEN

ITA

L H

EA

RT

DEFEC

T

#2. DECREASED PULM. BLOOD FLOW DEFECTS

1) Pulmonary Stenosis

2) Pulmonary Atresia

3) Tetrology of Fallot (most common)

TETRALOGY OF FALLOTCONSISTS OF THE FOLLOWING 4 DEFECTS:

Pulmonary artery stenosis

Ventruculoseptal defectR. ventricular hypertrophy

Overriding aorta

Note: The heart works harder because of the pulmonary artery stenosis

SIGNS & SYMPTOMS

Profound cyanosisTet spellsClubbing of nailbedsMurmurdyspnea

SquattingPoor growthsyncope

SURGICAL TREATMENT

Blalock-Taussig Shunt (temporary)

Closure of VSDPulmonic ValvotomyRepair of overriding aorta

#3 MIXED FLOW DEFECT

TGV – transposition of great vessels

S/S: severe cyanosisTreatment surgical repair a) Palliative b) Complete

#4 OBSTRUCTIVE FLOW DEFECTS

Pulmonary StenosisAortic StenosisCoartication of the AortaTreatment: surgical repair

COARCTATION OF THE AORTA

Narrowing of the aorta at the site of the ductus arteriosus

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.