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  1. 1. Nursing Care of Children Nursing 4000, Fall 2007
  2. 2. Module 1 Pediatric Basics
  3. 3. Objectives <ul><li>Upon completion of this learning unit, the student will be able to: </li></ul><ul><ul><li>List the most frequent causes of mortality and morbidity during infancy, childhood, and adolescence. </li></ul></ul><ul><ul><li>Describe at least two nursing interventions aimed at reducing mortality and morbidity in infancy, childhood, and adolescence. </li></ul></ul><ul><ul><li>Identify at least three factors that make children more vulnerable to illness than adults. </li></ul></ul>
  4. 4. <ul><li>Identify key differences between physical assessment findings in the pediatric versus the adult patient. </li></ul><ul><li>Describe at least one illness for each system that is frequently seen in the pediatric population. </li></ul><ul><li>Discuss methods of pain management for children based on their developmental stage. </li></ul><ul><li>Discuss the role of play in the development of children. </li></ul>
  5. 5. Pediatrics <ul><li>Defined as the care of infants age 4 weeks through 18-21 years. </li></ul><ul><li>Requires the nurse to: </li></ul><ul><ul><li>understand the differences between adults and kids at all stages of development </li></ul></ul><ul><ul><li>know developmental tasks of various stages </li></ul></ul><ul><ul><li>use different methods of assessment and providing care </li></ul></ul>
  6. 6. Typically divided into… <ul><li>Infancy: 4 weeks to 12 months </li></ul><ul><li>Toddlers: 13 - 36 months </li></ul><ul><li>Preschoolers: 3 – 5 years </li></ul><ul><li>School-Age: 6-11 years </li></ul><ul><ul><ul><li>Emergence of the ‘Tweens’ age 9-11 years </li></ul></ul></ul><ul><ul><ul><ul><li>This group of children receiving the attention of the media, game and movie producers. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Adolescents: 12+ years </li></ul></ul></ul></ul>
  7. 7. <ul><li>When working with pediatric patients, we discuss growth and development. It is important to note that these two terms refer to different processes. </li></ul><ul><ul><li>Growth refers to changes in the child’s body size. </li></ul></ul><ul><ul><li>Development refers to changes in the child’s psychomotor abilities. </li></ul></ul><ul><ul><ul><ul><ul><li>Growth and development should progress at a steady rate throughout childhood. </li></ul></ul></ul></ul></ul>
  8. 8. History <ul><li>Studies on the care of children began in the 1800s. </li></ul><ul><li>Early health care of children was primarily community based. </li></ul><ul><ul><li>Hospitals did not provide unique care for children until about the 1940s. </li></ul></ul><ul><ul><li>Pediatric health care dramatically improved in 1950-1960s. </li></ul></ul>
  9. 9. Current Emphasis in Pediatrics <ul><li>Now on family centered care. </li></ul><ul><ul><li>The pediatric ‘patient’ includes the child and their family members. </li></ul></ul><ul><li>It is vital that parents not be separated from their child when at all possible. </li></ul><ul><ul><li>All care planning must include the child and the parents. </li></ul></ul>
  10. 10. 3 Goals for all Pediatric Interactions <ul><ul><li>Minimize the separation of the child from the family. </li></ul></ul><ul><ul><li>Promote the child’s sense of control. </li></ul></ul><ul><ul><li>prevent pain and minimize fear. </li></ul></ul>
  11. 11. Morbidity and Mortality Special Considerations for the Pediatric Patient
  12. 12. Morbidity and Mortality <ul><li>These words are used to describe the impact of injuries and illnesses on a population group. </li></ul><ul><ul><li>These terms are used to describe the incidence of various illnesses and injuries in childhood. </li></ul></ul>
  13. 13. <ul><li>Morbidity refers to the prevalence of a specific illness in a population at a particular time. </li></ul><ul><ul><li>This number is expressed as cases per 1000. </li></ul></ul><ul><ul><li>Morbidity may also refer to the long term, disabling affects of a given condition. </li></ul></ul>
  14. 14. <ul><li>Mortality is the number of children who have died as a result of a particular illness or injury. </li></ul><ul><ul><li>This number is expressed as cases per 100,000 except infant mortality which is cases per 1000. </li></ul></ul>
  15. 15. Factors Contributing to Morbidity and Mortality in Children <ul><li>The most significant factor contributing to morbidity and mortality in children is the individual child’s physical growth and developmental level. </li></ul>
  16. 16. Factors Related to Morbidity and Mortality in Children <ul><li>Growth and Development </li></ul><ul><ul><li>The child’s cognitive abilities are related to chronological age. </li></ul></ul><ul><ul><ul><li>The younger the child, the more limited their cognitive abilities. </li></ul></ul></ul><ul><ul><li>Children have an inability to predict the consequences of their behaviors. </li></ul></ul><ul><ul><ul><li>This doesn’t really improve until late adolescence. </li></ul></ul></ul>
  17. 17. <ul><ul><li>The child’s gross and fine motor skills are continuously improving. </li></ul></ul><ul><ul><ul><li>What a child wasn’t able to do a short time ago, they now can accomplish. </li></ul></ul></ul><ul><ul><ul><li>Parents are often surprised and may say “she couldn’t roll over last week!” </li></ul></ul></ul><ul><ul><li>Children have a strong, natural curiosity that often places them in dangerous situations. </li></ul></ul>
  18. 18. <ul><li>Some physical characteristics related to their age group also make children more susceptible to illness and injury. </li></ul><ul><ul><li>Some body systems continue to mature throughout childhood. </li></ul></ul><ul><ul><ul><li>This is particularly true of the neurological, immune, integumentary, and respiratory systems. </li></ul></ul></ul>
  19. 19. <ul><li>Sociocultural factors also contribute to morbidity and mortality in children. </li></ul><ul><ul><li>Poverty increases a child’s risk for abuse and neglect. </li></ul></ul><ul><ul><ul><li>Environments of poverty typically experience more violence affecting children. </li></ul></ul></ul><ul><ul><li>Having difficulty in school can also increase morbidity and mortality for children. </li></ul></ul>
  20. 20. <ul><ul><li>Increased numbers of single-parent families puts children at increased risk for illness and injury. </li></ul></ul><ul><ul><ul><li>Having only one parent in the home typically means a child spends more time under or unsupervised. </li></ul></ul></ul>
  21. 21. <ul><ul><li>Immigrant families are at increased risk for illness and injury. </li></ul></ul><ul><ul><ul><li>Children may not have had routine healthcare including immunizations. </li></ul></ul></ul><ul><ul><ul><li>There may be a decreased ability to understand new risks associated with the environment. </li></ul></ul></ul><ul><ul><ul><li>This is particularly true in families in which the children are more ‘Americanized’ than the children. </li></ul></ul></ul>
  22. 22. Working with Children Special Considerations for the Nurse
  23. 23. Working with Children <ul><li>Environment should be non-threatening . </li></ul><ul><ul><li>Warm, appropriately lit, frightening equipment out of sight. </li></ul></ul><ul><li>Make use of toys, particularly the kid’s favorites. </li></ul><ul><ul><li>Do invasive procedures in a treatment room not the child’s bed. </li></ul></ul>
  24. 24. Working with Children <ul><li>Pediatric nurses not only have to understand the pathophysiology involved in a particular situation but also have to interpret the the developmental needs of the child as well as the needs of the other family members. </li></ul><ul><li>This is the part of pediatric nursing that can be particularly challenging. </li></ul>
  25. 25. Here’s some tips for successful pediatric interactions… <ul><li>The environment should be non-threatening. </li></ul><ul><ul><li>Warm, friendly, appropriately lit </li></ul></ul><ul><ul><li>Keep frightening equipment out of sight. </li></ul></ul><ul><li>Make use of toys, popular cartoon or movie characters. </li></ul><ul><ul><ul><li>Involve the child’s favorite toy in your nursing care. </li></ul></ul></ul>
  26. 26. <ul><li>Provide time to get acquainted. </li></ul><ul><ul><li>Introduce yourself and your role in simple terms. </li></ul></ul><ul><ul><li>Older children can relate to being a student. </li></ul></ul><ul><li>Do invasive procedures in a treatment room not the child’s bed. </li></ul><ul><ul><li>This gives the child a ‘safe’ place where bad things don’t happen. </li></ul></ul>
  27. 27. <ul><li>Provide privacy. </li></ul><ul><ul><li>Even young children want and need privacy though this need must be carefully balanced with safety. </li></ul></ul><ul><li>Observe for signs that the child is ready for your to touch her/him. </li></ul><ul><ul><li>This may include eye contact, body position. </li></ul></ul><ul><ul><li>The challenge is balancing the child’s readiness with your need to get certain things done. </li></ul></ul><ul><ul><li>Some negotiation may be necessary but only to a point. Use parents as your allies here! </li></ul></ul>
  28. 28. <ul><li>Use words that are appropriate to the child’s developmental level. </li></ul><ul><ul><li>Be sure that directions and requests are simple and clear. </li></ul></ul><ul><ul><li>Consult with parents to determine the presence of communication difficulties. </li></ul></ul>
  29. 29. <ul><li>Finally , and probably most importantly , never offer a choice where none is intended! </li></ul><ul><ul><li>We do this as a part of polite conversation. </li></ul></ul><ul><ul><li>Choices are important but be careful. </li></ul></ul><ul><ul><ul><li>“ Do you want to take your medication now?” is an unacceptable choice. </li></ul></ul></ul><ul><ul><ul><li>Saying “Do you want to take your medication with juice or water?” offers the child choices,both of which provide the outcome you’re seeking. </li></ul></ul></ul><ul><ul><li>Pay attention to the use of “okay?” at the end of your sentences. Children hear this as a choice which you may not intend it to be. </li></ul></ul>
  30. 30. <ul><li>Measuring vital signs is something you are all quite comfortable with. </li></ul><ul><li>Working with children can make this a bit more difficult. </li></ul><ul><li>Here’s some hints for success! </li></ul>Vital Signs
  31. 31. <ul><li>Start with the easiest things first. Count respiratory and heart rates while the child is quiet. </li></ul><ul><ul><li>Getting your temperature taken may be a frightening thing for a child. </li></ul></ul><ul><ul><li>Getting your blood pressure taken may be a painful thing for a child…that cuff may be awfully tight on a little arm! </li></ul></ul><ul><ul><ul><li>Describe this to the child as a hug around their arm or a ‘muscle-meter’ to see how strong they are! </li></ul></ul></ul>
  32. 32. Pediatric Care Priorities <ul><li>A irway </li></ul><ul><li>B reathing </li></ul><ul><li>C irculation </li></ul><ul><li>D isability </li></ul><ul><li>E nvironment </li></ul>
  33. 33. <ul><li>The ABCs will always provide you with a framework for setting care priorities. </li></ul><ul><ul><li>D/Disability refers to a child’s injury or other body area that may be impaired in some way. </li></ul></ul><ul><ul><ul><li>For example, disability may refer to a seizure, or vomiting depending on the specific situation. </li></ul></ul></ul><ul><ul><li>E/Environment refers to the child’s immediate physical environment and it’s safety for that child. </li></ul></ul>
  34. 34. <ul><li>Continue with your physical assessment. </li></ul><ul><ul><li>The concepts of physical assessment of adults apply here too; however, when working with children, these suggestions may help </li></ul></ul><ul><ul><li>Start with less invasive assessment (peripheral vascular, skin) and continue to more invasive (eyes, ears, nose). </li></ul></ul>
  35. 35. <ul><li>Focus your assessment as needed. </li></ul><ul><li>Make each step of the process a game…”I want to hear the sounds your tummy makes.” </li></ul><ul><ul><ul><li>How successful your physical assessment is depends on how well you’ve established trust with this child. </li></ul></ul></ul>
  36. 36. <ul><li>Review your MAPS and physical assessment skills from 310 or 320. </li></ul><ul><li>You will use your MAPS assessment with children. </li></ul><ul><ul><ul><ul><li>Think about ways in which you alter your MAPS approach when working with an infant, toddler, preschooler, school-age child, or teen. </li></ul></ul></ul></ul>
  37. 37. Pediatric Development
  38. 38. Working with Children of Different Ages <ul><li>The following slides are grouped first by developmental stage to highlight the unique needs of each group as well as the most common causes of morbidity and mortality. </li></ul>
  39. 39. Infancy <ul><li>Birth to 1 year </li></ul><ul><li>The period of most rapid growth and development in the lifespan. </li></ul><ul><li>Morbidity & mortality during infancy related to: </li></ul><ul><ul><li>congenital anomalies </li></ul></ul><ul><ul><li>low birth weights </li></ul></ul><ul><ul><li>SIDS </li></ul></ul><ul><ul><li>Accidents, closed head trauma and falls </li></ul></ul>
  40. 40. <ul><li>Infants are completely dependent on adults for their safety and well being. </li></ul><ul><li>Fatal accidents among infants during first year of life is significantly related to the cognitive level of the mother. </li></ul><ul><ul><li>Factoid : Fatal accidents double among infants of mothers who have not completed at least 8 years of school when compared to those mothers with high school educations. </li></ul></ul>
  41. 41. Toddlers <ul><li>13-36 months </li></ul><ul><li>Naturally curious and very active with increasing mobility. </li></ul><ul><li>Growth and development slows some. </li></ul><ul><li>Trying to establish independence from parents. </li></ul><ul><ul><li>Very egocentric </li></ul></ul>
  42. 42. <ul><li>Favorite words: No! Me! </li></ul><ul><li>Separation anxiety 18-24 months </li></ul><ul><ul><li>This is important to remember in the healthcare setting. </li></ul></ul><ul><ul><li>Not until age 2 that kids able to understand that parents exist even when they can’t see them. </li></ul></ul>
  43. 43. <ul><li>Morbidity & mortality for toddlers is related to: </li></ul><ul><ul><li>accidents: closed head trauma, motor vehicle accidents, drowning, burns, foreign bodies, playground injuries, the actions of siblings, homicides </li></ul></ul><ul><ul><li>congenital anomalies, cancer </li></ul></ul>
  44. 44. Preschoolers <ul><li>3-5 years </li></ul><ul><li>Has achieved some independence from parents with simple tasks. </li></ul><ul><ul><li>Toilet trained around 3 rd birthday. </li></ul></ul><ul><li>Growth begins to slow. </li></ul><ul><li>Can follow simple rules, developing a sense of right and wrong. </li></ul>
  45. 45. <ul><li>Gross motor skills well defined. A preschooler can walk, run, jump and climb efficiently. </li></ul><ul><li>Fine motor skills developing. Preschoolers enjoy coloring, drawing, manipulating smaller toys. </li></ul>
  46. 46. <ul><li>Can identify and verbalize simple feelings and is beginning to understand that their behavior affects others. </li></ul><ul><li>Favorite word: Why? </li></ul><ul><li>Morbidity & mortality risks same as toddlers. </li></ul>
  47. 47. School-Age <ul><li>6-11 years </li></ul><ul><li>Fine motor skills continue to develop. </li></ul><ul><li>Eager to please parents and other adults. </li></ul><ul><li>Friends becoming more important. </li></ul><ul><ul><li>Compares self to others. </li></ul></ul><ul><ul><li>Early peer pressure, particularly with regard to clothes, possessions. </li></ul></ul><ul><li>Learning rules, ‘winners’ and ‘losers.’ </li></ul>
  48. 48. <ul><li>They have the beginnings of problem solving skills, learning social skills and how to work in a group setting. </li></ul><ul><li>There are dramatic increases in cognitive skills during this period. Children want acknowledgement for that. </li></ul>
  49. 49. <ul><li>School age children can think about the future. </li></ul><ul><li>Mortality & morbidity related to: </li></ul><ul><ul><li>Accidents: similar causes but child may be more responsible as they typically have less adult supervision as they move through this age group. </li></ul></ul><ul><ul><li>Congenital illnesses and cancers </li></ul></ul><ul><li>Favorite words: ‘I know that.’ </li></ul>
  50. 50. Adolescence <ul><li>12+ years </li></ul><ul><li>Teenagers are really toddlers with money and car keys. </li></ul><ul><li>Central struggle is for independence </li></ul><ul><ul><li>Peers more important to them than family. </li></ul></ul><ul><ul><li>Significant peer pressure in most areas. </li></ul></ul><ul><li>Puberty begins. </li></ul><ul><li>Participating in group activities and fitting in is vital. </li></ul>
  51. 51. <ul><li>Experimentation and risk-taking is common during adolescence. </li></ul><ul><ul><li>They get their driver’s license. </li></ul></ul><ul><ul><li>Drinking, smoking, and drugs. </li></ul></ul><ul><ul><li>Participation in sports with more risk (skateboarding, rock climbing) </li></ul></ul><ul><ul><li>Sexual experimentation. </li></ul></ul><ul><li>Some teens begin to commit to personal values and morals. </li></ul>
  52. 52. <ul><li>Morbidity & mortality related to: </li></ul><ul><ul><li>accidents-motor vehicle accidents of all types, </li></ul></ul><ul><ul><ul><li>Drowning </li></ul></ul></ul><ul><ul><ul><li>sports injuries </li></ul></ul></ul><ul><ul><ul><li>head trauma </li></ul></ul></ul><ul><ul><ul><li>firearm injuries </li></ul></ul></ul><ul><ul><ul><li>farming and occupational injuries </li></ul></ul></ul><ul><ul><li>cancers </li></ul></ul><ul><ul><li>homicide </li></ul></ul><ul><ul><li>suicide </li></ul></ul>
  53. 53. Your next step… <ul><li>There are 7 additional PowerPoint presentations for you to watch. Each one is related to one of the functional patterns. You may view these in any order and at any time. </li></ul><ul><li>Good luck and enjoy! </li></ul>