Module1.Pediatric.Basics

Nursing Care of Children Nursing 4000, Fall 2007

Module 1 Pediatric Basics

Objectives
Upon completion of this learning unit, the student will be able to:
List the most frequent causes of mortality and morbidity during infancy, childhood, and adolescence.
Describe at least two nursing interventions aimed at reducing mortality and morbidity in infancy, childhood, and adolescence.
Identify at least three factors that make children more vulnerable to illness than adults.

Identify key differences between physical assessment findings in the pediatric versus the adult patient.
Describe at least one illness for each system that is frequently seen in the pediatric population.
Discuss methods of pain management for children based on their developmental stage.
Discuss the role of play in the development of children.

Pediatrics
Defined as the care of infants age 4 weeks through 18-21 years.
Requires the nurse to:
understand the differences between adults and kids at all stages of development
know developmental tasks of various stages
use different methods of assessment and providing care

Typically divided into…
Infancy: 4 weeks to 12 months
Toddlers: 13 - 36 months
Preschoolers: 3 – 5 years
School-Age: 6-11 years
Emergence of the ‘Tweens’ age 9-11 years
This group of children receiving the attention of the media, game and movie producers.
Adolescents: 12+ years

When working with pediatric patients, we discuss growth and development. It is important to note that these two terms refer to different processes.
Growth refers to changes in the child’s body size.
Development refers to changes in the child’s psychomotor abilities.
Growth and development should progress at a steady rate throughout childhood.

History
Studies on the care of children began in the 1800s.
Early health care of children was primarily community based.
Hospitals did not provide unique care for children until about the 1940s.
Pediatric health care dramatically improved in 1950-1960s.

Current Emphasis in Pediatrics
Now on family centered care.
The pediatric ‘patient’ includes the child and their family members.
It is vital that parents not be separated from their child when at all possible.
All care planning must include the child and the parents.

3 Goals for all Pediatric Interactions
Minimize the separation of the child from the family.
Promote the child’s sense of control.
prevent pain and minimize fear.

Morbidity and Mortality Special Considerations for the Pediatric Patient

Morbidity and Mortality
These words are used to describe the impact of injuries and illnesses on a population group.
These terms are used to describe the incidence of various illnesses and injuries in childhood.

Morbidity refers to the prevalence of a specific illness in a population at a particular time.
This number is expressed as cases per 1000.
Morbidity may also refer to the long term, disabling affects of a given condition.

Mortality is the number of children who have died as a result of a particular illness or injury.
This number is expressed as cases per 100,000 except infant mortality which is cases per 1000.

Factors Contributing to Morbidity and Mortality in Children
The most significant factor contributing to morbidity and mortality in children is the individual child’s physical growth and developmental level.

Factors Related to Morbidity and Mortality in Children
Growth and Development
The child’s cognitive abilities are related to chronological age.
The younger the child, the more limited their cognitive abilities.
Children have an inability to predict the consequences of their behaviors.
This doesn’t really improve until late adolescence.

The child’s gross and fine motor skills are continuously improving.
What a child wasn’t able to do a short time ago, they now can accomplish.
Parents are often surprised and may say “she couldn’t roll over last week!”
Children have a strong, natural curiosity that often places them in dangerous situations.

Some physical characteristics related to their age group also make children more susceptible to illness and injury.
Some body systems continue to mature throughout childhood.
This is particularly true of the neurological, immune, integumentary, and respiratory systems.

Sociocultural factors also contribute to morbidity and mortality in children.
Poverty increases a child’s risk for abuse and neglect.
Environments of poverty typically experience more violence affecting children.
Having difficulty in school can also increase morbidity and mortality for children.

Increased numbers of single-parent families puts children at increased risk for illness and injury.
Having only one parent in the home typically means a child spends more time under or unsupervised.

Immigrant families are at increased risk for illness and injury.
Children may not have had routine healthcare including immunizations.
There may be a decreased ability to understand new risks associated with the environment.
This is particularly true in families in which the children are more ‘Americanized’ than the children.

Working with Children Special Considerations for the Nurse

Working with Children
Environment should be non-threatening .
Warm, appropriately lit, frightening equipment out of sight.
Make use of toys, particularly the kid’s favorites.
Do invasive procedures in a treatment room not the child’s bed.

Working with Children
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.
This is the part of pediatric nursing that can be particularly challenging.

Here’s some tips for successful pediatric interactions…
The environment should be non-threatening.
Warm, friendly, appropriately lit
Keep frightening equipment out of sight.
Make use of toys, popular cartoon or movie characters.
Involve the child’s favorite toy in your nursing care.

Provide time to get acquainted.
Introduce yourself and your role in simple terms.
Older children can relate to being a student.
Do invasive procedures in a treatment room not the child’s bed.
This gives the child a ‘safe’ place where bad things don’t happen.

Provide privacy.
Even young children want and need privacy though this need must be carefully balanced with safety.
Observe for signs that the child is ready for your to touch her/him.
This may include eye contact, body position.
The challenge is balancing the child’s readiness with your need to get certain things done.
Some negotiation may be necessary but only to a point. Use parents as your allies here!

Use words that are appropriate to the child’s developmental level.
Be sure that directions and requests are simple and clear.
Consult with parents to determine the presence of communication difficulties.

Finally , and probably most importantly , never offer a choice where none is intended!
We do this as a part of polite conversation.
Choices are important but be careful.
“ Do you want to take your medication now?” is an unacceptable choice.
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.
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.

Measuring vital signs is something you are all quite comfortable with.
Working with children can make this a bit more difficult.
Here’s some hints for success!
Vital Signs

Start with the easiest things first. Count respiratory and heart rates while the child is quiet.
Getting your temperature taken may be a frightening thing for a child.
Getting your blood pressure taken may be a painful thing for a child…that cuff may be awfully tight on a little arm!
Describe this to the child as a hug around their arm or a ‘muscle-meter’ to see how strong they are!

Pediatric Care Priorities
A irway
B reathing
C irculation
D isability
E nvironment

The ABCs will always provide you with a framework for setting care priorities.
D/Disability refers to a child’s injury or other body area that may be impaired in some way.
For example, disability may refer to a seizure, or vomiting depending on the specific situation.
E/Environment refers to the child’s immediate physical environment and it’s safety for that child.

Continue with your physical assessment.
The concepts of physical assessment of adults apply here too; however, when working with children, these suggestions may help
Start with less invasive assessment (peripheral vascular, skin) and continue to more invasive (eyes, ears, nose).

Focus your assessment as needed.
Make each step of the process a game…”I want to hear the sounds your tummy makes.”
How successful your physical assessment is depends on how well you’ve established trust with this child.

Review your MAPS and physical assessment skills from 310 or 320.
You will use your MAPS assessment with children.
Think about ways in which you alter your MAPS approach when working with an infant, toddler, preschooler, school-age child, or teen.

Pediatric Development

Working with Children of Different Ages
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.

Infancy
Birth to 1 year
The period of most rapid growth and development in the lifespan.
Morbidity & mortality during infancy related to:
congenital anomalies
low birth weights
SIDS
Accidents, closed head trauma and falls

Infants are completely dependent on adults for their safety and well being.
Fatal accidents among infants during first year of life is significantly related to the cognitive level of the mother.
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.

Toddlers
13-36 months
Naturally curious and very active with increasing mobility.
Growth and development slows some.
Trying to establish independence from parents.
Very egocentric

Favorite words: No! Me!
Separation anxiety 18-24 months
This is important to remember in the healthcare setting.
Not until age 2 that kids able to understand that parents exist even when they can’t see them.

Morbidity & mortality for toddlers is related to:
accidents: closed head trauma, motor vehicle accidents, drowning, burns, foreign bodies, playground injuries, the actions of siblings, homicides
congenital anomalies, cancer

Preschoolers
3-5 years
Has achieved some independence from parents with simple tasks.
Toilet trained around 3 rd birthday.
Growth begins to slow.
Can follow simple rules, developing a sense of right and wrong.

Gross motor skills well defined. A preschooler can walk, run, jump and climb efficiently.
Fine motor skills developing. Preschoolers enjoy coloring, drawing, manipulating smaller toys.

Can identify and verbalize simple feelings and is beginning to understand that their behavior affects others.
Favorite word: Why?
Morbidity & mortality risks same as toddlers.

School-Age
6-11 years
Fine motor skills continue to develop.
Eager to please parents and other adults.
Friends becoming more important.
Compares self to others.
Early peer pressure, particularly with regard to clothes, possessions.
Learning rules, ‘winners’ and ‘losers.’

They have the beginnings of problem solving skills, learning social skills and how to work in a group setting.
There are dramatic increases in cognitive skills during this period. Children want acknowledgement for that.

School age children can think about the future.
Mortality & morbidity related to:
Accidents: similar causes but child may be more responsible as they typically have less adult supervision as they move through this age group.
Congenital illnesses and cancers
Favorite words: ‘I know that.’

Adolescence
12+ years
Teenagers are really toddlers with money and car keys.
Central struggle is for independence
Peers more important to them than family.
Significant peer pressure in most areas.
Puberty begins.
Participating in group activities and fitting in is vital.

Experimentation and risk-taking is common during adolescence.
They get their driver’s license.
Drinking, smoking, and drugs.
Participation in sports with more risk (skateboarding, rock climbing)
Sexual experimentation.
Some teens begin to commit to personal values and morals.

Morbidity & mortality related to:
accidents-motor vehicle accidents of all types,
Drowning
sports injuries
head trauma
firearm injuries
farming and occupational injuries
cancers
homicide
suicide

Your next step…
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.
Good luck and enjoy!

http://guidetonursingschool.blogspot.com	94
http://www.webicina.com	70
http://www.slideshare.net	10
http://translate.googleusercontent.com	4
http://blackboard.atc.edu	1
https://bbdev.vcu.edu	1
https://stuiterproxy.kuleuven.be	1

Module1.Pediatric.Basics

by mackenburg on Oct 01, 2007

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