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Introduction to Child Health Nursing

Introduction to Child Health Nursing. Who is your patient?. 6 year old female admitted to the hospital with a medical diagnosis of pneumonia Currently in 1 st grade Lives at home with Mother, Father, and 2 year old sibling Both parents work full time outside the home

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Introduction to Child Health Nursing

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  1. Introduction to Child Health Nursing

  2. Who is your patient? • 6 year old female admitted to the hospital with a medical diagnosis of pneumonia • Currently in 1st grade • Lives at home with Mother, Father, and 2 year old sibling • Both parents work full time outside the home • Grandparents live in near by town and assist with child care

  3. Answer:

  4. Pediatric Nursing • A parent-nurse partnership • Nurse’s goals are to promote • therapeutic relationship between parent and child • continued growth and development

  5. Growth and Development

  6. Definitions of Growth and Development • Growth • Increase in physical size of a whole or any of its parts • Increase in number and size of cells • Growth can be measured • Development • A continuous, orderly series of conditions • leads to activities and patterns of behavior

  7. Pace of Growth • A rapid pace from birth to 1 ½-2 years • A slower pace from 2 years to puberty • Expected 4-6 lb/year • A rapid pace from puberty to approximately 15 years • A sharp decline from 16 years to approximately 24 years when full adult size is reached

  8. Stages of Growth and Development • Neonate first 28 days of life • Infancy birth to 12 months • Toddler 1 to 3 years • Preschooler 4 to 5 years • School-ager 6 to 10 years • Prepubertal 11 to 12 years • Adolescent 13 to 18 + years

  9. Development Psychosocial & Intellectual

  10. Theorists Associated with Development • Piaget Stages of cognitive development • Erikson Stages of psychosocial development • Kohlberg Stages of moral development • Freud Stages of psychosexual development

  11. Psychosocial Development Trust vs. Mistrust (birth to 1 year) • Establishes a sense of trust when basic needs are • Nurses should provide consistent, loving care Autonomy vs. Shame & Doubt: (1-3 yrs) • Increasingly independent in many spheres of life • Nurses should allow for choices and self care

  12. Psychosocial Development Initiative vs. Guilt (3-6 yrs) • Learns to initiate play activities, imitate adult behavior • Nurses should encourage to explore environment with senses, promote imagination • Industry vs. Inferiority (6-12 yrs) • Learns self worth as workers & producers • Nurses should promote children to compete and cooperate

  13. Psychosocial Development Identity vs. Role Confusion (12-18 yrs) • Forms identity and establishment of autonomy from parents • Peers and society big influence • Nurses should encourage peer visitation, texting, phone calls

  14. Intellectual Development Sensorimotor (birth to 2) • Learns from movement and sensory input • Learns cause & effect Preoperational (2 to 7 years) • Increasing curiosity and explorative behavior • Thinking is concrete • Egocentrism is dominant

  15. Intellectual Development Concrete Operational (7 to 11 years) • Logical & coherent thought • Can now distinguish fact from fantasy Formal Operations (11 to adulthood) • Acquisition of abstract reasoning leading to • Analytical thinking • Problem solving • Planning for the future

  16. Factors Influencing Growth and Development • Genetics • Environment • Culture • Nutrition • Health status • Family • Parental attitudes • Child-rearing philosophies

  17. Play

  18. Purpose of Play • Sensorimotor development • Intellectual development • Socialization • Creativity • Self-awareness • Moral value • Therapeutic value

  19. Types of Play • Solitary • Parallel • Associative • Cooperative • Onlooker • Dramatic • Familiarization

  20. Communicating with Children

  21. Infancy • Responds to physical contact • Use a gentle voice • Sing-song quality • High pitched • Need to be held, cuddled

  22. Early Childhood < 7 yrs • Remember they are egocentric and interpret words literally • Tell them what “children” can do • Let them touch equipment • Nonverbal messages should be clear • Maintain eye level • Use quiet, calm voice • Be specific, use simple words, short sentences, be honest

  23. School Age • Wants to know why an object exists • How it works • Why it is being done to them • Concerned about body integrity

  24. Adolescents • Needs undivided attention • Listen, be open-minded • Avoid criticizing • Make expectations clear

  25. Physical & Developmental Assessment

  26. Physical Exam Guidelines • Non-threatening environment • Place frightening equipment out of sight • Provide privacy • Provide time for play (stuffed animals, dolls) • Observe for behaviors re: child’s readiness to cooperate • Begin with the least intrusive examination (observation)

  27. Age-specific approaches to exam • Infant: auscultate heart, lungs first (head to toe NOT always appropriate) • Toddler: inspect body area through play, introduce equipment slowly • Preschool: if cooperative: proceed head to toe, if not: same as toddler • School-age and Adolescents: head to toe, genitalia last, respect privacy

  28. Pediatric Physical Exam • Growth measurements • Height, weight, head circumference (<3 yrs) • Physiologic measurements (VS) • General appearance (hygiene, posture, behavior) • Body Systems (heart, lungs, abdomen are key areas)

  29. Denver Developmental Screening Test (DDST-II) • Evaluates development for children 0-6 in four areas • Personal-social • Fine-motor • Language • Gross motor • Child’s mood must be typical for results to be valid • Results may be altered if child is not feeling well, sedated

  30. Denver Developmental Screening Test (DDST-II) • Provides a clinical impression on child’s overall development • Not a predictor of future development, not an IQ test • Used for noting problems, monitoring, and to base a referral for additional developmental testing

  31. Nursing Interventions based on Developmental Age (not Chronological Age) • Infants (0-12m) • Use soft voice, sing-song, • Talk to and describe procedures as they are done • Toddlers (1-3 yr) • Separation anxiety peaks (nurse is a stranger) • Preparation for a procedure should begin immediately before the event

  32. Nursing Interventions based on Developmental Age (not Chronological Age) • Preschool (4-5 yr) • Explain procedures according to senses (what child will feel, see, hear) • Imagination is active...may see procedures as a consequence for misbehavior • School-age (6-10 yr) • Use books, pictures to explain procedures • Developmentally ready for detailed explanations • Organizing and collecting is an enjoyed activity • Peers become more important, parents still main influence

  33. Nursing Interventions based on Developmental Age (not Chronological Age) • Pre-Adolescents/Adolescents (11 & up) • Value privacy, group identification is important • May have an need for independence • Older adolescent can understand adult concepts • Can be prepared for a procedure up to a week in advance

  34. Discipline (Limit Setting) • Reinforcement of desired behaviors is most effective • Consequences for negative behaviors • Teaching parents how to discipline avoids problems related to incorrect use • Appropriate limit setting • Consistency • Consequences should be told in advance • Include truthful explanation of why behavior is unacceptable • Physical punishment is the least effective

  35. Limit Setting and the Toddler • Discipline must be consistent, immediate, realistic, age-appropriate, and related to the incident • Clearly explain limits and give time for toddlers to respond • Avoid arguments and extensive explanations • Avoid withdrawing love as punishment • Separate toddler from behavior • Praise toddler for good behavior

  36. Nutrition

  37. Infancy 0-6 months • Breastmilk most desirable • Fe fortified formula alternative • No whole milk until 1 year old • Altered ability to be digested • Increased risk of contamination • Lack of components needed for appropriate growth

  38. Infancy 6-12 months • Breast milk or formula remains the primary source of nutrition • May begin addition of solids b/c: • GI tract is mature to handle complex nutrients • GI tract is less sensitive to allergenic foods • Extrusion reflex has disappeared • Swallowing is more coordinated • Head control is well developed, voluntary grasping begins

  39. Infancy 6-12 months • 4- 6 months infant cereal mixed with formula or Breast milk (Rice, then oatmeal, barley) • 6 months can introduce crackers as a teething food. • 6 months fruit juice to substitute for one milk feeding • Baby food (pureed fruits and vegetables) • Introduce one food at a time at 4-7 day intervals • No strawberries, eggs, peanuts until after 12 months of age

  40. Infancy 0-6 months No solids before 4-6 months of age b/c: • Solids are not compatible with GI tract • Exposure to food antigens that may produce a food-protein allergy • Extrusion reflex still present (pushes food out of mouth)

  41. Infancy 6-12 months • By 8-9 months junior foods & finger foods • By 1-year well-cooked table foods

  42. Toddlerhood • From 12-18 months rate of growth slows • At 18 months decreased nutritional need, appetite declines, picky eaters • At 18 months may be able to adeptly use spoon, prefer fingers • Do not force food

  43. Toddlerhood • Mealtime should be pleasant • What is eaten is more important than how much is eaten • General serving size is ¼ to 1/3 of the adult portion • May have a hard time sitting through an entire meal

  44. Preschool • Needs are similar to toddler • Average daily intake: 1800 calories • More agreeable to try new foods • Ready to socialize during meals • General serving size is ½ of an adult’s portion

  45. School Age Years • Food likes and dislikes are established • Important for parents to choose foods that promotes growth • Children eat away from home • Important to teach Food Pyramid Guide for nutrition instruction • Encourage the child to make good choices

  46. Adolescence • Caloric and protein requirements are higher than almost any time in life • Eating habits easily influenced by peers • Fad diets, high caloric foods low in nutritional value popular

  47. Care of the Hospitalized Child

  48. “Atraumatic Care” Interventions that eliminate or minimize psychological and physical distress experienced by children and their families in the health care system

  49. Stressors of Hospitalization • Separation Anxiety • Loss of Control • Bodily Injury & Pain

  50. Stages of Separation Anxiety (Universal fear of toddler) • Protest • loud, demanding cries, rejects comfort measures • Despair • lies on abdomen, flat facial expression, weight loss, insomnia, loss of developmental skills • Denial or Detachment • silent expressionless child, deterioration of developmental milestones, may have trouble forming close relationships

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