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Introduction to Pediatric Nursing

Introduction to Pediatric Nursing. Who is the “patient” ?. 6 year old female admitted to the hospital with a 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 Pediatric Nursing

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  1. Introduction to Pediatric Nursing

  2. Who is the “patient” ? • 6 year old female admitted to the hospital with a 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 is: • A parent-nurse partnership • Nurse’s goal is to promote a therapeutic relationship between parent and child • Accomplished by family-centered care

  5. Definitions of Growth and Development • Growth • Increase in physical size of a whole or any of its parts, or an increase in number and size of cells: Growth can be measured • Development • A continuous, orderly series of conditions that leads to activities, new motives for activities, and patterns of behavior

  6. Stages of Growth and Development Neonate: first 28 days of life Infancy: birth to 1 year Toddler: 1 to 3 years Preschooler: 3 to 6 years School-ager: 6 to 10 years Prepubertal: 10 to 13 years Adolescent: 13 to 18 + years

  7. Biologic Determinants of Growth in Infancy • Height: stable measurement of growth (double birth height at 2 years) • Weight: birth weight triples by end of 1st year

  8. Pace of Growth • A rapid pace from birth to 1 ½-2 years • A slower pace from 2 years to puberty • 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

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

  10. Psychosocial, Intellectual, and Moral Development

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

  12. Psychosocial Development (Erikson) Trust vs. Mistrust: (birth to 1 year) • Provide consistent, loving care Autonomy vs. Shame & Doubt: (1-3 yrs) • Allow for self care, imitation Initiative vs. Guilt: (3-6 yrs) • Encourage to explore environment with senses, promote imagination

  13. Psychosocial Development (Erikson) • Industry vs. Inferiority: (6-12 yrs) • Want to be workers & producers, like to compete and cooperate Identity vs. Role Confusion: (12-18 yrs) • Peers, society big influence • Forms identity and establishment of autonomy

  14. Intellectual Development (Piaget) • Sensorimotor (birth to 2) learn cause & effect • Preoperational (2 to 7) Thinking is concrete “egocentrism”

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

  16. Important Tasks of Toddlerhood • Recognition of self as a separate person, with own will • Control of impulses and acquisition of socially acceptable ways to communicate wants and needs • Control of elimination • Toleration of separation from the parent

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

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

  19. Communicating with children

  20. Infancy • Respond to physical contact • Gentle voice • Sing-song quality • High pitched • Need to be held, cuddled

  21. Early Childhood < 5 yrs egocentric, interpret words literally • tell them what “they” 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

  22. School Age • want to know why an object exists • how it works • why it is being done to them • concerned about body integrity

  23. Adolescents • give undivided attention • listen, be open-minded • avoid criticizing • make expectations clear

  24. Physical & Developmental Assessment

  25. 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

  26. 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: head to toe, genitalia last, respect privacy • Adolescent: same as school-age

  27. Pediatric Physical Exam: Key Points • Growth measurements • Physiologic measurements • General appearance (hygiene, posture, behavior) • Lungs/ Heart • Skin (color, texture, moisture, turgor) • Lymph nodes (tender, large, warm may indicate infection) • Eyes, ears, nose, throat • Abdomen/Genitalia

  28. 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)

  29. 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

  30. Nursing Interventions based on Developmental Level • Infants (0-12m) Use soft voice, sing-song, talk to and describe procedures as they are done • Toddlers (1-2 yr) Separation anxiety peaks, seeing the nurse as a stranger increased anxiety: establish trust first Preparation for a procedure should begin immediately before the event • Preschool (3-5 yr) Explain procedures according to senses (what child will feel, see, hear) Imagination is active...may see procedures as a consequence for misbehavior

  31. Nursing Interventions based on Developmental Level • School-age (6-11 yr) Use books, pictures to explain procedures, developmentally ready for detailed explanations. Organizing and collecting is an enjoyed activity, peers become more important • Adolescents (12 & up) Value privacy, group identification is important, may have an need for independence. Can understand adult concepts and can be prepared for a procedure up to a week in advance

  32. 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

  33. Guidelines for Discipline 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

  34. Nutrition

  35. Infancy (0-6 months) • Breastmilk most desirable • Fe fortified formula alternative. No whole milk until 1 yoa b/c: • Altered ability to be digested • Increased risk of contamination • Lack of components needed for appropriate growth

  36. No solids before 4-6 mos b/c: • 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)

  37. Infancy (6-12 months) • Breastmilk or formula remains the primary source of nutrition. Addition of solids b/c: • GI tract is mature to handle complex nutrients & is less sensitive to allergenic foods. • Extrusion reflex has disappeared. • Swallowing is more coordinated. • Head control is well developed, voluntary grasping begins.

  38. Infancy (6-12 months) • 4- 6 mos infant cereal mixed with formula or Breast milk • 6 mos can introduce crackers as a teething food. • 6 mos fruit juice to sub for one milk feeding • Baby food (fruits first then vegs) • *** introduce one at a time at 4-7 day intervals

  39. Infancy (6-12 months) • By 8-9 months junior foods & finger foods. • By 1-year well-cooked table foods are served.

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

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

  42. Preschool Years • Needs are similar to toddler. • Average daily intake: 1800 calories. • By age 5 they are more agreeable to try new foods; are ready to socialize during meals. • ½ of an adult’s portion

  43. School-age Years • Likes & dislikes are established. • Important for parents to choose foods that promotes growth. • Eat away from home. • Important to teach Food Pyramid Guide for nutrition instruction. • Encourage the child to make good choices.

  44. Adolescence • Caloric & 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.

  45. Dietary Guidelines for Children older than 2 Years • Aim for fitness ̶Healthy weight ̶Daily physical activity • Build a healthy base ̶Use pyramid to guide food choices ̶Eat a variety of grains, fruits, and vegetables ̶Keep food safe to eat • Choose sensibly ̶Foods low in fat, cholesterol, sugar, and salt

  46. Care of the Hospitalized Child

  47. “Atraumatic Care” use of interventions that eliminate or minimize psychological and physical distress that is experienced by children and their families in the health care system

  48. Promotion of normal development • Infants: oral-motor development • Toddlers: encourage mobility & exploration, language development • Preschoolers: assistance with self-care • School-aged: socialization, provision of games & tasks for mastery • Adolescents: increased independence in managing own care

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

  50. 1. Separation Anxiety(Universal fear of toddler) • Protest: loud, demanding cries, rejects comfort measures • Despair: wailing cry, rejects parents, 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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