Chapter 71 Fundamentals of Pediatric Nursing

1. Chapter 71 Fundamentals of Pediatric Nursing

2. Pediatric Nursing • Pediatrics • The area of care that deals with children and adolescents • Pediatric nursing • Nursing care of children—well, ill, physically challenged, and mentally challenged children • Healthcare delivery settings • Home, school, community healthcare facility, day-surgery center, physician’s office, summer camp, residential setting, or hospital

3. Health Maintenance • Goal of pediatric nursing • Prevention of disease, disorders, and disability • Well-baby and well-child visits • Most effective method of promoting the growth and development of healthy children

4. Physical Examination • Primary caregiver • Head-to-toe checklist • Body system approach • Exception to the established normal trend is noted and described in detail on the child’s chart. • Denver II developmental test • OFC- to 3 years

5. Immunization • Immunization • Provides temporary or permanent protection against certain diseases • Begins shortly after the child’s birth and should be continued on a regular schedule

6. Specific Care for Age Groups • Infant care • Toddler care • Preschooler care • School-age child care • Adolescent care • A nurse must be sure to keep in mind the age of the client and the expected behaviors for that age group.

7. The Hospital Experience • Age-related concerns • Family-centered care • Preparation • Stages of separation anxiety ( 1-5) • Protest • Despair • Denial • Transcultural Considerations

8. Reducing Anxiety in Children • General guidelines • Explain procedure and results in terms that the child can understand. • Never tell the child something will not hurt if it might. • Use the examination or treatment room. • Give an analgesic before a painful procedure, if possible. • Check the child’s condition frequently. • Document any unusual reactions.

9. Question Is the following statement true or false? It is important to ensure that the sick child does not cry.

10. Answer False Crying is a normal response to pain and fear. A nurse should never tell a child not to cry because it may shame or embarrass him or her.

11. Basic Pediatric Care • Admitting children to the healthcare facility • Be alert to the needs of both the family caregivers and the child. • Assisting with the physical examination • Show the child the equipment and let him or her handle it to promote a sense of control. • Use restraints only as a last resort.

12. Data Collection on Admission • Vital signs • Respiration • Take respirations before taking other vital signs. • Pulse • Temperature • Height and weight

13. Question Is the following statement true or false? In children older than 1 year, thigh pressure is approximately 20 mm Hg higher than arm pressure.

14. Answer True In children older than 1 year, thigh pressure is approximately 20 mm Hg higherthan arm pressure. If taking blood pressure at an infant’s thigh, record it as “thigh pressure.” Radial blood pressure is 10 mm Hg lowerthan that of the brachial artery. Note use of the radial artery on the record.

15. Data Collection on Admission (cont’d) • Head circumference • Occipital–frontal circumference (OFC) reflects intracranial volume pressure. • Chest circumference • Measure and compare the child’s chest circumference with the OFC. • Other measurements • Abdominal circumference, extremity length, and extremity circumference

16. Question Is the following statement true or false? The nurse should always use a clothtape measure when obtaining measurements.

17. Answer False A cloth tape measure may stretch and alter measurement findings. A disposable paper tape must be used, it also prevents cross-contamination.

18. Daily Collection and Documentation • Observe and document • Normal behavior and reactions, abnormal symptoms, unfavorable signs and nonverbal signals • Diet • General appearance • Family caregivers’ comments • Physical signs • Visitors

19. Discharging Children • Children are taken home by their family caregivers who are responsible for follow-up care. • Teach family caregivers follow-up care and document this teaching. • All states require placement of children in a car seat or restraining safety device.

20. Pediatric Safety and Infection Control • Nurses are legally responsible for the safety of children in their care. • Safety devices • Jacket device • Clove hitch restraint • Mummy device • Papoose board • Follow Standard and Transmission-Based Precautions as appropriate.

21. Nutrient Intake • Record all food and fluid consumed by the child. • Always supervise children who are eating. • Fluids • Gavage feeding • Parenteral fluid administration

22. Protective Devices for IV Sites

23. Protective Devices for IV Sites (cont’d)

24. Other Pediatric Procedures • Elimination • Collecting a urine specimen • Catheterizing the child • Administering enemas • Using suppositories • Treating diarrhea • Daily cleanliness • Infant bath, oral hygiene

25. Question Is the following statement true or false? A tap-water enema is the best option for a small child.

26. Answer False A tap-water enema is particularly dangerous for small children because it can cause fluid and electrolyte imbalances and dehydration.

27. Glycerin suppositories • Uses: This product is used to relieve occasional constipation. Glycerin belongs to a class of drugs known as hyperosmotic laxatives. It works by drawing water into the intestines. This effect usually results in a bowel movement within 15 ... Glycerin suppositories are for rectal use only. • Do not use glycerin suppositories for longer than 1 week without checking with your doctor. • Do not take glycerin suppositories without talking to your doctor if you have had a sudden change in bowel movements lasting longer than 2 weeks or you are experiencing nausea, vomiting, or stomach pain.

28. Other Pediatric Procedures (cont’d) • Oxygen • Isolette or incubator • Nasal cannula • Mask • Mist Tent • Hood • Intermittent positive pressure breathing • Resuscitation • Diversion and recreation

29. Question Is the following statement true or false? It is especially important to use an infant seat for a child with respiratory distress.

30. Answer False An infant seat should not be used for a child with respiratory distress. Because of the lack of head control, the infant’s head tends to fall forward, thereby closing off the airway. In addition, the infant tends to “scrunch” down in an infant seat. In this position, the abdominal organs push up on the diaphragm, preventing full lung expansion (excursion). The head of the crib is elevated instead.

31. Advanced Pediatric Care and Procedures • Diagnostic procedures • Venipuncture • Heel stick blood samples • Lumbar puncture • Therapeutic procedures • Managing a fever • Medication administration

32. The Child Having Surgery • Note any untoward signs; normal ranges of vital signs differ with age. • Children need analgesia appropriate for their body size after surgery. • The rapid rate of metabolism and growth in children increases the healing ability of their tissues. • Children become dehydrated very quickly. • Electrolytes are not as stable in children as they are in adults. • The high metabolic rate dictates a high caloric intake.

33. The Child Having Surgery (cont’d) • Preoperative care • Preparation • Nursing observations • Immediate measures before surgery • Postoperative care • Reorient the child to the room • Nursing observations • Evaluate pain or discomfort • Document thoroughly

34. Skill • Collecting a urine specimen • Frog leg position • Foreskin in normal position • Check bag 15-30 min/ offer fluids • Take specimen to lab within 30 min

35. End of Presentation