Fundamentals of Pediatric Nursing (Pediatric Nursing) Part 1

Learning Objectives

1.??? Explain the concepts of prevention and health maintenance as they pertain to children.

2.??? State six immunizations provided to children.

Identify three nursing considerations related to immunizations.

3.??? Discuss five specific nursing observations needed for the care of an infant, toddler, preschooler, school-age child, and adolescent.

4.??? Provide three topics of therapeutic communications with a toddler, preschool-age child, and school-age child.

5.??? Define and differentiate among the stages of separation anxiety.

6.??? State the normal limits of pulse, respiration, temperature, blood pressure, height, and weight for infants and children of different ages.

7.??? Identify five concerns related to pediatric safety during a hospital admission.

8.??? List four types of pediatric restraints. State three nursing concerns regarding pediatric restraints.

9.?? In the skills laboratory, demonstrate the application of a urine collection device on an infant. State three nursing concerns for this procedure.

10.??? Identify three nursing concerns for bathing an infant.

11.??? Define and differentiate among the following: oxygen mask, mist tent, and hood. State two nursing concerns for each.

12.??? Identify nursing considerations for each of the following: venipuncture, heel stick, and lumbar puncture. State three nursing concerns for each procedure.

13.??? Differentiate and discuss the treatments for fever lower than 102?F (38.8?C) and higher than 102?F (38.8?C). State three nursing concerns for each.

14.??? State three nursing concerns when administering PO and IM medications to an infant, a toddler, a preschool-age child, and a school-age child.

15.??? State eight nursing considerations for a child before and following a surgical procedure.

16.??? Identify five concepts that need to be discussed with the caregivers of a child who is scheduled to undergo a surgical procedure.

IMPORTANT TERMINOLOGY
circumoral cyanosis health supervision health maintenance immunization	pediatrician pediatrics

Acronyms
DDST	MMR	PICC
H flu	NPO	TPN
IPPB	OFC	URI

Pediatrics is the area of care that deals with children and adolescents. Nursing care of children is called pediatric nursing. Generally, the provider in this field is a pediatrician, although family practitioners, nurse practitioners (NP), and physician assistants (PA) also provide pediatric care. Changes in healthcare delivery have greatly decreased the number of children cared for in hospitals. The primary emphasis in current pediatric healthcare is on health maintenance and promotion, including disease prevention.

As a nurse, you will encounter children in various healthcare settings. You may care for well, ill, physically challenged, and mentally challenged children. Possible settings for healthcare delivery include the home, school, community healthcare facility, day-surgery center, physician?s office, summer camp, residential setting, or hospital. The fundamentals of pediatric nursing discussed in this topic apply regardless of where you provide care. Note that the nursing procedures in this topic can be used or adapted for children of all ages. Many skills in Unit 8 also are applicable to and adaptable for pediatric nursing.

NCLEX Alert Questions on examinations typically include clinical scenarios that mention "ages and stages." Always consider a child?s developmental stage when adopting nursing procedures.

HEALTH MAINTENANCE

Prevention of disease, disorders, and disability is the goal of pediatric nursing. The concept of well-baby and well-child visits for health maintenance or health supervision has proved to be the most effective method of promoting the growth and development of healthy children. Caregivers must be aware of the importance of routine, scheduled trips to a primary provider or community health facility. Preventive healthcare monitors growth rates and achievement of developmental milestones, and provides opportunities for early detection of health problems.

Well-child visits allow for immunization appointments, school and athletic physicals, and screening for eye and ear problems. The child also may visit one of these settings for specific complaints of distress or injury. Well-child visits are also excellent opportunities for the nurse to provide teaching about health, safety, and nutrition issues. The nurse has an opportunity to observe family interactions and can notify the physician of behaviors that suggest family dysfunction. Counseling of family caregivers can be provided before crises develop (see In Practice: Educating the Client 71-1).

Remember that some children are cared for in families headed by persons other than their biological parents. Gather data that includes information about the relationships within a child?s immediate family when you initiate care. Also consider the child?s cultural and religious background.

Key Concept Basic principles of safety and child care apply for both well and ill children.

During each visit, the nurse should obtain specific information related to the child?s age. Well-child visit information includes vital signs, height and weight, occipital-frontal circumference (OFC) of the head (to 3 years of age), abdominal girth, and limb measurements. Plot the child?s height and weight on a growth chart that allows comparison with other children of the same age. At each visit, the child?s growth should be compared with what is considered ?normal limits.? Early detection of abnormal trends can lead to preventive treatments. You can view comprehensive growth charts on the Centers for Disease Control and Prevention Website.

IN PRACTICE: EDUCATING THE CLIENT 71-1

FAMILY CAREGIVER INSTRUCTION

Infant

???? Proper diet and feeding techniques

???? Teething

???? Feeding routine, colic, and spitting up

???? Need to suck; pacifiers

???? Positioning and sleep habits

???? Diaper rash

???? Bathing and bathing safety

???? Urinary and bowel habits

???? Crib safety

???? Use of a car restraint or safety device

???? Accident prevention: suffocation, drowning, poisoning, and falling

???? Beginning dental care: wipe the infant?s gums with a damp cloth to remove excess food

Toddler

???? Dental care: dental visits

???? Weaning from the bottle

???? Diet and solid food

???? Behavior patterns: separation anxiety negativism, and temper tantrums

???? Discipline and limit setting

???? Poison prevention

???? Toilet training

Preschooler

???? Eating habits: dawdling over food, "picky" eaters

???? Night waking, bedtime fears, and nightmares

???? Development of a positive self-concept and body image

???? Aggressive behavior and sibling rivalry

???? Preparation for school

???? Thumb-sucking; dental care

???? Care for common childhood diseases

Separate charts for males and females from infant-hood to adolescence are available.

The Denver-II Developmental Screening Test (DDST) is a tool used to identify developmental delays in infants, toddlers, and preschoolers. If a delay is identified or suspected, a more detailed evaluation of the child may be performed.

Physical Examination

The primary caregiver will complete a physical examination that will become a reference point for evaluating future illnesses. Many examiners use a head-to-toe checklist. Some protocols use a body system approach (e.g., cardiovascular, neurologic, pulmonary). In this way, patterns are established, and nothing is overlooked. When an exception to the established normal trend is noted, it is described in detail on the child?s chart.

Immunization

Immunization provides people with temporary or permanent protection against certain diseases. The immunization program begins shortly after the child?s birth and should be continued on a regular schedule. Family caregivers must present records of immunizations to the child?s school; failure to do so may result in the child?s exclusion from the school. Most immunizations can be given even when the child has a mild illness.Immunization against tuberculosis is not done in the United States, but is commonly done in some countries. Tuberculin testing varies among states. Some states require testing before and/or during the school years. Additional testing is indicated if tuberculosis exists within a given population.

Specific Care for Age Groups

Infant Care

Infant health supervision includes documentation of milestones of development and growth, as well as documentation of immunizations and family teaching. Examinations center around discussion with family caregivers and anticipatory teaching.

General observations include the following:

???? How family caregivers hold the infant

???? If the infant ?cuddles? with family caregivers

???? General cleanliness of the infant

???? The infant?s response to painful procedures

???? The infant?s appearance of health or illness; weight compared to length

Specific observations include the following:

???? Equal, active movement of all extremities

???? General activity level

???? Alertness

???? Skin color, warmth, and texture

???? Tone and pitch of the infant?s cry

???? General respiratory status

???? Fontanels, reflexes

???? Achievement of developmental milestones Toddler Care

As a toddler?s growth progresses, independence and autonomy become important. Documentation for a well-child checkup will include:

???? Age of weaning from breast or bottle to cup (usually achieved by age 12 months)

???? Ages at which toilet training was started and completed

???? Language development

???? Play patterns and activities

???? Sleep patterns

Discuss with family caregivers their child?s behavior patterns and the type of discipline they use at home. Encourage caregivers to begin dental checkups for toddlers as early as 12 months of age.

Teaching requires a strong focus on safety. Toddlers are very mobile, but lack the judgment to protect themselves. Observe caregiver-toddler interaction.

Preschooler Care

The physical examination for preschool children focuses on readiness for school. Use a systems checklist to evaluate each child?s physical condition. Focus attention also on sleep patterns, safety, and relationships with peers, siblings, and family caregivers.

Evaluation of speech, hearing, and vision is critical in the preschool years. Each must be within normal limits to facilitate learning. Determine if a child?s developmental age is commensurate with his or her chronological age. An adequate attention span is essential. Your observational skills are important, and you will need to document each child?s ability to pay attention, follow directions, and focus on a task. Evaluate gross and fine motor control. These characteristics are evaluated earlier, but they become a special focus in the preschool examination.

School-Age Child Care

Continue to plot the school-age child?s heights and weights on the growth grid to establish a comparison with other children of the same age. Emphasize successful completion of schoolwork and relationships with peers, siblings, and family caregivers. Evaluate nutrition, elimination, and sleep patterns. Immunization status needs to be reviewed, using the most current immunization recommendations. Some healthcare providers may have specific guidelines they prefer.

Adolescent Care

Health supervision issues for adolescents focus on puberty and a smooth transition to young adulthood. Adolescents require an update of the diphtheria-tetanus immunization.

Key Concept Adolescents may be too embarrassed to ask questions, particularly about their health. A bulletin board or brochure rack well stocked with informational pamphlets about common concerns can aid communication.

Adolescents are capable of expressing individual concerns; therefore, you will benefit from talking separately with caregivers and with adolescents. A tactful approach to care includes detailed explanations of procedures you are to perform. The transition from childhood to adolescence can be difficult. The adolescent may present with such problems as acne vulgaris, menstrual dysfunction, inadequate nutrition, sexually transmitted diseases, suicidal ideation, or chemical abuse. Many adolescents benefit from professional counseling.

Adolescents need certain accommodations to preserve their self-respect and identity. They do not belong either with young children or only with adults. Adolescents feel more comfortable and are able to relate better with healthcare personnel in a setting customized for them. The healthcare staff should be chosen to work specifically with adolescents. If a specialized setting is unavailable, the adolescent should be placed with others close to his or her age. In any situation, clear rules should be posted so that all adolescents know the setting?s guidelines.

Illness or injury can seriously threaten self-image. Many young people worry about damage to their bodies or about death, whether the threat is real or not. In addition, they are often acutely aware of their emerging sexuality; therefore, their modesty should be respected. Include adolescents in planning and performing care as much as possible to encourage their emerging independence.

Adolescents need nonbiased and accurate information regarding their rapidly changing bodies and the issues they may encounter during this transition to young adulthood. Health education should include information concerning sexually transmitted infections and prevention (including human immunodeficiency virus and acquired immunodeficiency syndrome [HIV/AIDS]), homosexuality, pregnancy, and birth control. Teenagers also need clear and nonjudg-mental information about substance use and abuse, depression, and suicide.

NCLEX Alert Clinical scenarios involving infants and children often relate to appropriate level of care for a specific age group. When reviewing question options, be sure to keep in mind the age of the client and the expected behaviors for that age group.

THE HOSPITAL EXPERIENCE

Short- or long-term hospitalization can be traumatic and disturbing for children and families. Small children usually do not understand what is happening or why they are being taken away from home. Illness threatens body image at any age. You will see nurses in the pediatric department dressed in colorful scrubs. The units are decorated with pictures of animals or cartoon characters to make the children feel more comfortable.

Key Concept Pediatric nurses provide care not just for the sick child but for the entire family.

Age-Related Concerns

Infants, Toddlers, and Preschoolers

Even before children are 1 year of age, they become frightened of strangers and are aware of their family?s absence. From ages 1 to 5 years, children often exhibit severe anxiety when separated from home and family.

Very young children have concrete thought processes and often misinterpret what they hear. The following statements are examples of what to avoid saying when caring for children. (The statements in parentheses give an example of what the child might be thinking.)

???? ?I am going to take your blood pressure.? (Where are you taking it?) Instead you might say: ?I am going to find out how strong your heart is beating right now.?

???? ?I am going to give you a shot.? (Are you going to shoot me with a gun?) Instead, you might say: ?I am going to give you some medicine.?

???? ?This will only feel like a little bee sting.? (Oh, no, I?m afraid of bees!) Instead you might say: ?This may hurt a little. Hold your teddy bear tightly to help you.?

Keep sentences short, and phrase statements so the child knows what to do, not what to avoid. (For example, instead of saying, ?Don?t cross the street alone,? say to the child, ?Always cross the street with an adult.?) Tell children who are to remain in the hospital overnight that nurses work at night also, in case they are worried that they will be alone (see In Practice: Nursing Care Guidelines 71-1).

Source: http://what-when-how.com/nursing/fundamentals-of-pediatric-nursing-pediatric-nursing-part-1/

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