Unit 2
Pediatric Nursing

Communicating With
Infants and Young Children
Infants respond to sounds and actions.
Distrust of strangers may last through the first 3 or 4 years of life.
Get down on their eye level.
The perceptions of young children are literal.

Communicating With
School-Age Children
Interested in knowing what and why
Simple explanations that help them understand how equipment works are important.
These children will ask more questions if their curiosity is not satisfied.

Communicating With Adolescents
Young teenagers frequently waver between thinking like children and like adults.
Teens may need to relate information that they do not wish others to know, and a discussion about confidentiality may ease their concerns.
The nurse should listen attentively in an open-minded, nonjudgmental way.

Communicating With Family Caregivers
Keep family caregivers well informed about what is happening and being planned for their child.
Some caregivers are so anxious and apprehensive that they communicate their concerns and negative reactions to the child rather than provide support.

Health Maintenance
• Routine well-baby or well-child visits are recommended throughout childhood.
• Dental caries (cavities) are a major health problem in children and adolescents.
• Protection against disease in the form of immunizations is available against several serious or disabling diseases.

Pediatric Assessment
• Collecting Subjective Data
– Conducting the Client and Family Interview
– Obtaining a Client History

Collecting Objective Data
• General Status
• Observing General Appearance
• Noting Psychological Status and Behavior
• Measuring Height and Weight
• Measuring Head Circumference
• Vital Signs

Providing a Physical Examination
• Head and Neck
• Chest and Lungs
• Abdomen
• Genitalia and Rectum
• Back and Extremities
• Neurologic

Hospitalized Child
• Pediatric Unit
• Infection Control
• Caregiver Participation
• Child Undergoing Surgery
• Play

Assisting with Basic Needs
Nutrition
– Intake Measurement
– Gavage Feeding
– Gastrostomy Feeding
Safety
Pain Management
Oxygenation

Assisting With Basic Needs
• Elimination
Output Measurement
Specimen Collection
• Positioning
Restraints
Transporting
Holding
Sleeping

Medication Administration
• Evaluate each child from a developmental point of view to administer medications successfully.
– Always calculate the drug dosage to ensure administration of the correct dosage.
• Oral medications may be given to infants through a nipple, with a medicine dropper, or with an oral syringe.
• Medications should not be given in food.

Infants: 28 Days To 1 Year
• Trust Versus Mistrust
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

Toddler: 1 To 3 Years
• Autonomy Versus Shame and Doubt
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

Preschool Child: 3 To 6 Years
• Initiative Versus Guilt
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

School-age Child:
6 To 12 Years
• Industry Versus Inferiority
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

Preadolescent: Ages 10 to 12
• Physical Characteristics
• Preparation for Adolescence

Adolescent: Ages 12 to 18
• Ego Identity Versus Role Confusion
• Physical Characteristics
• Social Characteristics
• Nursing Implications
• In the Health Care Facility

Developmental Disorders
• Autism: pervasive developmental disorder
• Down Syndrome: trisomy 21
• Fetal Alcohol Syndrome
• Lead Poisoning (Plumbism)

Mental Retardation
• The most common classification of mental retardation is based on IQ.
• Medical Management: goal is to keep child in home environment

Nursing Process: The Child With Cognitive
Impairment
• Self-Care Deficit: Bathing/Hygiene,
Dressing/Grooming, Feeding, Toileting related to cognitive or neuromuscular impairment (or both)
• Impaired Verbal Communication related to impaired receptive or expressive skills
• Delayed Growth and Development related to physical and mental disability

The Child With Cognitive Impairment
(Continued)
• Compromised Family Coping related to emotional stress or grief
• Risk for Social Isolation (family or child) related to fear of and embarrassment about the child’s behavior or appearance

Attention Deficit–Hyperactivity Disorder
• Syndrome characterized by degrees of inattention, impulsive behavior, and hyperactivity
• Medical Management: treatment is multidisciplinary
– Stimulants
• Nursing Management
– Build the child’s self-esteem, confidence, and academic success

Child Abuse and Neglect
• Dysfunctional family
• State laws require health care personnel to report suspected child abuse
• Physical Abuse
• Emotional Abuse and Neglect
• Sexual Abuse
• Nursing Management for the Abused or Neglected Child

Nonorganic Failure to Thrive
• Children who fail to gain weight and show signs of delayed development
• Organic failure to thrive: result of a disease condition
• Nonorganic failure to thrive (NFTT): no apparent physical cause
• Medical Management

Nursing Process: The Child With
Nonorganic Failure to Thrive
• Imbalanced Nutrition: Less than Body
Requirements related to inadequate intake of calories
• Risk for Delayed Growth and Development related to physical or emotional neglect, lack of stimulation and insufficient nurturing
• Impaired Parenting related to lack of knowledge and confidence in parenting skills

Respiratory Disorders
• Acute Bronchiolitis/Respiratory Syncytial Virus
• Croup Syndromes
– Spasmodic Laryngitis
– Acute Laryngotracheobronchitis

Nursing Process: The Child With a
Respiratory Disorder
• Ineffective Airway Clearance related to obstruction associated with edema, mucous secretions, nasal and chest congestion
• Impaired Gas Exchange related to inflammatory process
• Risk for Deficient Fluid Volume related to respiratory fluid loss, fever, and difficulty swallowing
• Compromised Family Coping related to child’s respiratory symptoms and illness

Cystic Fibrosis
• Assessment
• Medical Management
– Pulmonary treatment
– Dietary treatment
– Home care
• Nursing Management

Sudden Infant Death Syndrome
• Leading cause of infant mortality worldwide
• No single cause has been identified; SIDS can neither be prevented nor predicted.
• American Academy of Pediatrics recommends that infants must be placed in a supine position to sleep.
• Referrals should be made to the local chapter of the
National SIDS Foundation.

Cardiovascular and Hematopoietic
Disorders
• Congenital Heart Disease
• Congenital Heart Defects
– Ventricular Septal Defect
– Atrial Septal Defects
– Patent Ductus Arteriosus
– Coarctation of the Aorta
– Tetralogy of Fallot
– Transposition of the Great Arteries

Cardiovascular and Hematopoietic
Disorders (Continued)
• Rheumatic Fever
• Kawasaki Disease
• Hemophilia
– Factor VIII Deficiency (Hemophilia A; Antihemophilic
Globulin Deficiency; Classic Hemophilia)
– Factor IX Deficiency (Hemophilia B; Plasma
Thromboplastin Component Deficiency; Christmas
Disease)

Neurologic Disorders
• Cerebral Palsy
– Ataxia type
– Rigidity type
– Mixed type
• Hydrocephalus
– Ventriculoperitoneal shunting

Nursing Process: Postoperative Care of a Child
With a Shunt Placement
• Risk for Ineffective Cerebral Tissue Perfusion related to IICP
• Risk for Impaired Skin Integrity related to pressure from physical immobility
• Risk for Infection related to the shunt
• Risk for Delayed Growth and Development related to impaired ability to achieve developmental tasks
• Anxiety related to family caregivers’ fear of surgical outcome

Haemophilus influenzae Meningitis
• Assessment
• Medical Management: The child is initially isolated and treatment is started using IV administration of antibiotics.
• Nursing Management
– Closely monitor the child for signs of IICP.
– Side-lying position with the neck supported and head elevated

Reye Syndrome
• Assessment: symptoms appear within 3 to 5 days after the initial illness
• Medical Management:improving respiratory function, reducing cerebral edema, and controlling hypoglycemia
• Nursing Management
– Accurate intake and output
– Avoid giving aspirin to children

Spina Bifida
• Failure of the posterior laminae of the vertebrae to close as a result of a defect in the neural arch, generally in the lumbosacral region
• Surgery is required to close the open defect
• Nursing Management
– Until surgery is performed, the sac must be covered with a sterile dressing moistened in a warm sterile solution.

Sensory Disorders
• Cleft Lip and Cleft Palate
• Vision Impairment
• Hearing Impairment

Gastrointestinal Disorders
• Celiac Syndrome/Gluten-Induced Enteropathy
• Colic
• Diarrhea and Gastroenteritis
• Hernias

Gastrointestinal Disorders (Continued)
• Congenital Aganglionic Megacolon
• Intussusception
• Pyloric Stenosis
• Type 1 Diabetes Mellitus

Urinary and Renal Disorders
• Cryptorchidism
• Hydrocele
• Enuresis
• Encopresis
• Exstrophy of the Bladder
• Hypospadias and Epispadias
• Nephrotic Syndrome

Nursing Process: The Child With Nephrotic
Syndrome
• Excess Fluid Volume related to fluid accumulation in tissues and third spaces
• Risk for Imbalanced Nutrition: Less than Body
Requirements related to anorexia
• Risk for Impaired Skin Integrity related to edema
• Fatigue related to edema and disease process
• Risk for Infection related to immunosuppression
• Deficient Caregiver Knowledge related to disease process, treatment, and home care

Urinary and Renal Disorders (Continued)
• Urinary Tract Infections
• Wilms’ Tumor (Nephroblastoma)

Musculoskeletal Disorders
• Juvenile Rheumatoid Arthritis
• Hip Dysplasia

Nursing Process: The Child in an
Orthopedic Device or Cast
• Acute Pain related to discomfort of orthopedic device or cast
• Risk for Impaired Skin Integrity related to pressure of the cast on the skin surface
• Risk for Delayed Growth and Development related to restricted mobility secondary to orthopedic device or cast
• Deficient Knowledge of family caregivers related to home care of the child in the orthopedic device or cast

Musculoskeletal Disorders (Continued)
• Legg-Calvé-Perthes Disease (Coxa Plana)
• Muscular Dystrophy
• Scoliosis
• Talipes Equinovarus

Integumentary Disorders
• Candidiasis
• Diaper Rash
• Acute Infantile Eczema
• Fungal Infections
• Impetigo
• Parasitic Infections

Immune Disorders
• Communicable Diseases
• Infectious Mononucleosis