Pediatric Study Guide Family Centered Care Role of the Pediatric Nurse Recognizing the family as the constant in a child's life and delivering care that promotes empowerment for the family Advocating, teaching, supporting, and counseling families in a therapeutic way that does not impede proper judgement and care Biological Development Infant 1 mo- Can turn head side to side 2mo-Infant Social smile, distinct cry 3mo- Turns head to sounds, Coos 4mo- No head lag, primitive reflexes gone, rolls from back to side 5mo- rolls from abdomen to back 6mo- imitates sounds, birth weight doubles Toddler 1yr-3yr Pre-School Imitates lines, can draw a cross Feeds self with spoon and drinks from cup Jumps with both feet Knows 300 words by 24 months 3yr-6yr Copies a square Rides a tricycle uses 4-5 word sentences Jump rope Sing simple songs Erikson Trust V Mistrust- Birth-1yr: Basic needs of infant need to be met in order for them to feel sense of trust. Autonomy V Shame/Doubt- 1yr-3yr: Toddler's want the ability to control their body and environment. If not encouraged to or scolded then they feel shame/doubt Initiative V Guilt- 3yr-6yr: Strong imagination and conscience warns and threatens. If not allowed or choices conflict with parents then they feel guilty Industry V Infereority- 6yr-12yr: Need to accomplish tasks and work on things. If not allowed to carry out tasks they feel inferior Identity V Role Confusion- 12yr-18yr: Rapid body changes, attempting to figure out their role in life and peer acceptance. Birth-1yr 7mo- transfer objects from one hand to other, "Stranger danger" 8mo- sits unsupported 9mo- pulls self to stand, cruise furniture 10mo- Develops object permanence 11mo- cruises or walks with hands held 12mo- Walks with one hand, says 3-5 words besides "mama", "dada". Birth weight triples School-Age 6yr-12yr Dress self completely Develops concept of number Writes brief stories Understand concept of time, space, cause and effect, and conservation Adolescent 12yr-18yr Improved abilities to communicate their thoughts and ideas Good finger dexterity Piaget Sensorimotor- Birth-2yr: Simple learning takes place, Learning through trial and error. (aware that objects have permanence) Preoperational- 2yr-7yr: Egocentric thinking (the world revolves around only them), thinking is concrete and tangible. Ex. Anybody with a big belly must be pregnant Concrete operations (7-11 years)Thoughts becoming logical and coherent; able to classify and sortProblem solving is concrete and systematicLess self-centered Formal Operations- 11yr-15yr- More abstract thinking versus concrete. Ex. There are many reasons why someone could have a bigger belly. Types of Play: Onlooker- Not playing but watching other children play Solitary- Playing alone with all of their attention focused on their own toy/activity Parallel- Playing in the same area as others but not the same activity (Ex. Kid A plays with car, Kid B plays with blocks) Associative- Children playing together but no goal or task to complete (Ex. Playing with dolls and exchanging clothes) Cooperative- Playing together with specific goal and possible winner (Ex. Finishing game of Sorry or Trouble) Feelings about hospitalization and Loss of Control Infant- Reliant on parent and needs to be assigned a primary nurse, sticking to routine is important Toddler- Hospitalization gets in the way of autonomy and can cause regression (potty training, sleeping). Needs to follow a daily routine while in the hospital Pre-School- Egocentric thinking can lead them to think hospitalization is a punishment, fear of being harmed or body mutilation, needs a lot of reassurance that things are going to be okay. School- Age- Need to be able to have some freedom/independence. Fear of abandonment, injury, and death. Needs reassurance and the ability to make some of their own choices while in the hospital (Ex. Doing homework, Self-care) Adolescent- loss of independence and contact with peers while hospitalized, may become angry. Contact or conversations with peers can help (Ex. Calling peers and encouraging them to visit) Nutritional Assessment Infants need iron supplementation at 4-6 months if breast-feeding because breast milk is low in iron **Formula or breast milk primary source of food until 12 months ** Additional Notes: Cardiac Dysfunction in Pediatrics Indicators of Cardiac Dysfunction Poor feeding Low energy Tachypnea/ Tachycardia Developmental Delays Prenatal history Family history of cardiac disease Nursing Care for Cardiac Cath Consent H/H, PT, PTT, INR, Type and Cross for blood products BMP Post Op- Monitor vitals especially distal pulses to cath site, keep patient flat, monitor site for bleeding Atrial Septal Defect- ASD Hole in between the two atria Acyanotic Heart Defects Increased pulmonary blood flow Ventricular Septal Defect- VSD Hole in between the two ventricles Left- to- Right shunt Usually no symptoms but if severe child will have poor feeding, shortness of breath, fatigue, and FTT PDA Patent Ductus Arteriosus- Extra blood vessel found at birth that typically closes on its on Left- to- Right shunt Left- to- Right shunt Symptoms include rapid heartbeat, difficulty feeding, and possible heart murmur Symptoms include rapid heartbeat, difficulty feeding, and bounding pulse, poor growth, easily fatigued Cardiac Dysfunction in Pediatrics Cyantotic Heart Defects Coarctation of the aorta Most common occurrence is in the Aorta but can happen anywhere Common to see heart failure symptoms in an infant decreased pressure to lower extremities Increased pressure to head and upper extremities Tetralogy of Fallot Pulmonic stenosis causes more pressure in the right ventricle VSD lower pressure in the left ventricle (stress on right ventricle) Right ventricular hypertrophy Overriding aorta- the body is receiving blood from both sides "Tet Spells" Nursing Care Knee-chest position during “Tet” spell to increase blood flow Sudden tachycardia/tachypnea Give O2 to prevent spell from happening Keep patient calm and comfortable Triggers are pain, stress, and anxiety Additional Notes: Cardiac Dysfunction in Pediatrics Congestive Heart Failure Heart unable to pump enough blood to supply the circulatory system Right: Systemic problems Left: Lung problems *If left untreated the heart muscles become damaged * Clinical Manifestations Treatment Goals Tachypnea/Tachycardia at rest Retractions Activity intolerance (poor feeding) Weight gain (edema) Increased pulmonary blood flow ECG that shows ventricular hypertrophy Improve Cardiac function Give Digoxin (DO NOT GIVE IF HR <90 ACE Inhibitors Beta Blockers "Pacing" Remove accumulated fluid & Sodium Diuretics Decrease cardiac demands Improve tissue oxygenation (only when necessary) Rheumatic Fever Inflammatory disease that takes place after Group A strep infection Affects the skin, joints , heart, and brain If not managed well can lead to Rheumatic heart disease Clinical Manifestations Inflammation of the joints small painless nodules under the skin Heart inflammation (Carditis) Unusual facial movements that can affect speech Abd pain Fever Additional Notes: Treatment Goals Treat the strep infection with Penicillin prevention to help recurrence Prevention of serious cardiac damage Cardiac Dysfunction in Pediatrics Kawasaki Disease Acute vasculitis and extensive inflammation of the vessels with unknown cause Risk for coronary aneurysm Diagnosed based on clinical findings Clinical Manifestations Treatment Goals Fever over 102.2 Strawberry tongue/ Red lips Red soles and palms Peripheral edema Conjuctival redness Lethargy Irritability Colicky ABD pain **Usually seen in children under 5 yr** High-dose IVIG within the first 7 days of illness Y-globulins Promote rest, quiet environment Treat symptoms Assess for any signs of heart failure **Goal is to prevent coronary aneurysm** Respiratory Dysfunction in Pediatrics Respiratory dysfunction is often seen in younger infants because they are most susceptible to viral illness Younger than 3mo have lower infection rates because of maternal antibodies Viral infections highest in toddlers and preschool children Tonsillitis Clinical manifests as inflammation After 6-7 episodes of infections PCP will recommend removal this surgery is called a Tonsillectomy and Adenoidectomy or T & A T&A Post-Op Care Cool clear liquids No citrus flavor or carbonated drinks No milk or milk products Soft foods to help prevent coughing Pre-Op Doctor has to explain procedure Only witness signature on consent Labs; H&H, Type and cross, Coag studies Respiratory Dysfunction in Pediatrics Otitis Media Two viruses most likely to cause OM- RSV and influenza Pre-school age boys are at greater risk than girls Passive smoke causes an increased risk of developing OM AOM- Acute ear pain and fever- wait 72hrs for spontaneous resolution unless child is less than two years old and has a fever w severe pain OME- Rhinitis, cough, or diarrhea- Not treated if persisted more than 3 mo Therapeutic management Amoxicillin for 10-14 days Surgical- Tube placement and adenoidectomy Occurence Nursing Care Analgesic drugs (Acetaminophen/Ibuprofen), Codeine may be used for more severe pain Ice compress over affected ear Educate family that child may experience temporary hearing loss Keep water out of ear Prevent OM by holding child upright during feedings Take ALL ANTIBIOTICS Croup Syndromes Characterized by: Hoarseness Barking Cough Inspiratory stridor worse at night Epiglottitis Clinical Manifestations Sore throat, pain, tripod positioning Potential for respiratory obstruction Epiglottitis Drooling because not able to swallow Up-right posture Throat pain Never use a tongue blade- can cause resp. distress Epiglottitis Therapeutic Management Airway management Maintain hydration, Oral or IV High humidity w cool mist Nebulizer treatment Epinephrine Steroids
