PEDIATRICS Unit 2 Rev. July, 2011 History of Child Care Colonial

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
PEDIATRICS
Unit 2

Rev. July, 2011

History of Child Care

Colonial America

Industrialized America

Dr. Abraham Jacobi –Father of Pediatrics

Pediatric Nursing - Purpose

Prevent disease or injury

Optimal health and development

Treat health problems

Qualities of the Pediatric Nurse

Keen observation skills

Conveys respect and honesty

Communication

Enjoys working with children

Teaches parents & children

Good role model

Special Needs Children

Congenital anomalies

Malignancies

Abnormalities

35% of hospitalized children

Family Centered Care

24 hour visitation

Parental access to health information

Parents involved in decisions

Growth and Development

Are complex processes

Occur in stages

Knowing normal milestones  easier to identify delays

Cognitive Impairment

Anticipatory Guidance

Physical Assessment

Use different skills for each age group

Follow head to toe direction

Alter sequence based on developmental needs

See Box 30-3 pg. 948

Physical Growth Parameters

Ht or Length

WT.- Balance scale first

Head Circ.- up to 36 mo.

Temperature
Tympanic-most common for infant or small child
Rect, Axillary & oral acceptable
**Think critically as to why temp is needed**

Heart Rate & Respirations

Resp.- always do first

1 full minute

< 6 yrs – abd breathers

Neonate – nasal breathers

Apical rate up to 5 yrs, for 1 full minute @ apex of heart

Blood Pressure

Sites pg. 951 Fig. 30-3

Correct cuff size- covers 2/3 of upper arm

Explain each step

Perform prior to anxiety provoking procedures

Head to Toe Assessment

Head:

Circ.

Fontanel's

Eyes, nose, mouth

Lungs Box 30-8, pg. 953

Chest

Back

Abd.

Extremities

Renal Function

Anus

Genitalia

Factors Influencing G&D

Nutrition ^ Most important influence on bone & muscle growth

0-6 mo Breast/bottle

6-12 monow add food

> 12 mo  cows milk O.K.

In hospital serve high quality food when child is hungry

Metabolism/Sleep/Speech

MetabolismFaster than adultsHeal quickly

Sleepless required as they mature

Speechability determined by stage of development

The Hospitalized Child

Pre admission education varies by age

Anticipatory guidance

Be honest to establish trust

Allow parents to stay

Considerations/Communication

Pg. 958,961, Table 30-7

Expect regression

anger and

rejection

Surgery

Age appropriate pre op teaching

Allow to verbalize fears

Pre-op teaching is important

Parent Participation

Review info from physician

Parents may not understand due to anxiety

Listen

Pain Management

Anything that is painful to an adult is painful to a child

Observe for changes in behavior

PEDIATRIC PROCEDURES

Bathing

Before a feeding

Prevent chilling

Only water on face

Feeding/Burping
Breast or Bottle

Burping positions

Solids introduced @ 4-6 mo

Weaning

Bedtime bottle removed last

Safety Devices

Restraints:

Used as a last resort

Remove Q2 hours ot exercise body part

Urine Collection

Urine collection bag

Cath specimen

Voided specimen

Veni & Lumbar Puncture

Venipuncture Position securely

Lumbar puncture Side lying

Oxygen Therapy

Hood

Mist tent

Nasal canula

Mask

Suctioning

No more than 5 seconds

I&O

Weigh all diapers

Medication Administration

6 rights

Calculate safe dose

P.O. is preferred route

Children more susceptible to toxic effects of drugs than adults

Use a syringe to measure exact dose

Aim toward side of mouth

Injections

Vastus lateralis is preferred site until walking

Ventral Gulteal on children who are walking

Ear & Nasal gtts.

< 3 y/o pinna down and back

> 3 y/o pinna up and back

Nasal hyper extend head over edge of bed

Rectal

See box 30-11

Less reliable

Suppository w/ jelly

Enema procedure same as adult

Safety

Prevent accidents

See Table 30-12 for Developmental Safety Hazards & Prevention

Caring for Pediatric Patient with a Cardiovascular Disorder

Congenital Heart Diseases

Congenital Heart Disease

Present at birth

Majority are treated with surgery

5-10% of term neonates

Etiology

Environmental

Genetic

4 Types of CHD

Increased pulm. blood flow

Decreased pulm. blood flow

Obstruction to systemic flow

Mixed blood flow

Clinical Manifestations

Cyanosis

Pallor

Cardiomegly

Murmurs

Additional heart sounds

Digital clubbing

Apical and radial pulse differences

Cardiac murmurs

http://depts.washington.edu/physdx/heart/demo.html

#1 Increased Pulmonary Blood Flow Defects

PDA  Patent Ductus Arteriosis

ASD  Atrial Septal Defect

VSD  Ventricular Septal Defect

PDA

Patent Ductus Arteriosis

Blood shunts from aorta to pulmonary artery

“Machine like” murmur

PEDIATRICS

UNIT 2

ASD

Atrial Septal Defect

Opening in atrial septum

Murmur

Atrial Septal Defect

Blood flows from high pressured left atrium to lower pressured right atrium.

VSD

Ventricular Septal Defect

Murmur

50% close spontaneously

Remainder require open heart surgery

Dacron patch or close w/ sutures

The most common congenital heart defect

#2. Decreased Pulm. Blood Flow Defects
1) Pulmonary Stenosis
2) Pulmonary Atresia
3) Tetrology of Fallot (most common)

Tetralogy of Fallot
consists of the following 4 defects:

Pulmonary artery stenosis

Ventruculoseptal defect

R. ventricular hypertrophy

Overriding aorta

Note: The heart works harder because of the pulmonary artery stenosis

Signs & Symptoms

Profound cyanosis

Tet spells

Clubbing of nailbeds

Murmur

dyspnea

Squatting

Poor growth

syncope

Surgical Treatment

Blalock-Taussig Shunt (temporary)

Closure of VSD

Pulmonic Valvotomy

Repair of overriding aorta

#3 Mixed Flow Defect

TGV – transposition of great vessels

S/S: severe cyanosis

Treatment  surgical repair a) Palliative b) Complete

#4 OBSTRUCTIVE FLOW DEFECTS

Pulmonary Stenosis

Aortic Stenosis

Coartication of the Aorta

Treatment: surgical repair

Coarctation of the Aorta

Narrowing of the aorta at the site of the ducturs arteriosus

Results in increased pressure to heard and arms and

Decreased pressure to lower extremities

BP in arms will be higher than in legs
(upper extremity hypertension)

Surgery

Remove the narrowed portion of the aorta and an end to end anastomosis or graft replacement
if narrowing is extensive.
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