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 monow add food > 12 mo cows milk O.K. In hospital serve high quality food when child is hungry Metabolism/Sleep/Speech MetabolismFaster than adultsHeal quickly Sleepless required as they mature Speechability 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.