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PEDIATRICS
UNIT 2
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
The pediatric nurse
•Keen observation skills
•Conveys respect and honesty
•Communication
•Enjoys working with children
•Teaches parents and children
•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
•Know normal to recognize abnormal
•Illness, lack of stimulation affect G&D
Anticipatory Guidance
•To decrease anxiety, teach parents and children what to expect
Physical Assessment
•Use different skills for each age group
•Growth assessment:
•Ht or Length
•WT.- Balance scale first
•Head Circ.- up to 36 mo.
Vital Signs
•Resp.- always do first
•1 full minute
•< 6 yrs – abd breathers
•Neonate – nasal breathers
•Heart rate:
•Apical rate up to 5 years
•One full minute
•Temperature:
•Tympanic – most common for infant or small child
•Rect., ax., oral
•B.P.:
•Sites: pg. 960
•Correct cuff size- covers 2/3 of upper arm
Head to Toe Assessment
•Head:
•Circ.
•Fontanel's
•Eyes, nose, mouth
•Lungs
•Chest
•Back
•Abd.
•Extremities
•Genitalia
•Renal Function
•Bowel Function
Factors Influencing G&D
•Nutrition:
•Most important influence on growing bones and muscles
•0-6 mo. - Breast or bottle
•6-12 mo.- breast/bottle, food
•> 12 mo. – cows milk
•In hospital serve high quality food when child is hungry
•Metabolism:
•Faster than adults
•Heal faster
•Rest and sleep:
•Sleep less when older
•Infant – 2 naps/day
•Toddler/preschool – 1 nap/day
•Communication:
•Determined by stage of development
The Hospitalized Child
•Pre admission education varies by age
•Anticipatory guidance – explain what to expect
•Be honest to establish trust
•Allow parents to stay
•Developmental support:
•Expect regression,
• anger and
•rejection
Surgery
•Age appropriate pre op teaching
•Allow to verbalize fears
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
• infants are nose breathers
•burping
•Solids:
•Introduce at 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
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
•Review Safety Considerations
•Use a syringe to measure exact dose
•Aim toward side of mouth
•Children are more susceptible to toxic effects of drugs than adults
Injections
•Vastus lateralis is preferred site until walking
•Ventral Gulteal on children who are walking
Ear gtts.
•< 3 y/o pinna down and back
•> 3 y/o pinna up and back
Nasal gtts.
•Head hyper extended 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
Child With A Physical Disorder
•Children are not miniature adults
•Care may differ from care for adults with the same disorder
•
Caring for the Pediatric Patient with a Cardiovascular Disorder
Congenital Heart Disease
•Present at birth
•Majority are treated with surgery
•10% of term neonates
Etiology
•Environmental
•Genetic
•Foramen Ovale and Ductus arteriosis close at birth
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
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
ASD
•Atrial Septal Defect
•Opening in atrial septum
•Murmur
VSD
•Ventricular Septal Defect
•Murmur
•50% close spontaneously
•Remainder require open heart surgery
•Dacron patch or close w/ sutures
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
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
Mixed Flow Defect
•TGV – transposition of great vessels
•S/S: severe cyanosis
•Treatment  surgical repair a) Palliative b) Complete
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.