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Pediatric Safety and
Prevention
Susan Beggs, RN MSN, CPN
Fall 2009
Improving child health
• “health maintenance”
• “preventive health”
Definitions
• Mortality: the # of deaths/100,000
• Morbidity: used to express the ratio
of sick to well in a community
• Infant mortality # of children per
1000 live births who die before 1st
birthday
Major causes of death during infancy
and childhood (these represent death
rates for the ages of 1-14 yrs per
100,000
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Accidents
Congenital abnormalities
Cancer
Homicide
Heart disease
Pneumonia & influenza
Suicide
Human immunodeficiency disease
Denver II developmental
test (DDST II)
• Standardized test for surveillance of
most children
• Applied as a developmental chart
• Nurses make sure the directions are
followed:
• Specific recommendations by APA:
– Minor infections without fever are not
contraindication
– If reaction occurs, consult dr. before
next immunization
– Pertussis not give for children
over 6
4mos-6 yrs of age:
• DTaP (4 doses)
• IPV (3 doses)
• HepB (3 doses)
• MMR (@ 12
months)
• PCV (1 dose)
7-18 yrs of age
Td (every 10 years
after initial
immunizations)
IPV (not rec. if >18
yrs of age)
Nurses responsibilites
with immunizations
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Know the action of the vaccine
Careful history of patient
Aspirate when injecting
Educate parents (schedule, side
effects)
• Proper documentation
• Assess for reaction 15-30 min after
injection
• Epinephrine 1:1000 available
• Check immunization records with
each visit
• Parent teaching: fever, or other
symptoms
Safety risks to
developmental levels
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Infant
Toddler
Preschool
School age
Adolescent
Major childhood
prevention measures
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Aspiration
MVA
Burns
Drowning
Bodily injury/fractures
• Leading cause of fatal injury under 1 year
of age
• Prevention:
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Inspection of toys, small parts
Out of reach objects
Selective elimination of certain foods
Proper posturing of the infant for feeding
Pacifier with one piece construction
• Vehicular risk greatest when child
improperly restrained
• Pedestrian
• Prevention
• Children are inquisitive
• Become able to climb and explore
• Prevention of household injury:
• Child does not recognize danger of
H2O
• Unaware of inability to breath
underwater
• No conception of water depth
• Hypoxia greatest concern
• Prevention
• Still developing sense of balance
• Easily distracted from tasks
• Prevention:
• Common in early childhood (2 yrs)
• 75% poisons are ingested
• Major reason for poisoning:
• Sources of poison:
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Cosmetics
Household cleaners
Plants
Drugs
Insecticides
Gasoline
Household items
Stats on drug poisonings
• Therapeutic interventions
• In every instance, medical eval is
necessary
• Call poison control center 1st
• Remove child from exposure
• Identify poison
• Prevent absorption
Ask yourself:
• Why do you think the American
Pediatric Association no long advises
parents to keep syrup of Ipecac in
the home?
• Ingestion of lead-based materials
• “Maybe it’s the lead poisoning!”
• Lead poisoning can cause:
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Brain and nerve damage
Behavior problems
Learning disabilities
Slowed growth
Headaches
Low energy
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Life threatening
More likely to drop out of school
Become disabled
Disturbed brain and nervous system
function
• Prevent child from full potential
• Pathophysiology of lead poisoning
• System assessments
• Therapeutic Interventions
Criteria for treatment of
lead poisoning
• < 9 not lead poisoned
• 10-14: prescreen
• 15-19: nutritional and educational
interventions
• 20-44: environmental eval and medication
• 45-69: chelation therapy
• >70: medical emergency
• Make environment lead-free
• Inspect buildings >25 years of age
• Areas painted with lead paint should be
covered with plywood or linoleum
• Educate the parents
• Follow up testing for lead levels
• Screening all school age children (required
in some states)