Pediatric Nursing
Content
PEDIATRIC NURSING
PRINCIPLES OF GROWTH and DEVELOPMENT a. Continuous process b. Proceeds in an orderly sequence c. Predictable stage at different rates d. Do not develop at the same rate e. Directional PSYCHOSEXUAL STAGES STAGES ORAL (0-18 months)
Center of Gratification Mouth-sucking
ANAL (18-3yo)
Anus-toilet training
PHALLIC (3-6yo)
Genitals
LATENCY (6-12yo)
School accomplishments
GENITAL (12-18yo)
Peers
Nursing responsibilities Breastfeeding Use pacifier on NPO Allow thumb sucking with clean hands Bowel and bladder control routine Anal sphincter control- 18-20 months Urination Day: 2-4 years Night: 4-6 years Accept child sexual interest as a normal area of exploration Help answer child’s curiosity Masturbation Pre: Privacy During: Divert Help attain (+) experiences and feelings of success Best reward: immaterial reward Relate with opposite sex Allow verbalization
PSYCHOSEXUAL THEORY STAGES Infancy (0-18 months)
DEVELOPMENTAL TASK Trust VS Mistrust
Toddlers (18-3yo)
Autonomy VS Shame and Doubt
Pre-schoolers (3-5yo)
Initiative VS Guilt
School age (6-12yo)
Industry VS Inferiority Identity VS role confusion
Adolescence (12-18yo)
Nursing responsibilities Attend to needs Provide primary caregiver Consistent care Allow to do own activities Provide opportunities for decision making Offer choices Allow to play Toy: Bigger than the close fist Respond to questions Encourage accomplishments Give immaterial rewards Discuss feelings Give support system
Development of moral reasoning Level Stage Motivation for Behavior Pre-conventional 1 Punishment (toddler-10yo) 2 Rewards Conventional 3 Good boy-Nice girl (10-13yo) 4 Social order Post-conventional 5 Laws (adolescence-adult) 6 Conscience COMPARISON ACROSS THE PEDIATRIC AGE Age group Significant Fears person Infancy Primary Stranger caregiver Toddlers Parents Separation PreFamily Body schoolers mutilation Schoolers Teachers Belongingness Adolescence Peers Loss of control MAJOR STAGES of DEVELOPMENT 1 month: lifts head in prone position 2 months: social smile 3 months: ability to laugh 4 months: rolls from front to rear 5 months: smiles at mirror, imitate sounds
Accidents Aspiration Fall House School ______
Play Solitary Parallel Associative Cooperative Competitive
6 months: eruption of the first temporary tooth Sits with support Weaning age from breast to bottle 7 months: start of stranger anxiety 8 months: peak of stranger anxiety Sits without support 9 months: pincer grasp Crawling 10 months: stands with support 11 months: walks with support 12 months: stands alone Emotions 15 months: walks alone 18 months: bring spoon without rotating it towards the mouth 2 YO: can open door by turning doorknobs Running 3 YO: copies circle Rides a tricycle Undressing Temporary teeth complete 5 YO: dressing Tying shoe laces REGULAR NURSING CARE Initial Assessment Weight: (6-8.5 lbs) Anthropometric HC: 33-35 cm AbdC: 31-33 cm CC: 31-33 cm Scaphoid abdomen-notify the physician -abdominal organs are pushed upward/Diaphragmatic hernia Respiration: 30-60, with regular apnea (<20 seconds) Cardiac rate: 120-140 bpm Temperature: 37.2 C Blood pressure: 65/41 mmHG Skin color Pinkish to reddish Green: Meconium stained Ashed/Gray: septicemia Yellow: Jaundice Bluish: Cyanotic, with congenital heart defects Initial Bath Vitamin K injection: promote synthesis of prothrombin II (.1mg/mL) Cord care
Crede’s Prophylaxis: prevent opthalmia neonatorum Terramycin-1% Rooming in: (RA 7600) Initiate breastfeeding and promote bonding EO 51: promote breastmilk (Colostrum-Antibodies) Home bath: Not done if sick and after feeding No baby powder and no tab baths Breastfeeding: every 2-3 hours Physiologic weight loss: (5-10% in first Two weeks) RISK NEWBORN 1. DM Babies LGA: Infant Macrosomia Preterm delivery Uterine rupture Hypoglycemia after birth Management Check blood sugar: 40-60 D50% 2. Drug addiction a. Smoking: causes vasoconstriction (SGA, respiratory infection) b. Alcohol: (SGA, facial defects, microcephaly) Red wine-1 shot glass a day c. Drugs (Vomiting, Diarrhea, Seizure, Tremors) 3. Premature Babies -immature organs -Lungs: decrease surfactant S/S: nasal flarig Expiratory grunting Tachypnea Management ET tube Oxygen supplement Ventilator 4. Retrolental hyperplasia -toxic level of oxygen -lend to blindness Management Incubation
5. Hyperbilirubenemia Kernicterus Management Phototherapy: Bilirubin-make it water soluble and reabsorb in the blood 6. Post-Maturity Placental degeneration: decrease oxygen and glucose Problems: Hypoxia Hypoglycemia Seizure RESPIRATORY PROBLEMS 1. Pharyngitis: beta-hemolytic streptococcus Complications Acute glumerolonephritis Renal failure RHD Management Penicillin for 7 days Erythromycin Sorethroat: warm saline gargle Calamansi juice Milk/ ginger tea 2. Recurrent tonsillitis Tonsillectomy: Dental check-up Prone position Observe frequent swallowing Avoid suctioning Discourage throat clearing Discourage valsalva maneuver Use ice collar Drink cold and clear fluid Pain management: Acetaminophen No contact sports for 7 days 3. Spasmodic croup/ Laryngotracheobronchitis a. Drooling of Saliva b. Dysphagia c. Dysphonia d. Respiratory stridor e. Low grade fever f. Brassy cough Management Prevent attacks Mist therapy and hydrate with strict aspiration precaution
4. Epiglottitis Haemophillus Bacteria Cherry-red a. Respiratory distress b. Severe restlessness Management Urgent hospitalization Tracheostomy Start IV fluids Medications (cephalosphorins, cloramphenicol, cold mist therapy) 5. Choanal atresia Cyanosis at rest/feeding relieved by crying Management Surgery CONGENITAL HEART DEFECTS DISEASE MANIFESTATION Patent Ductus Murmurs, widening Arteriosus pulse pressure, bounding femoral pulse Atrial Septal Defect Enlargement of the right side of the atrium Ventricular septal Righ ventricle defect enlargement Pulmonary artery dilatation Coarctation of the Assymetrical vital Aorta signs Upper: High Lower: Low Tricuspid Atresia Neck vein distention Hepatomegaly, jaundice, ascites Peripheral edema Pulmonary stenosis VSD RV hypertrophy Overriding of the aorta
MANAGEMENT Indomethacin therapy (Prostaglandin) Surgical closure Surgical closure
Vital signs every 2 hours Give antihypertensives Avoid strenuous activities
Tetralogy of fallot
Transposition of great vessels Truncus Arteriosus
Knee-chest, oxygenation, prostaglandin-open ductus arteriosus for chances of reoxygenation Surgery Surgery
Bounding peripheral pulses
GASTROINTESTINAL PROBLEMS DISEASE Cleft lip Problems: Nutrition, Speech, Middle ear infection MANIFESTATION MANAGEMENT Cheiloplasty Rule of 10 Atleast 10 weeks Weight 10 lbs 10 grams of hemoglobin WBC not more than 10,000 -supine position -prevent tension from suture lines (crying) -splint (Rogan device) Palatoplasty 12-18 months Use cup in feeding Place infant on NPO Place gastrostomy as needed Pyloromyotomy Fredet-Ramstedt procedure -upright feeding Surgical resection
Cleft palate Esophageal atresia and tracheosophageal fistula Pyloric stenosis
Hollow opening Aspiration, poor nutrition, coughing, cyanosis, choking Mother:Polyhydramnios Projectile vomiting (non bile) Visible peristalsis Olive shaped-mass Abdominal pain,jelly stool, sausage shaped mass at RUQ No meconium for 24 hours Abdominal distention, refuse to feed, ribbon like stool
Intussusception -telescoping of the adjacent parts of bowel Imperforate anus -rectum ends as a closed pouch Hirschsprung Disease/Aganglionic megacolon -no peristalsis because of absence of parasympathetic cells Volvulus -twisting of the intestinal organ Appendicitis
Manual dilation Reconstruction Position: side-lying Laxatives, Enema, digital extraction, avoid gas-forming food Swenson’s pull-through Barium enema Appendectomy within 24 hours Cold packs not more than 15 minutes
Alkalosis-vomiting, abdominal pain, abdominal distention Mcburney’s point Psoa’s sign: right hip flexion Rovsing sign Obturator sign: flexed then rotate internally
URINARY PROBLEMS DISEASE Renal Agenesis -absence of one or both kidneys MANIFESTATION Oligohydramnios, no urination Potter’s syndrome: Pulmonary hyperplasia Facial and limb abnormalities MANAGEMENT Kidney transplant
Cryptorchisdism -the testes fail to descend Hypospadias and Epispadias -Ventral nad dorsal Hydronephrosis Polycistic kidneys Wilm’s tumor
Urinary meatus unaligned Repeated UTI’s Abdominal pain Oliguria, systemic hypertension, potter facies Nephroblastoma
Orchiodexy (1-2 years old) HCG administration Urethroplasty Surgery Removal of the kidney and kidney transplant No palpation, nephrectomy, radiation therapy, chemotherapy NEPHROTIC SYNDROME Idiopathic Insidiousa Rare Extreme ^CHON,˅Fats,˅NA Not known
FACTOR Cause Onset Hematuria Edema Diet Prevention
ACUTE GLUMERULONEPHRITIS Immune reaction to GABHS Abrupt Profuse Mild Normal Prevent strep infection
4 major symptoms Proteinuria Hypoalbuminemia Edema Hyperlipidemia
PRINCIPLES OF GROWTH and DEVELOPMENT a. Continuous process b. Proceeds in an orderly sequence c. Predictable stage at different rates d. Do not develop at the same rate e. Directional PSYCHOSEXUAL STAGES STAGES ORAL (0-18 months)
Center of Gratification Mouth-sucking
ANAL (18-3yo)
Anus-toilet training
PHALLIC (3-6yo)
Genitals
LATENCY (6-12yo)
School accomplishments
GENITAL (12-18yo)
Peers
Nursing responsibilities Breastfeeding Use pacifier on NPO Allow thumb sucking with clean hands Bowel and bladder control routine Anal sphincter control- 18-20 months Urination Day: 2-4 years Night: 4-6 years Accept child sexual interest as a normal area of exploration Help answer child’s curiosity Masturbation Pre: Privacy During: Divert Help attain (+) experiences and feelings of success Best reward: immaterial reward Relate with opposite sex Allow verbalization
PSYCHOSEXUAL THEORY STAGES Infancy (0-18 months)
DEVELOPMENTAL TASK Trust VS Mistrust
Toddlers (18-3yo)
Autonomy VS Shame and Doubt
Pre-schoolers (3-5yo)
Initiative VS Guilt
School age (6-12yo)
Industry VS Inferiority Identity VS role confusion
Adolescence (12-18yo)
Nursing responsibilities Attend to needs Provide primary caregiver Consistent care Allow to do own activities Provide opportunities for decision making Offer choices Allow to play Toy: Bigger than the close fist Respond to questions Encourage accomplishments Give immaterial rewards Discuss feelings Give support system
Development of moral reasoning Level Stage Motivation for Behavior Pre-conventional 1 Punishment (toddler-10yo) 2 Rewards Conventional 3 Good boy-Nice girl (10-13yo) 4 Social order Post-conventional 5 Laws (adolescence-adult) 6 Conscience COMPARISON ACROSS THE PEDIATRIC AGE Age group Significant Fears person Infancy Primary Stranger caregiver Toddlers Parents Separation PreFamily Body schoolers mutilation Schoolers Teachers Belongingness Adolescence Peers Loss of control MAJOR STAGES of DEVELOPMENT 1 month: lifts head in prone position 2 months: social smile 3 months: ability to laugh 4 months: rolls from front to rear 5 months: smiles at mirror, imitate sounds
Accidents Aspiration Fall House School ______
Play Solitary Parallel Associative Cooperative Competitive
6 months: eruption of the first temporary tooth Sits with support Weaning age from breast to bottle 7 months: start of stranger anxiety 8 months: peak of stranger anxiety Sits without support 9 months: pincer grasp Crawling 10 months: stands with support 11 months: walks with support 12 months: stands alone Emotions 15 months: walks alone 18 months: bring spoon without rotating it towards the mouth 2 YO: can open door by turning doorknobs Running 3 YO: copies circle Rides a tricycle Undressing Temporary teeth complete 5 YO: dressing Tying shoe laces REGULAR NURSING CARE Initial Assessment Weight: (6-8.5 lbs) Anthropometric HC: 33-35 cm AbdC: 31-33 cm CC: 31-33 cm Scaphoid abdomen-notify the physician -abdominal organs are pushed upward/Diaphragmatic hernia Respiration: 30-60, with regular apnea (<20 seconds) Cardiac rate: 120-140 bpm Temperature: 37.2 C Blood pressure: 65/41 mmHG Skin color Pinkish to reddish Green: Meconium stained Ashed/Gray: septicemia Yellow: Jaundice Bluish: Cyanotic, with congenital heart defects Initial Bath Vitamin K injection: promote synthesis of prothrombin II (.1mg/mL) Cord care
Crede’s Prophylaxis: prevent opthalmia neonatorum Terramycin-1% Rooming in: (RA 7600) Initiate breastfeeding and promote bonding EO 51: promote breastmilk (Colostrum-Antibodies) Home bath: Not done if sick and after feeding No baby powder and no tab baths Breastfeeding: every 2-3 hours Physiologic weight loss: (5-10% in first Two weeks) RISK NEWBORN 1. DM Babies LGA: Infant Macrosomia Preterm delivery Uterine rupture Hypoglycemia after birth Management Check blood sugar: 40-60 D50% 2. Drug addiction a. Smoking: causes vasoconstriction (SGA, respiratory infection) b. Alcohol: (SGA, facial defects, microcephaly) Red wine-1 shot glass a day c. Drugs (Vomiting, Diarrhea, Seizure, Tremors) 3. Premature Babies -immature organs -Lungs: decrease surfactant S/S: nasal flarig Expiratory grunting Tachypnea Management ET tube Oxygen supplement Ventilator 4. Retrolental hyperplasia -toxic level of oxygen -lend to blindness Management Incubation
5. Hyperbilirubenemia Kernicterus Management Phototherapy: Bilirubin-make it water soluble and reabsorb in the blood 6. Post-Maturity Placental degeneration: decrease oxygen and glucose Problems: Hypoxia Hypoglycemia Seizure RESPIRATORY PROBLEMS 1. Pharyngitis: beta-hemolytic streptococcus Complications Acute glumerolonephritis Renal failure RHD Management Penicillin for 7 days Erythromycin Sorethroat: warm saline gargle Calamansi juice Milk/ ginger tea 2. Recurrent tonsillitis Tonsillectomy: Dental check-up Prone position Observe frequent swallowing Avoid suctioning Discourage throat clearing Discourage valsalva maneuver Use ice collar Drink cold and clear fluid Pain management: Acetaminophen No contact sports for 7 days 3. Spasmodic croup/ Laryngotracheobronchitis a. Drooling of Saliva b. Dysphagia c. Dysphonia d. Respiratory stridor e. Low grade fever f. Brassy cough Management Prevent attacks Mist therapy and hydrate with strict aspiration precaution
4. Epiglottitis Haemophillus Bacteria Cherry-red a. Respiratory distress b. Severe restlessness Management Urgent hospitalization Tracheostomy Start IV fluids Medications (cephalosphorins, cloramphenicol, cold mist therapy) 5. Choanal atresia Cyanosis at rest/feeding relieved by crying Management Surgery CONGENITAL HEART DEFECTS DISEASE MANIFESTATION Patent Ductus Murmurs, widening Arteriosus pulse pressure, bounding femoral pulse Atrial Septal Defect Enlargement of the right side of the atrium Ventricular septal Righ ventricle defect enlargement Pulmonary artery dilatation Coarctation of the Assymetrical vital Aorta signs Upper: High Lower: Low Tricuspid Atresia Neck vein distention Hepatomegaly, jaundice, ascites Peripheral edema Pulmonary stenosis VSD RV hypertrophy Overriding of the aorta
MANAGEMENT Indomethacin therapy (Prostaglandin) Surgical closure Surgical closure
Vital signs every 2 hours Give antihypertensives Avoid strenuous activities
Tetralogy of fallot
Transposition of great vessels Truncus Arteriosus
Knee-chest, oxygenation, prostaglandin-open ductus arteriosus for chances of reoxygenation Surgery Surgery
Bounding peripheral pulses
GASTROINTESTINAL PROBLEMS DISEASE Cleft lip Problems: Nutrition, Speech, Middle ear infection MANIFESTATION MANAGEMENT Cheiloplasty Rule of 10 Atleast 10 weeks Weight 10 lbs 10 grams of hemoglobin WBC not more than 10,000 -supine position -prevent tension from suture lines (crying) -splint (Rogan device) Palatoplasty 12-18 months Use cup in feeding Place infant on NPO Place gastrostomy as needed Pyloromyotomy Fredet-Ramstedt procedure -upright feeding Surgical resection
Cleft palate Esophageal atresia and tracheosophageal fistula Pyloric stenosis
Hollow opening Aspiration, poor nutrition, coughing, cyanosis, choking Mother:Polyhydramnios Projectile vomiting (non bile) Visible peristalsis Olive shaped-mass Abdominal pain,jelly stool, sausage shaped mass at RUQ No meconium for 24 hours Abdominal distention, refuse to feed, ribbon like stool
Intussusception -telescoping of the adjacent parts of bowel Imperforate anus -rectum ends as a closed pouch Hirschsprung Disease/Aganglionic megacolon -no peristalsis because of absence of parasympathetic cells Volvulus -twisting of the intestinal organ Appendicitis
Manual dilation Reconstruction Position: side-lying Laxatives, Enema, digital extraction, avoid gas-forming food Swenson’s pull-through Barium enema Appendectomy within 24 hours Cold packs not more than 15 minutes
Alkalosis-vomiting, abdominal pain, abdominal distention Mcburney’s point Psoa’s sign: right hip flexion Rovsing sign Obturator sign: flexed then rotate internally
URINARY PROBLEMS DISEASE Renal Agenesis -absence of one or both kidneys MANIFESTATION Oligohydramnios, no urination Potter’s syndrome: Pulmonary hyperplasia Facial and limb abnormalities MANAGEMENT Kidney transplant
Cryptorchisdism -the testes fail to descend Hypospadias and Epispadias -Ventral nad dorsal Hydronephrosis Polycistic kidneys Wilm’s tumor
Urinary meatus unaligned Repeated UTI’s Abdominal pain Oliguria, systemic hypertension, potter facies Nephroblastoma
Orchiodexy (1-2 years old) HCG administration Urethroplasty Surgery Removal of the kidney and kidney transplant No palpation, nephrectomy, radiation therapy, chemotherapy NEPHROTIC SYNDROME Idiopathic Insidiousa Rare Extreme ^CHON,˅Fats,˅NA Not known
FACTOR Cause Onset Hematuria Edema Diet Prevention
ACUTE GLUMERULONEPHRITIS Immune reaction to GABHS Abrupt Profuse Mild Normal Prevent strep infection
4 major symptoms Proteinuria Hypoalbuminemia Edema Hyperlipidemia
