chapter 30 basic pediatric nursing care · pdf filebasic pediatric nursing care chapter 30 ......

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Chapter 30Basic Pediatric Nursing CareChapter 30Basic Pediatric Nursing Care

College of DuPage – Grant # CB-15948-07-60-A-17 - PN Program Toolkit

NCLEX Test Plan Categories

3. Health Promotion & Maintenance

Developmental Stages


Concepts of Child Development

• Infancy: birth to 1 year– Trust versus mistrust

• Toddler: 1-3 year-old– Autonomy versus shame and doubt

• Preschool: 3-5 year-old– Initiative versus guilt

• School age: 6- 12 year old– Industry versus inferiority

• Adolescence: 13-18 year old– Identity versus identity confusion


Pediatric Nursing• Purpose of Pediatric Nursing

– Preventing disease or injury– Achieving and maintaining an optimum

level of health and development– Treating and rehabilitating children who

have health deviations


Pediatric Nursing• Family-centered Care

– A philosophy of care – Family as the constant in the child’s life

and holds that systems and personnel must support, respect, encourage, and enhance the strengths and competence of the family

See Box 30-2


Pediatric Nursing• Partnerships with Parents

– Parental involvement– Parents are treated as equals – Parents of special needs children often

become experts


Pediatric Nursing• Future Challenges for the Pediatric

Nurse– Shift from treatment of disease to

promotion of health – Technological advances – Adolescent medicine


Pediatric Nursing• Nursing Implications of Growth and

Development– Measurement of physical growth

• Percentiles on growth charts– Anticipatory guidance

• Psychological preparation of a patient for an event expected to be stressful

See Health Promotion Considerations Christensen pg. 955 and Table 30-1




Screening Programs


Physical Assessment of the Pediatric Patient

• Growth Measurements – Length

• Measurements are taken when children are supine until 2 years of age.

– Height• Measurement is of a child standing upright.

See Christensen Box 30-3 & 30-4


Figure 30-1

Measurement of head, chest, and abdominal circumference and crown-to-heel measurement.

(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants and children. [7th ed.]. St. Louis: Mosby.)



• Growth Measurements (continued)– Weight– Head circumference– Skin Thickness


Figure 30-2

A, Infant on scale. B, Toddler on scale.




7. Reduction of Risk Potential

Vital Signs



• Vital Signs– Temperature

• Reflects metabolism• Routes: oral, rectal, axillary, and tympanic• Normal findings approximately 97° F to 99° F

– Heart Rate/Pulse• Apical pulse: infants and young children; radial

pulse: children 5 years of age and older• Pulse rate should be counted for 1 full minute.



• Vital Signs (continued)– Respirations

• Rate, depth, and quality should be assessed.• 1 full minute in infants• Rate may be as rapid as 40 to 50 breaths per

minute, gradually slowing to 25 to 32 per minute.– Blood Pressure

• Children 3 and older.• Use anticipatory guidance




Data Collection Techniques



• Head-to-Toe Assessment– Skin

• Pallor: anemia, chronic disease, edema, or shock.

• Erythema: increased temperature, local inflammation, or infection.



• Head-to-Toe Assessment (continued)– Accessory Structures

• Hair• Nails• Handprints and footprints

– Eyes– Ears

• Inspect for general hygiene.• Advise parents and children to clean the ears

with a washcloth; wipe only the outer portion of the canal with a swab.

• Mineral oil may be used to soften cerumen.College of DuPage – Grant # CB-15948-07-60-A-17 - PN Program Toolkit


• Head-to-Toe Assessment (continued)– Nose, Mouth, and Throat– Lungs

• Not crying.• Have them “blow out.”

– Chest• Asymmetry may indicate serious underlying

problems.



• Head-to-Toe Assessment (continued)– Back

• Newborn is C-shaped.• Older child typically has S-shaped curve.• Marked curvature in posture is abnormal.

– Abdomen• Inspection: cylindrical and flat• Auscultation: listen for peristalsis


Figure 30-7

Development of spinal curvatures.




• Head-to-Toe Assessment (continued)– Extremities

• Examine for symmetry, range of motion, and signs of malformation

– Renal Function



• Head-to-Toe Assessment (continued)– Anus

• Check the anal sphincter• History of bowel movements • Assess for perianal itching; may be pinworms.

– Genitalia


Normal Development• Infancy

– Gross Motor• Head control• Locomotion

• Toddler– Parallel play– Gross Motor

• Running/skipping/hopping/jumping – Fine Motor

• Scribble/draws circle• Preschool

– Refines gross motor and fine motor skills– Cooperative play– Seeks information


Normal Development• School age

– Learns work habits, organization, goals– Refines gross/fine motor skills– Socialization skills

• Adolescent– Peers important– Develop value system– Philosophy of life


Factors Influencing Growth and Development

• Nutrition• Metabolism• Sleep and rest




Developmental Stages and Transitions


Factors Influencing Growth and Development

• Speech and Communication– Crying at birth– Cooing, laughing, or babbling.– By 9 months, infants practice and repeat the noises

they can make– A 1-year-old has a three- to four-word vocabulary; by

18 months, they usually know 25 to 50 words; by 2 years, they may know more than 250 words.

– Rule: # words in sentence = age + 1– Non verbal communication

See Christensen Box 30-9College of DuPage – Grant # CB-15948-07-60-A-17 - PN Program Toolkit

NCLEX Test Plan Categories1. Coordinated Care

AdvocacyClient Rights

Informed ConsentLegal Responsibilities


Hospitalization of a Child• Preadmission Programs

– Child’s level of understanding and stage of development

– An emergency admission thrusts the child into an unknown environment surrounded by strange equipment, frightening sounds, and unfamiliar adults.


Hospitalization of a Child• Hospital Policies

– Parental involvement– After a child is admitted, a nursing

history is obtained; an identification bracelet is usually worn on the wrist.

– Vital signs and weight are measured and recorded.

– Blood samples drawn by a laboratory technician


Hospitalization of a Child• Developmental Support for the Child

– Interruption of normal routines and threatens normal developmental process

– Children to regress when hospitalized



5. Physiological Integrity: Basic Care and Comfort

Validate pain using rate scale.


Hospitalization of a Child• Pain Management

– Wong-Baker Faces Scale– Non verbal behaviors of pain


NCLEX Test Plan Category

8. Physiological Adaptation

Perform care for client before and after surgical procedure.


Hospitalization of a Child• Surgery

– Anticipatory guidance– Six Common Stress Points

• Admission, blood tests, the afternoon of the day before surgery, injection of preoperative medication before and during transport to the operating room, and return to the postanesthesia care unit



Physiological Integrity

5. Basic Care and ComfortADLs


Common Pediatric Procedures

• Bathing– Use dry hands to pick up the infant.– Allow play and splash.– Toddlers love to be placed in a tub for their

bath.– Toys should be provided.– Never be left in a tub without supervision.– School-aged children may be reluctant to

bathe; encourage them to participate in their care.

– Adolescents; privacy is important.College of DuPage – Grant # CB-15948-07-60-A-17 - PN Program Toolkit



5. Basic Care and ComfortADLs and

Care of feeding tubes



• Feedings– Breastfeeding

• If the mother is unable to be present for every feeding, encourage her to use a breast pump; bottles of breast milk can be frozen and given later by bottle or tube feeding.

– Solids– Gavage– Gastrostomy– TPN



2. Safety

Injury Prevention



• Safety Reminder Devices– Types

• Elbow safety reminder• Mummy safety reminder• Clove-Hitch safety reminder• Jacket safety reminder


Figure 30-10

Mummy restraint.

(From Lowdermilk, D.L., Perry, S., Bobak, I.M. [1997]. Maternity & women’s health care. [6th ed.]. St. Louis: Mosby.)




7. Reduction of Risk PotentialDiagnostic Tests



• Urine Collection– Methods of Collection

• Suprapubic bladder tap• Plastic urine collection bags• Catheterizations


Figure 30-11

Suprapubic bladder aspiration.


Figure 30-12

Application of a urine collection bag.

(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St. Louis: Mosby.)


Figure 30-13

Correct position for jugular venipuncture procedure.


Venipunctures to Obtain Blood Specimens


Figure 30-14

Position for femoral venipuncture procedure.



Figure 30-15

A, Modified side-lying position for lumbar puncture. B, Older child in side-lying position.


Lumbar Puncture



Safe and Effective Care Environment 1. Coordinated CareResource Management

Recognize client need for materials and equipment



• Oxygen Therapy– Methods

• Hood and incubator• Mist tents• Nasal cannula


Figure 30-16

Oxygen is administered to an infant by means of a plastic hood (Oxy-Hood).




8. Physiological Adaptation

Intervene to improve client respiratory status



• Suctioning– Bulb syringe, straight suction catheter– Depth: approximately 1/4 to 1/2 inch– Timing: not more than 5 seconds– Frequency: allow 30 seconds between

attempts



• Intake and Output– All fluids given to a child are

documented on a record kept at the bedside

– All urine voided is measured before it is discarded; weigh diapers




6. Pharmacological Therapies



• Medication Administration– Compute the dose correctly – Dosages must be checked by a second nurse for

safety– The right amount of the right medication must be

given to the right child at the right time and via the right route.

– Observe and document a child’s response to the drug.

– Consider age, body weight, and body surface area.



• Medication Administration (continued)– Routes of Administration

• Oral• Intradermal, subcutaneous, and

intramuscular• Intravenous• Optic, otic, and nasal• Rectal


Figure 30-17

Intramuscular injection sites.

(Courtesy of Marjorie Pyle, RNC, Lifecircle, Costa Mesa, California.)



Safe and Effective Care Environment 2. Safety


Safety• Protect child from harm • Anticipatory guidance • Health teaching• Injuries cause more deaths and disabilities

in children • Parents and children should talk and listen

to each other to prevent many accidents.• The adult who is a role model can influence

a child immensely.


• This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented by the U.S. Department of Labor’s Employment and Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational non-commercial use only.


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