pediatric nursing concepts

8/6/2019 Pediatric Nursing Concepts

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PEDIATRIC NURSINGPEDIATRIC NURSINGPEDIATRIC NURSINGPEDIATRIC NURSINGADDITIONAL FACTSADDITIONAL FACTS

PREPARED BY: LIZA CLAIRE S. TORRNEO, BSN. RN.


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Stages of Development

Infancy is the period frombirth until age 1.

The toddler stage

istheperiod from ages 1 to 3.

The preschool stage lasts from3 to 6.

School-age refers to childrenages 6 to 12.

Adolescence is the period from

age 12 to

19.


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Psychosocial Development

A developmental framework for the entirelife span was first proposed by ErikErikson in 1959. Eriksons psychosocialtheory has been further refined butessentially remains the same today.

Erikson believed that the psychosocialdevelopment of the individualis a functionof the ego as well associal and biologic

processes. In order for the person togrow, he must resolve these crises andmaster the task at hand.


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Stages of PsychosocialTheory

Trust Vs. MistrustTrust Vs. Mistrust (birth(birth -- age 1).age 1).

Autonomy Vs. Shame & DoubtAutonomy Vs. Shame & Doubt (ages 1(ages 1--3)3)Initiative Vs. GuiltInitiative Vs. Guilt (ages 3(ages 3--6)6)

Industry Vs. InferiorityIndustry Vs. Inferiority (ages 6(ages 6--12)12)

Identity Vs. Role ConfusionIdentity Vs. Role Confusion (ages 12(ages 12--19)19)

IN ORDER FOR THE PERSON TO GROW, HEMUST RESOLVE THE CRISIS AND MASTER THETASK AT HAND.


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Cognitive DevelopmentCognitive DevelopmentAccording toJean PiagetJean Piaget, cognitive or

intellectual actsoccur when the

individualis adapting to andorganizing the perceived environmentaround him.

PiagetPiaget thought the childmoves throughfour stagesof cognitive development.

MOVING FROM RELATIVELY SIMPLE TO VERY

COMPLEX OPERATIONS.


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Cognitive DevelopmentCognitive Development

Sensorimotor stage (birth age 2)Object permanence

Casuality

Spatial relationship

Preoperational stage (age 2 7)Representationallanguage andsymbols

Transductive reasoning

Concrete Operational stage (ages 7-11)

Formal Operational Thought stage (ages 11-15)

IT IS THROUGH EXPERIENCE WITH THEENVIRONMENT THAT DEVELOPMENT IS PUSHEDAHEAD.


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Psychosexual Development!

Development of human sexuality isinfluencedby physical, emotional, and cultural aspectsin the society in which we live. Thissexuality is part of the total person, whichdevelopsovertime. Its expressed throughmany avenues, including a persons attitudes,feelings, beliefs, andself-image.

SIGMUND FREUD THEORIZED THAT SEXUALFEELINGS ARE PRESENT IN SOME FORMFROM THE NEWBORN PERIOD THROUGHADULTHOOD. HE FELT THAT HUMANNATURE HAS TWO SIDES: RATIONALINTELLECT AND IRRATIONAL DESIRES.


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Psychosexual Development Oral Stage ( birth age 1 )

Anal Stage ( ages 1 3 )

Phallic Stage ( age

s3 6 )

Latency Period ( ages 6 12 )

Genitalia Stage ( ages 12 andolder )

SATISFACTION MUST BE ACHIEVED BEFOREA PERSON CAN MOVE ON TO THE NEXTSTAGE. IF HE ISNT FULLY SATISFIED, ITSPOSSIBLE HE MAY NEVER FULLY COMPLETETHE STAGE.


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Moral Development

LAWRENCE KOHLBERGSLAWRENCE KOHLBERGS ideasofmoral reasoning (the basisof ethicalbehavior) are basedon the work of

Piaget and the American philosopherJohn Dewey. As the childsintelligence and ability to

interact with othersmature, hispatternsof moral behavior mature aswell.

MORAL DEVELOPMENT OCCURS THROUGHSOCIAL INTERACTION AND COULD BE

PROMOTED THROUGH FORMAL EDUCATION.


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Moral Development

Preconventionallevelof morality(ages 2 to 7)

Conventionallevelof morality

(ages 7 to 12 ) Postconventional autonomouslevelof

morality

(ages 12 andolder)KOHLBERG PROPOSED THREE LEVELS OF MORALDEVELOPMENT THROUGH WHICH THE PERSONMUST PASS. AS THE CHILD COMPREHENDS ANDUNDERSTANDS A STAGE, HE CAN THEN

PROGRESS TO THE NEXT STAGE.


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Caring for the Hospitalized ChildCaring for the Hospitalized Child

Hospitalization is a major stressor forany individual, but especially for achild.

Separation of the child from hisparents, siblings, and usualsupport

systems further adds to theemotionalstress.Added to these stressors are fear,

pain, anddiscomfort associated withthe childsillnessor injury, as well as

the diagnostic and therapeuticinterventions.

PARENTS SHOULD BE ALLOWED TO SPEND ASMUCH TIME AS POSSIBLE WITH THE HOSPITALIZED

CHILD.


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The Importance of Play

PlayPlay is an excellent stress reducer andtensionreliever. It allows the childfreedom of expressionto act out his fears, concerns, and anxieties.

Play provides a source of diversional activity,alleviating separation anxiety.

Play provides the child with a sense of safety andsecurity, because while playing, he knows that nopainful procedures willoccur.

Developmentally appropriate play foster the childsnormal growth and development.

Play allows the child tomake choices andgives hima sense of control.

PLAY IS THE MOST IMPORTANT ASPECTOF THE CHILD. IT BECOME EVEN MOREIMPORTANT TO A HOSPITALIZED CHILD.


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Assessing PAIN!

To help you stay focused when assessing pain theyoung patient, remember, QUEST.Q question the childs parents and the child too,

if hesold enough to respond.U - use appropriate pain assessment tools.E evaluate the childs behavior.S secure the parents active participation in

treatment.T take the cause of the pain into consideration.

THE CHILDS VITAL SIGNS CAN BE PAININDICATORS. ELEVATED PULSE, BLOOD PRESSURE,OR RESPIRATIONS CAN BE SIGNS OF PAIN ANDSTRESS.


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PAINFUL MEASURES

CRIES Inventory isone of the easier tools to use. Five separatefactors are scoredon a scale of 0 to 2. Infants with a score ofzero would be pain-free. A totalscore of 10 wouldindicateextreme pain.

CRIES Neonatal Postoperative Pain Measurement Scale

Neonatal InfantPain Scale

Facial Expression

Crying

Breathingpatterns

State of arousal

Movementsofarms andlegs

Premature Infant

Pain Profile

Gestational Age

Heart rate

Oxygen saturation

Behavioralstate

Brow bulge

Eye squeeze

Nasol

abia

lfurr

ow

C crying

R requires Oxygensaturation

I increase Heartrate andBlood

pressureE Expression

S - Sleeplessness


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Pain measures.for a child capable of speaking! FACES pain-measuring scale

For the child ages 3 andolder can use facesscale to rate his pain.

Visual analog scale

Issimply a straight line with phrase No painand at one end The most pain possible Chip pain-measuring tool

Uses four identical chips tosignify levelsofpain and can be used for a child who

understands the concept of adding1. This chip is just a little bit of hurt.

2. This next chip is a little more hurt.

3. This next chip is a lot of hurt.

4. Thislast chip is the most hurt you can have.


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MANAGING PAIN

Pharmacologic Intervention1. Opioid analgesics2. Non-opioid analgesics

3. Adjuvant therapiesNon-pharmacologic Intervention1. Cognitive-behavioral therapies

2. Physi

calTherapy3. Complementary Therapy

Morphine (MS Contin) andfentanyl(Duragesic), PCAs!

NSAIDs, acetaminophens

Antianx

iety

me

ds, ant

ic

onvu

lsant

s,Corticosteroids, etc.

Positioning,distraction,touching,gentle massage

Thermo

therapyMusic and Aroma therapy

PAIN MANAGEMENT IS MOST EFFECTIVE WHENIT PREVENTS, LIMITS, OR AVOIDS NOXIOUSSTIMULI AND INVOLVES ADMINISTERING

ANALGESICS.


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Sequence of Tooth EruptionTeeth Lower/Mandibular Upper/Maxillary Purpose

CentralIncisor

6-10 months 8-12 months Shear, cut

LateralIncisor

10-16 months 9-13 months Shear, cut

Cuspid 17-23 months 16-22 months TearFirstmolar

14-18months 13-19 months Grind, chew

Secondmolar

23-31 months 25-33 months Grind, chew

MOST NEONATES DONT HAVE TEETH.OCCASIONALLY, A NATAL TOOTH WILL BEPRESENT AT BIRTH. THIS TOOTH REQUIRES NOINTERVENTION UNLESS ITS LOOSE AND POSES ARISK OF ASPIRATION.

THE AVERAGE AGE AT FIRST TOOTH ERUPTION IS 8 MONTHS.


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Common Manifestations in an infantwho is teething:

DROOLING

EAR PULLING

COUGHING DUE TOEXCESSIVE SALIVA

CHIN OR FACILA RASHES

WAKEFULNESS

CHEEK RUBBING

LOSS OF APPETITE

DIFFICULTY BREASTFEEDING

Note:

Although some infantsexhibit vomiting,

diarrhea, and fever while

teething, nurses mustnot ascribe these

symptoms right away toteething. Further

assessment must be

performed to make surethat these signs and

symptoms are not causeby more serious

conditions such as

infection.


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Sleep Requirements in

InfancyAGE Hours of Sleep / Day

1 week 16

1 month 15 3 months 15

6 months 14

9 months 1412 months 13

THIS CHART SHOWS THE AMOUNT OF SLEEP PER24 HOURS ( including nighttime and naps ) NEEDED

BY INFANTS AGES 1 WEEK TO 12 MONTHS


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CHOKING HAZARDS These foods can easily cause choking and

should be avoidedduring infancy:

hotdogs nuts popcornhard candy ice cubesgrapes

uncooked vegetable chunks

lumps of peanut butter


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APGAR SCORINGCriteria Indicator 0 1 2

Appearance Color Pale orBlue

Acrocyanosis Totally Pink

Pulse Heart Rate Absent Less than100

More than100

Grimace Reflex

Irritability

No

Response

Grimace Vigorous cry

Activity MuscleTone

Limp SomeFlexion

ActiveMovement

Respirations RespiratoryEffort

Absent Slow andRegular

Good Cry

EACH ITEM IS GIVEN A SCORE OF 0, 1, 2.

Total scores of 0 -3 represent severe distress;

Scores of 4 6 signify moderate difficulty; and scoresof 7 10 indicate absence of difficulty in adjusting to

extrauterine life.


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Denver DevelopmentalDenver Developmental

ScreeningScreening TestTest The most widely used

developmentalscreening test for

young ch

ildren that have beendeveloped by Dr. William

Frankenburg and his colleaguesinDenver, Colorado.

Interpretation of scoresInterpretation of scores: Advanced, OK, Caution, Delay

Interpretation of testInterpretation of test:

Nor

ma

l, Su

spect, Unte

stab

le


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Newborn ReflexesNewborn Reflexes -- EyesEyes

Blinking or Corneal ReflexBlinking or Corneal ReflexInfant blinks at sudden appearance of a brightlight or at approach of an object toward cornea;

persists throughout life.Pupillary reflexPupillary reflex

Pupil constricts when a bright light shines towardit; persists throughout life.

Dolls eye reflexDolls eye reflexAs head is moved slowly to right or left, eyes lagbehind and do not immediately adjust to newposition of head; disappears as fixation develops;

if persists, indicate neurologic damage.


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Newborn ReflexesNewborn Reflexes -- NoseNoseSneezeSneeze

Spontaneous response of nasal passages

to irritation or obstruction; persistthroughout life.

GlabellarGlabellarTapping briskly on glabella (bridge of thenose) causes eyes to close tightly.


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Newborn ReflexesNewborn Reflexes Mouth & ThroatMouth & Throat

SuckingSuckingInfant begins strong sucking movements ofcircumoral area in response to stimulation; persiststhroughout infancy; even without stimulation, suchas during sleep.

GagGagStimulation of posterior pharynx by food, suction,or passage of a tube causes infant to gag; persistthroughout life.

RootingRootingTouching or stroking the cheek along side of mouthcauses infant to turn head toward that side andbegin to suck; should disappear at about 3-4months, but may persist up to 12 months.


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ExtrusionExtrusionWhen tongue is touched or depressed, infantresponds by forcing it outward; disappears by age4 months.

YawnYawnSpontaneous response to decreased oxygen byincreasing amount of inspired air; persiststhroughout life.

CoughCoughIrritation of mucous membranes of larynx ortracheobronchial tree cause coughing; persistthroughout life; usually present after first day of

birth.

Newborn ReflexesNewborn Reflexes Mouth & ThroatMouth & Throat


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Newborn reflexesNewborn reflexes -- ExtremitiesExtremities

GraspGraspTouching palmsof handsor solesof feet near base

of digits causes flexion of hands and toes.Palmar grasp lessens after age 3 months; to be

replaced by voluntary movement; plantar grasplessens by 8monthsof age.

BabinskiBabinskiStroking outer sole of foot upward from heel and

across ballof foot causes toes to hyperextend andhallux todorsiflex;disappears after age 1 year.

Ankle clonusAnkle clonusBriskly dorsiflexing foot while supporting knee in

partially flexed position resultsin one to twooscillating movements; eventually no beatsshould be

felt.


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Newborn ReflexesNewborn Reflexes -- MassMassMoroMoro

Sudden jarring or change in equilibrium cause suddenextension and abduction of extremities and fanning offingers, with index finger and thumb forming a C shape,followed by flexion and adduction of extremities;legsmay weakly flex;infant may cry;disappears after age3-4 months; usually strongest during first 2 months.

CrawlCrawlWhen placedon abdomen, infant makes crawling

move

ment

sw

ith ar

msan

dleg

s;dis

appears

at about age6 weeks.

Trunk incurvation (Galant) reflexTrunk incurvation (Galant) reflexStroking the infants back alongside spine causes hips tomove towardstimulatedside;disappears by age 4 weeks.


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Newborn ReflexesNewborn Reflexes -- MassMass

StartleStartleA sudden loud noise causes abduction of the arms withflexion of elbows; hands remain clenched;disappears byage 4 months.

Asymmetric tonic neckAsymmetric tonic neckWhen infants headis turned toside, arm andleg extendto that side, andopposite arm andleg flex;disappears byage 3-4 months, to be replaced by symmetric positioningof both sidesof body.

PlacingPlacingWhen infant is held upright under arms anddorsalsideof foot is briskly placed against hardobject, such astable, leg lifts asif foot isstepping on table; age ofdisappearance varies.


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Newborn ReflexesNewborn Reflexes -- MassMass

PerezPerezWhile infant is prone on a firmsurface, thumb is

pressed along spine fromsacrum to neck; infant

responds by crying, flexing extremities, andelevating pelvis and head;lordosisof the spine, aswell asdefecation and urination, may occur;disappears by age 4-6 months.

Dance or StepDance or StepIf infant is heldso that sole of foot touches a hardsurface, there is a reciprocal flexion and extensionof the leg, stimulating walking;disappears after age3-4 weeks, to be replaced by deliberate movement.


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II ron supplement (4 toron supplement (4 to6 months), immunization6 months), immunization

NN o choking hazardo choking hazard FF ear of strangerear of strangerpeaks at 8 monthspeaks at 8 months

AA llow to use a pacifierllow to use a pacifierif NPOif NPO

NN ote the weightote the weightchangeschanges

TT rust V.S. mistrustrust V.S. mistrust SS olitary play


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TT alk to the child atalk to the child at

simple termssimple terms

OO ffer choices to theffer choices to thechild to provide somechild to provide somecontrolcontrol

DD ont leave alone near theont leave alone near thebathtub or swimming poolbathtub or swimming pool

DD oubt and Shame Vs.oubt and Shame Vs.AutonomyAutonomy

LL earns about death @earns about death @age 3age 3

EE limination patternlimination pattern

RR rituals and routinesrituals and routines


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PP ushush--pull toyspull toys(mobile), parallel play(mobile), parallel play

(forget sharing)(forget sharing) RR rituals and routinesrituals and routines

(eyes & consistency),(eyes & consistency),

regressionregression AA utnomy VS shameutnomy VS shame

and doubt, accidentsand doubt, accidents

(death)(death) II nvolve parentsnvolve parents

SS eparation anxietyeparation anxiety

EE limination and explorelimination and explore


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PP lay islay isassociative/cooperativeassociative/cooperative

RR gression is commongression is common EE xplain proceduresxplain procedures

SS ame age group for roomame age group for roomassignmentassignment

CC -- uriousurious HH ighly imaginativeighly imaginative OO bserve for Initiative Vs.bserve for Initiative Vs.

GuiltGuilt

OO ff limits to the kitchenff limits to the kitchen(risk for poisoning and burn)(risk for poisoning and burn)

LL oss of body part is aoss of body part is acommon fearcommon fear


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SS ame sex stageame sex stage

CC ompetitive playompetitive play HH eroworshiperoworship

OO bserve for Industrybserve for Industry

Vs. InferiorityVs. Inferiority OO ff limits to vehiclesff limits to vehicles

LL oss of control is aoss of control is a

common fearcommon fear EE xplain proceduresxplain procedures

RR egression is commonegression is common


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DD eath (bogeyman),eath (bogeyman),honestyhonesty funerals andfunerals and

burialsburials II ndustry VS inferiorityndustry VS inferiority

(collections)(collections) MM odesty (privacy)odesty (privacy) PP eers (own sex)eers (own sex) LL oss of controloss of control

hospitalization,hospitalization,

encourage decisionencourage decisionmakingmaking

EE -- xplanation ofxplanation ofproceduresprocedures


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PP eer groupeer group activities, peeractivities, peer

pressurepressure AA ltered bodyltered bodyimageimage dont wantdont want

to be seen differentto be seen different II dentitydentity imageimage college or careercollege or career

RR ole diffusionole diffusion SS eparation fromeparation frompeerspeers

pediatric nursing concepts

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