pediatrics acute care kim martin, rn,msn nursing instructor harrisburg area community college...
TRANSCRIPT
Pediatrics Acute Care
Kim Martin, RN,MSN
Nursing Instructor
Harrisburg Area Community College
Pediatric Lab Day
2012
Communication with Children
• Infants– -Respond quickly, soothing,
mothering tone– Gentle handling, no sudden
movements – Hold infant firmly and close to
body for security– Stranger anxiety 4-6months
Communication with Children
• Toddlers– Give toddlers their space– Talk with parents first so they
can see that parents accept you
– Routine– Simple words and directions– Play!
Communication with Children
• Preschooler– Strives for independence– Give choices– Use doll or puppet to help
explain procedures– Let them touch and explore the
equipment– Be honest
Communication with Children
• School Age– Use concrete explanation– Formal presentations– Answer questions honestly– Concerned about mutilation
Communication with Children
• Adolescents– Concrete, logical, abstract– Do not demean them– Observe language, actions and
body language– Social connections are most
important
Assessment
• Obtain history first• Head to toe• Save ears and perineal area
for last • Observe parent’s interactions• Growth and Development• Nutritional status• Hygiene• Behavior
Assessment
• Temperature– Temporal– Axillary– Rectal for infants
Assessment
• Pulse– Take apical– Count for one full minute
AGE RANGE
Infant 100-140
Toddler 90-120
Preschooler 80-120
School Age 70-110
Adolescent 60-100
Assessment
• Respirations
AGE RANGE
Infant 26-40
Toddler 20-30
Preschooler 20-25
School-Age 17-22
Adolescent 15-20
Assessment
• Blood Pressure
AGE RANGE
Infant 74/50 – 100/70
Toddler 80/50 - 112/70
Preschooler 82/50 – 110/78
School Age 84/54 -120/80
Adolescent 94/62- 140/88
Assessment
• Weight and Height– Infant- naked and no diaper– Children
• Head Circumference– Chest and abdominal
circumference as per institutional policy
Assessment
• Pain- 5th vital sign– Must assess with vital signs– Use faces scale for toddlers
and preschooler– Numeric scale for older
children
Assessment
• Face pain scale
Assessment
• University of Wisconsin Children’s Hospital Pain Scale
Vocal/cry No cry Occasional Whimpers
Moaning, gentle cry
Consistent cry that increases in volume and duration
Facial Smiling, calm, relaxed
Neutral expression, frowning, occasional grimace
Occasional tense expression; slightly negative expressions; brow bulge
Marked distress; Brow bulge; eyes squeezed shut; open mouth; taut tongue
Behavior Neutral, moves easily; interacts with people or environment; strong suck
Easy to console with holding, position change; or sucking; winces when touched/moved
Consoles with moderate difficulty; sucks for very short time; followed by crying; cries when moved or touched
Inconsolable; absent or disorganized sucking; high pitched cry or scream when touched or moved
Body Movement/Posture
Normal motor activity; baseline muscle tone
Fidgeting; mild hyper tonicity above baseline
Moderate agitation or moderate immobility; intermittent flexion; moderate hyper tonicity above base line
Thrashing; flailing; incessant agitation or strong voluntary immobility; pronounced flexion; strong hyper tonicity above baseline
Sleep Sleeping quietly with easy respirations; normal sleep/rest periods
Restless while asleep
Sleep periods shorter than normal, awakes easily, sleeps intermittently
Unable to sleep or sleeping for prolonged periods of time interrupted by jerky movements
Overall Rating 0 1 2 3 4 5
Assessment
• Pain– Pain management
• Non-pharmacological• Pharmacological
– Invasive procedure• EMLA- Eutectic Mixture Local
Anesthetic or LMX• Apply 30 minutes before
procedure• Cover with occlusive dressing
Developmental Approach
• Infant– Trust– Stranger Anxiety– Memory of past experience
Developmental Approach
• Toddler– Autonomy– Preoperational thought– Negativism– Ritualism– Limited language– No concept of time
Developmental Approach
• Preschooler– Initiative– Concrete– Egocentrism– Fear of bodily harm– Illness is punishment
Developmental Approach
• School Age– Industry– Concrete– Increased language skills– Understanding of time– Self control– Relationships with peers
Developmental Approach
• Adolescent– Identity- self concept– Formal operations– No concern for the future– Peers
Milestones
• ..\child-development-milestone-chart.pdf
• http://www.child-development-guide.com/child-development-milestone.html