Chapter 30 Basic Pediatric Nursing Care. College of DuPage Grant # CB A-17 - PN Program Toolkit

Transcription

1 Chapter 30 Basic Pediatric Nursing Care 1

2 NCLEX Test Plan Categories 3. Health Promotion & Maintenance Developmental Stages

3 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: year old Identity versus identity confusion

4 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

5 NCLEX Test Plan Categories 3. Health Promotion & Maintenance

6 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

7 Pediatric Nursing Partnerships with Parents Parental involvement Parents are treated as equals Parents of special needs children often become experts

8 Pediatric Nursing Future Challenges for the Pediatric Nurse Shift from treatment of disease to promotion of health Technological advances Adolescent medicine

9 NCLEX Test Plan Categories 3. Health Promotion & Maintenance Developmental Stages

10 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

11 NCLEX Test Plan Categories 3. Health Promotion & Maintenance Screening Programs

12 Physical Assessment of the Pediatric Patient See Christensen Box 30-3 & 30-4 Growth Measurements Length Measurements are taken when children are supine until 2 years of age. Height Measurement is of a child standing upright.

13 Figure 30-1 (From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong s nursing care of infants and children. [7 th ed.]. St. Louis: Mosby.) Measurement of head, chest, and abdominal circumference and crown-toheel measurement.

14 Physical Assessment of the Pediatric Patient Growth Measurements (continued) Weight Head circumference Skin Thickness

15 Figure 30-2 (From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong s nursing care of infants and children. [7 th ed.]. St. Louis: Mosby.) A, Infant on scale. B, Toddler on scale.

16 NCLEX Test Plan Categories 7. Reduction of Risk Potential Vital Signs

17 Physical Assessment of the Pediatric Patient 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.

18 Physical Assessment of the Pediatric Patient 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

19 NCLEX Test Plan Categories 3. Health Promotion & Maintenance Data Collection Techniques

20 Physical Assessment of the Pediatric Patient Head-to-Toe Assessment Skin Pallor: anemia, chronic disease, edema, or shock. Erythema: increased temperature, local inflammation, or infection.

21 Physical Assessment of the Pediatric Patient 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.

22 Physical Assessment of the Pediatric Patient Head-to-Toe Assessment (continued) Nose, Mouth, and Throat Lungs Not crying. Have them blow out. Chest Asymmetry may indicate serious underlying problems.

23 Physical Assessment of the Pediatric Patient 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

24 Figure 30-7 (From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong s nursing care of infants and children. [7 th ed.]. St. Louis: Mosby.) Development of spinal curvatures.

25 Physical Assessment of the Pediatric Patient Head-to-Toe Assessment (continued) Extremities Examine for symmetry, range of motion, and signs of malformation Renal Function

26 Physical Assessment of the Pediatric Patient Head-to-Toe Assessment (continued) Anus Check the anal sphincter History of bowel movements Assess for perianal itching; may be pinworms. Genitalia

27 NCLEX Test Plan Categories 3. Health Promotion & Maintenance Developmental Stages

28 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

29 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

30 Factors Influencing Growth and Development Nutrition Metabolism Sleep and rest

31 NCLEX Test Plan Categories 3. Health Promotion & Maintenance Developmental Stages and Transitions

32 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 30-9

33 NCLEX Test Plan Categories 1. Coordinated Care Advocacy Client Rights Informed Consent Legal Responsibilities

34 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.

35 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

36 Hospitalization of a Child Developmental Support for the Child Interruption of normal routines and threatens normal developmental process Children to regress when hospitalized

37 NCLEX Test Plan Categories 5. Physiological Integrity: Basic Care and Comfort Validate pain using rate scale.

38 Hospitalization of a Child Pain Management Wong-Baker Faces Scale Non verbal behaviors of pain

39 NCLEX Test Plan Category 8. Physiological Adaptation Perform care for client before and after surgical procedure.

40 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

41 NCLEX Test Plan Categories Physiological Integrity 5. Basic Care and Comfort ADLs

42 Bathing Common Pediatric Procedures 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.

43 NCLEX Test Plan Categories Physiological Integrity 5. Basic Care and Comfort ADLs and Care of feeding tubes

44 Feedings Common Pediatric Breastfeeding Procedures 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

45 NCLEX Test Plan Categories 2. Safety Injury Prevention

46 Common Pediatric Procedures Safety Reminder Devices Types Elbow safety reminder Mummy safety reminder Clove-Hitch safety reminder Jacket safety reminder

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

48 NCLEX Test Plan Categories Physiological Integrity 7. Reduction of Risk Potential Diagnostic Tests

49 Common Pediatric Procedures Urine Collection Methods of Collection Suprapubic bladder tap Plastic urine collection bags Catheterizations

50 Figure Suprapubic bladder aspiration.

51 Figure (From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2 nd ed.]. St. Louis: Mosby.) Application of a urine collection bag.

52 Figure Venipunctures to Obtain Blood Specimens (From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2 nd ed.]. St. Louis: Mosby.) Correct position for jugular venipuncture procedure.

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

54 Figure Lumbar Puncture (From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2 nd ed.]. St. Louis: Mosby.) A, Modified side-lying position for lumbar puncture. B, Older child in sidelying position.

55 NCLEX Test Plan Category Safe and Effective Care Environment 1. Coordinated Care Resource Management Recognize client need for materials and equipment

56 Common Pediatric Procedures Oxygen Therapy Methods Hood and incubator Mist tents Nasal cannula

57 Figure (From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2 nd ed.]. St. Louis: Mosby.) Oxygen is administered to an infant by means of a plastic hood (Oxy- Hood).

58 NCLEX Test Plan Category 8. Physiological Adaptation Intervene to improve client respiratory status

59 Common Pediatric Suctioning Procedures 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

60 NCLEX Test Plan Categories 3. Health Promotion & Maintenance

61 Common Pediatric Procedures 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

62 NCLEX Test Plan Categories Physiological Integrity 6. Pharmacological Therapies

63 Common Pediatric Procedures 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.

64 Common Pediatric Procedures Medication Administration (continued) Routes of Administration Oral Intradermal, subcutaneous, and intramuscular Intravenous Optic, otic, and nasal Rectal

65 Figure (Courtesy of Marjorie Pyle, RNC, Lifecircle, Costa Mesa, California.) Intramuscular injection sites.

66 NCLEX Test Plan Category Safe and Effective Care Environment 2. Safety

67 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.

68 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 nongovernmental 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 noncommercial use only.