Pediatrics Acute Care Kim Martin, RN,MSN Nursing Instructor Harrisburg Area Community College...

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