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