NUR 425

What is a Pediatric Nurse?1Philosophy of Pediatric NursingFamily-Centered Care

Atraumatic Care

Evidenced-based practice2Nursing Process: Growth and DevelopmentAssessmentNursing diagnosisOutcome identification and planningImplementationOutcome evaluation

3Growth and Development Growth increase in size and weight

Development gradual change to a more advanced stage of complexity

Maturation increase in competence and adaptability, makes it possible for functioning at a higher level4Principles of Growth and DevelopmentHead to Toe (cephalocaudal)Near to Far (proximodistal)Simple to complex functions (differentiation)Predictable sequenceDoes not progress at constant rateBody system differences in patterns and ratesCritical periods when particular influences must be present

5THE FOUR STAGES OF LIFE:

1) You believe in Santa Claus. 2) You don't believe in Santa Claus.3) You are Santa Claus.4) You look like Santa Claus.

6Developmental Age PeriodsPrenatal Conception to birthInfancy Birth to 12 mo. Neonatal - Birth to 27 or 28 daysEarly Childhood - 1-6 yr Toddler 1-3 yr Preschool 3-6 yrMiddle Childhood 6- 11 or 12yrLater Childhood 11-19 yr Prepubertal 10-13 yr Adolescence 13-18 yr7Influences on Growth and DevelopmentFamily Structure Parenting Styles Birth Order (ordinal position)Culture Race Ethnicity Subculture NationalityReligion

8Socioeconomic Status

School / Education / Teachers

Peers / Socialization

Heredity

Nutrition

Prenatal Health Care

Gender9Nursing Care Implications of Diet and Nutrition(cont.)MyPlate guidelinesVariety of foodsBalance; portion size; physical activityGrain products, fruits, and vegetablesDiet low in fat, saturated fat, and cholesterolModerate: sugars, salt/sodium, alcoholHealth Care

Disease

Environment

Media

Temperament

11Developmental TheoristsEriksons Theory of Psychosocial Development

Piagets Theory of Cognitive Development

12Theorists:FreudKohlbergEriksonPiagetWhat does your theorist study?Look at toddler development according to your theorist. Develop a nursing plan for a toddler based on the principles of the theorist. (How would the theory influence your care of the toddler patient?)Pick someone in your group to share your information.A world without children is a world without newness, regeneration, color, and vigor Gods Little Instruction Book for Parents

14 Please pick up a crossword puzzle and see how much you can complete.15Unit 1: Infant

NOTE:To change images on this slide, select a picture and delete it. Then click the Insert Picture iconin the placeholder to insert your own image.16

Physical GrowthWeight doubles by 4-6 mo. triples by 12 mo.Length increases by 50% by 12 mo doubles by 2 yrn

NOTE:To change images on this slide, select a picture and delete it. Then click the Insert Picture iconin the placeholder to insert your own image.17Organ System MaturityNOTE:To change images on this slide, select a picture and delete it. Then click the Insert Picture iconin the placeholder to insert your own image.

NeuroFontanelsReflexesCardiovascularBloodRespiratoryGIGUImmunity18Psychosocial DevelopmentErikson Stage:NarcissismLittle tolerance for delayed gratificationNOTE:To change images on this slide, select a picture and delete it. Then click the Insert Picture iconin the placeholder to insert your own image.

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Stranger Anxiety&Separation Anxiety20Progress from primitive reflex behaviors to voluntary acts

Body image development (separates self from environment)

Object permananceCognitive DevelopmentPiaget Stage: Sensorimotor

21Gross Motor head control, sitting, standing, walking, running, coordination

Fine Motor use of hands and fingers

Language development of language skills

Personal/ Social personality/ social development / self care

Developmental Milestones Defined22

Communication23PlayThe work of childrenWay of learning and practicing new behaviorsHelp parents understand importance

24SafetyInjuries major cause of death in infancyneed for constant supervision/ safety measuresChildproofing before they are needed assess home environment25Nurses Role

26Group 1Gross Motor / Fine MotorGroup 2LanguageGroup 3Personal / Social : Sensory & Solitary PlaySkill & Imitative PlayGroup 4Safety: Car / WaterGroup 5Safety: HomeGroup 6Safety: Sleep27SafetyCarUse car seat (federally approved), properly attached and used correctlyRear facing seat for 1st year and till 20 lbsBackseat safest area of carCar seat till age 4 or 40 lbs, then booster till 9yr, 4ft. 9 inchesFront passenger airbags back seat till 13yr

28SafetyHomeAspirationSuffocationFallsBurnsPoisoningsWater

29Promoting Healthy Sleep and RestSafe sleepEstablish routine at 4 monthsMinimize stimulation during night

NOTE:To change images on this slide, select a picture and delete it. Then click the Insert Picture iconin the placeholder to insert your own image.30NutritionBirth to 6 Mo.Schedule Burping Spitting Up Monitor

31Nutrition (cont)6mo to 12 mo. Nutrition needs breast milk or formula still main source , if breast feeding stopped, substitute iron fortified formula, not more than a quart per day32Solid FoodsInfants not developmentally ready for solids till after 4 monthsSigns of Readiness for Solids:Head controlAble to sit with helpTooth eruption is starting extrusion reflex is disappearing33Solid FoodsFirst food usually iron fortified cerealJuice good source of Vit. C, after 6 mo.New Foods add new foods, one at a timeBaby Foods pureed, strained, or mashedavoid combination productsdont add fat, salt or sugarnot in bottle34Solid Foods (Cont)Finger Foods crackers at 6 mo.cheerios at 9 mo.junior and chopped table food after 9 mo.Weaning from bottle to cup by 12 mo tooth decaySelf-feeding

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Common Developmental ConcernsPromoting Healthy Teeth and GumsThumb Sucking vs. PacifiersTeethingDiaper RashSpitting up

36Case Study- hospitalized infantBobby baby, age 8 months has been hospitalized with croup. What kinds of stressors would he face?What interventions could the nurse take to minimize the effects?37Case Study -The mother of six week old Ernie infant tells the nurse that her son has been very fussy and cries a lot, especially in the evening. She is concerned he might be sick, and says the constant crying is driving she and her husband crazy.What other information would the nurse want to know about this situation?What is probably wrong with this baby?38)

Group 1Increasing the number of mothers who exclusively breastfeed until 6 months of ageGroup 2Reducing the rate of infant deathsGroup 3Increasing immunization levels for universally recommended vaccines among young childrenGroup 4Increasing age-appropriate vehicle restraint systems in children aged 0 to 12 monthsGroup 5Decreasing the number of children who die from sudden infant death syndrome (SIDS)39Nursing Care of a Family when a Child has a Gastrointestinal DisorderChapter 45

The Beginning and the End40Differences between the adult and pediatric clientSwallowingStomach capacity For infants or nonverbal children must monitor behavioral changes

41Differences between the adult and pediatric clientWater balanceextracellular fluid(ECF)body surface areabasal metabolic ratekidney functionfluid requirements42Nursing DiagnosisImpaired Parenting related to interference with establishing the infant-parent bondInterrupted family processes related to a chronic illness in childRisk for deficient fluid volume related to chronic diarrheaImbalanced nutrition, less than body requirements, related to malabsorption of necessary nutrientsSituational low self esteem related to feelings of being different resulting from special dietary restrictions

43AssessmentFailure to thriveSpitting up/regurgitationNausea, vomiting, diarrhea, constipationAbdominal pain, distention, GI bleeding44AssessmentJaundiceDysphagiaHypoactive, hyperactive, or absent bowel sounds45Observation & Physical ExamGrowth and DevelopmentGeneral AppearanceAlways assess for dehydration46Diagnosis and Therapeutic TechniquesLabsBowel StudiesAbdominal radiographsAbdominal &pelvic ultrasounds

Familiy/Child need preparation for procedures47 answer the following questionsStephen is a 5 month old infant visiting the well-child clinic for his second series of immunizations.Stephen weighed 7lb and was 20in long at birth. On the basis of normal growth and development parameters, what should his weight be at this visit?List a normal set of vital signs that may be assessed from Stephen.On what physiologic principle might the physician prescribe a vitamin with iron?Stephens mother is eager to feed him solid foods and asks you if it would be recommended. What response would you give? Why?48Health Promotion and Risk ManagementTeach proper hand washing and food prepTeach nutritional guidelinesPromote family bonding by eating at least one meal as a familyTeach S&S of GI dysfunction (diarrhea and vomiting)49Fluid, Electrolyte, and Acid Base ImbalancesDaily Maintenance Fluid Requirements Table 45.1 pg 1313

Up to 10 kg> 100ml/kg/24 hr11-20kg> 1000ml + (50ml/kg for wt>10 kg)24hr>20kg> 1500ml + (20ml/kg for wt > 20kg)/24hrDivide total amount by 24hr to obtain hourly rate50