Nursing Care of Nursing Care of ChildrenChildren

Nursing Care of Nursing Care of ChildrenChildren

Nursing 4000, Fall 2007Nursing 4000, Fall 2007

Module 1

Pediatric Basics

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ObjectivesUpon completion of this learning unit, the student will be able to:

• List the most frequent causes of mortality and morbidity during infancy, childhood, and adolescence.

• Describe at least two nursing interventions aimed at reducing mortality and morbidity in infancy, childhood, and adolescence.

• Identify at least three factors that make children more vulnerable to illness than adults.

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• Identify key differences between physical assessment findings in the pediatric versus the adult patient.

• Describe at least one illness for each system that is frequently seen in the pediatric population.

• Discuss methods of pain management for children based on their developmental stage.

• Discuss the role of play in the development of children.

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Pediatrics• Defined as the care of infants age 4

weeks through 18-21 years.

• Requires the nurse to:– understand the differences between adults

and kids at all stages of development– know developmental tasks of various stages– use different methods of assessment and

providing care

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Typically divided into…• Infancy: 4 weeks to 12 months• Toddlers: 13 - 36 months• Preschoolers: 3 – 5 years• School-Age: 6-11 years

• Emergence of the ‘Tweens’ age 9-11 years – This group of children receiving the attention of

the media, game and movie producers.

•Adolescents: 12+ years

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When working with pediatric patients, we discuss growth and development. It is important to note that these two terms refer to different processes.

– Growth refers to changes in the child’s body size.

– Development refers to changes in the child’s psychomotor abilities.

Growth and development should progress at a steady rate throughout childhood.

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History• Studies on the care of children began

in the 1800s.

• Early health care of children was primarily community based.

– Hospitals did not provide unique care for children until about the 1940s.

– Pediatric health care dramatically improved in 1950-1960s.

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Current Emphasis in Pediatrics

• Now on family centered care.– The pediatric ‘patient’ includes the child

and their family members.

• It is vital that parents not be separated from their child when at all possible.– All care planning must include the child

and the parents.

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3 Goals for all Pediatric Interactions

– Minimize the separation of the child from the family.

– Promote the child’s sense of control.

– prevent pain and minimize fear.

Morbidity and Morbidity and MortalityMortality

Morbidity and Morbidity and MortalityMortality

Special Considerations for the Special Considerations for the Pediatric PatientPediatric Patient

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Morbidity and MortalityThese words are used to describe the impact of injuries and illnesses on a population group.

– These terms are used to describe the incidence of various illnesses and injuries in childhood.

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• Morbidity refers to the prevalence of a specific illness in a population at a particular time.

– This number is expressed as cases per 1000.

– Morbidity may also refer to the long term, disabling affects of a given condition.

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• Mortality is the number of children who have died as a result of a particular illness or injury.

– This number is expressed as cases per 100,000 except infant mortality which is cases per 1000.

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Factors Contributing to Morbidity and Mortality in Children

The most significant factor contributing to morbidity and mortality in children is the individual child’s physical growth and developmental level.

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Factors Related to Morbidity and Mortality in Children

• Growth and Development– The child’s cognitive abilities are

related to chronological age.• The younger the child, the more limited

their cognitive abilities.

– Children have an inability to predict the consequences of their behaviors.• This doesn’t really improve until late

adolescence.

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– The child’s gross and fine motor skills are continuously improving.•What a child wasn’t able to do a short

time ago, they now can accomplish.•Parents are often surprised and may

say “she couldn’t roll over last week!”

– Children have a strong, natural curiosity that often places them in dangerous situations.

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• Some physical characteristics related to their age group also make children more susceptible to illness and injury.

– Some body systems continue to mature throughout childhood.

• This is particularly true of the neurological, immune, integumentary, and respiratory systems.

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• Sociocultural factors also contribute to morbidity and mortality in children.– Poverty increases a child’s risk for

abuse and neglect.• Environments of poverty typically

experience more violence affecting children.

– Having difficulty in school can also increase morbidity and mortality for children.

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– Increased numbers of single-parent families puts children at increased risk for illness and injury.

• Having only one parent in the home typically means a child spends more time under or unsupervised.

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Immigrant families are at increased risk for illness and injury.

•Children may not have had routine healthcare including immunizations.

•There may be a decreased ability to understand new risks associated with the environment.

•This is particularly true in families in which the children are more ‘Americanized’ than the children.

Working with ChildrenWorking with ChildrenWorking with ChildrenWorking with ChildrenSpecial Considerations Special Considerations

for the Nursefor the Nurse

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Working with Children

• Environment should be non-threatening.– Warm, appropriately lit, frightening

equipment out of sight.

• Make use of toys, particularly the kid’s favorites.

•Do invasive procedures in a treatment room not the child’s bed.

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Working with ChildrenPediatric nurses not only have to understand the pathophysiology involved in a particular situation but also have to interpret the the developmental needs of the child as well as the needs of the other family members.

This is the part of pediatric nursing that can be particularly

challenging.

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Here’s some tips for successful pediatric interactions…

• The environment should be non-threatening.– Warm, friendly, appropriately lit– Keep frightening equipment out of sight.

• Make use of toys, popular cartoon or movie characters.

•Involve the child’s favorite toy in your nursing care.

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• Provide time to get acquainted.– Introduce yourself and your role in

simple terms.– Older children can relate to being a

student.

• Do invasive procedures in a treatment room not the child’s bed.– This gives the child a ‘safe’ place

where bad things don’t happen.

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• Provide privacy.– Even young children want and need privacy

though this need must be carefully balanced with safety.

• Observe for signs that the child is ready for your to touch her/him.– This may include eye contact, body position.– The challenge is balancing the child’s

readiness with your need to get certain things done.

– Some negotiation may be necessary but only to a point. Use parents as your allies here!

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• Use words that are appropriate to the child’s developmental level.

– Be sure that directions and requests are simple and clear.

– Consult with parents to determine the presence of communication difficulties.

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• Finally, and probably most importantly, never offer a choice where none is intended!– We do this as a part of polite conversation.– Choices are important but be careful.

• “Do you want to take your medication now?” is an unacceptable choice.

• Saying “Do you want to take your medication with juice or water?” offers the child choices,both of which provide the outcome you’re seeking.

– Pay attention to the use of “okay?” at the end of your sentences. Children hear this as a choice which you may not intend it to be.

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Measuring vital signs is something you are all quite comfortable with.

Working with children can make this a bit more difficult.

Here’s some hints for success!

Vital Signs

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Start with the easiest things first. Count respiratory and heart rates while the child is quiet.– Getting your temperature taken may

be a frightening thing for a child.

– Getting your blood pressure taken may be a painful thing for a child…that cuff may be awfully tight on a little arm!• Describe this to the child as a hug around

their arm or a ‘muscle-meter’ to see how strong they are!

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Pediatric Care PrioritiesAirway

Breathing

Circulation

Disability

Environment

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• The ABCs will always provide you with a framework for setting care priorities.– D/Disability refers to a child’s injury

or other body area that may be impaired in some way.• For example, disability may refer to a

seizure, or vomiting depending on the specific situation.

– E/Environment refers to the child’s immediate physical environment and it’s safety for that child.

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Continue with your physical assessment.

• The concepts of physical assessment of adults apply here too; however, when working with children, these suggestions may help

• Start with less invasive assessment (peripheral vascular, skin) and continue to more invasive (eyes, ears, nose).

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• Focus your assessment as needed.

• Make each step of the process a game…”I want to hear the sounds your tummy makes.”

•How successful your physical assessment is depends on how well you’ve established trust with this child.

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• Review your MAPS and physical assessment skills from 310 or 320.

• You will use your MAPS assessment with children.

–Think about ways in which you alter your MAPS approach when working with an infant, toddler, preschooler, school-age child, or teen.

Pediatric Pediatric DevelopmentDevelopment

Pediatric Pediatric DevelopmentDevelopment

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Working with Children of Different Ages

The following slides are grouped first by developmental stage to highlight the unique needs of each group as well as the most common causes of morbidity and mortality.

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Infancy• Birth to 1 year• The period of most rapid growth and development

in the lifespan.• Morbidity & mortality during infancy related to:

– congenital anomalies– low birth weights– SIDS– Accidents, closed head trauma and falls

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• Infants are completely dependent on adults for their safety and well being.

• Fatal accidents among infants during first year of life is significantly related to the cognitive level of the mother.

Factoid: Fatal accidents double among infants of mothers who have not completed at least 8 years of school when compared to those mothers with high school educations.

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Toddlers• 13-36 months• Naturally curious and

very active with increasing mobility.

• Growth and development slows some.

• Trying to establish independence from parents.– Very egocentric

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• Favorite words: No! Me!

• Separation anxiety 18-24 months

– This is important to remember in the healthcare setting.

– Not until age 2 that kids able to understand that parents exist even when they can’t see them.

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• Morbidity & mortality for toddlers is related to:

– accidents: closed head trauma, motor vehicle accidents, drowning, burns, foreign bodies, playground injuries, the actions of siblings, homicides

– congenital anomalies, cancer

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Preschoolers• 3-5 years• Has achieved some

independence from parents with simple tasks.– Toilet trained around 3rd

birthday.

• Growth begins to slow.• Can follow simple rules,

developing a sense of right and wrong.

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• Gross motor skills well defined. A preschooler can walk, run, jump and climb efficiently.

• Fine motor skills developing. Preschoolers enjoy coloring, drawing, manipulating smaller toys.

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• Can identify and verbalize simple feelings and is beginning to understand that their behavior affects others.

• Favorite word: Why?

• Morbidity & mortality risks same as toddlers.

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School-Age• 6-11 years• Fine motor skills

continue to develop.• Eager to please parents

and other adults.• Friends becoming more

important.– Compares self to others.– Early peer pressure,

particularly with regard to clothes, possessions.

• Learning rules, ‘winners’ and ‘losers.’

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• They have the beginnings of problem solving skills, learning social skills and how to work in a group setting.

• There are dramatic increases in cognitive skills during this period. Children want acknowledgement for that.

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• School age children can think about the future.

• Mortality & morbidity related to:– Accidents: similar causes but child

may be more responsible as they typically have less adult supervision as they move through this age group.

– Congenital illnesses and cancers

• Favorite words: ‘I know that.’

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Adolescence• 12+ years• Teenagers are really toddlers with money and

car keys.• Central struggle is for independence

– Peers more important to them than family.– Significant peer pressure in most areas.

• Puberty begins.• Participating in group activities and fitting in is

vital.

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• Experimentation and risk-taking is common during adolescence.

– They get their driver’s license.– Drinking, smoking, and drugs.– Participation in sports with more risk

(skateboarding, rock climbing)– Sexual experimentation.

• Some teens begin to commit to personal values and morals.

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• Morbidity & mortality related to:– accidents-motor vehicle accidents of all

types, • Drowning• sports injuries• head trauma• firearm injuries• farming and occupational injuries

– cancers– homicide– suicide

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Your next step…• There are 7 additional PowerPoint

presentations for you to watch. Each one is related to one of the functional patterns. You may view these in any order and at any time.

• Good luck and enjoy!

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