Pediatric Nursing

Focus: Newborn, Infancy, Early Childhood, Middle Childhood, Adolescence

Temperature 0 12 months (Axillary) 1 12 years (Oral) > 12 years (Oral) Heart Rate 0 1 Week 1 week 3 months 3 months 2 years 2 years 12 years > 12 years Respirations Newborn 0 12 months 1 year 2 years 2 years 6 years 6 years 12 years > 12 years Blood Pressure - Averages Infant 1 year 3 years 6 years 10 years 16 years

97.7 - 98.9 F 98.1 - 99.9 F 97.8 - 98.0 F 100 160/min 100 220/min 80 150/min 70 110/min 50 90/min 30 60/min (brief periods of apnea) 30/min 25 30/min 21 24/min 19 21/min 16 18/min 70/45 100/55 105/63 110/71 117/77 127/80

What is the leading cause of death for children 1-19? Accidents What is the most common cause of death for children older than 1? Motor Vehicle Accidents Type of MVA fatalities by age <1 = occupant/car seat 2-4 = pedestrian 5-9 = bicycle Poisoning most affects? Children <2 (also at risk for aspiration) Top 3 causes of fatalities in children? MVA Drowning Burns What is most likely to kill teen females? MVA Intentional poisoning (drugs/suicide)

Risk factors for childhood injuries? Sex Temperament Stress

Pediatric Nursing
Alcohol / drug use Hx of previous injury Developmental Characteristics Cognitive characteristics (Age specific) Anatomical characteristics large head/spleen/liver & small light body Poverty Family stress Substandard alternative childcare Young maternal age Low maternal education Multiple siblings What are the age specific cognitive characteristic risk factors? Infant sensorimotor explores through taste/touch Young child object permanence actively searches for attractive object cause and effect lacks awareness of consequential dangers School-age child Transitional cognitive processes doesnt understand casual relationships; attempts dangerous without detailed planning or thinking about consequences Adolescent Formal operations preoccupied with abstract thinking and loses sight of reality; may lead to feeling of invulnerability Causes of death for children ages 1-4 MVA Congenital anomalies Cancer Homicide Heart disease Causes of death for children ages 5-9 MVA Cancer Congenital anomalies Homicide Heart disease Causes of death for children ages 10-14 MVA Cancer Suicide Homicide Congenital anomalies Causes of death for children ages 15-19 MVA Homicide Suicide Cancer Heart disease

Pediatric Nursing
How much is the risk of suicide increased in the household with a gun? Fivefold How do you deal with a toddler when they show regression from a present pattern of functioning to a past level of behavior? Ignore it, while praising existing patterns of appropriate behavior How to deal with temper tantrums? 1) Ignore the behavior, but remain with the child 2) Once it passes, give comfort, but do not give into the original request. A toy or favorite activity may be substituted. Time out (starting at 18 months old) Childhood Mortality pg. 7 Who governs the immunization policies and procedures? ACIP = Advisory Committee on Immunization Practices (CDC) and Committee on Infectious Diseases (AAP) If kids begin the primary immunization but miss doses do they have to start all over? No, they only need to receive the missed doses What are contraindications to giving childhood vaccinations? severe febrile illness; live virus if altered immune system; passive immunity from blood, IVIG, maternal antibodies; allergy = anaphylactic reaction to neomycin, gelatin, or the vaccine itself How can you decrease localized edema and tenderness when administering vaccines intramuscularly? By using longer needles

Nutrition 0 6 Months: Breast feed (add 400iu/day vitamin D) or iron-fortified commercial formula 6 12 Months: Breast feed or iron-fortified commercial formula (add fluoride 0.25mg/day) 4 6 Months: Begin rice cereal (which is iron fortified) and give daily until 18 months 5 6 Months: Begin solid foods (strained/pureed/finely mashed) and soft meat/cheeses sequence: (fruit, veggies, meat) or (veggies, fruit, meat) 6 7 Months: Begin finger foods (teething crackers/raw fruit or veggies) 9 12 Months: Begin chopped table foods > 1 year: Whole cows milk & honey End of the first year, introduce egg whites (1 tsp at a time) *allergy risk Offer diluted juice from a cup only & no more than 4 oz/day Introduce a new food every 5 7 days Avoid foods that are a choking hazard (hot dogs, nuts, grapes, popcorn, raw carrots, hard candy)

Pediatric Nursing
Immunizations & What they prevent? HBV = Hepatitis B (3) RV = Rotavirus (3) DTaP = Diphtheria/Tetanus/acellular Pertussis (5) Hib = Haemophilus influenza type b (4) PCV = Pneumococcal conjugate vaccine (4) IPV = Inactivated Poliovirus (4) *min 6 months apart MMR = Measles/Mumps/Rubella (2) Varicella = Chicken Pox (2)*min 3 months apart HAV = Hepatitis A (2) *min 6 months apart Influenza & H1N1 (annually >6 months old) Meningococcal (1) Tdap =Tetanus/Diphtheria/Pertussis (1) HPV = Human Papillomavirus Vaccine (3) Schedule Birth HBV 1 2 Months HBV 2 Months RV, DTaP, Hib, PCV, IPV 4 Months RV, DTaP, Hib, PCV, IPV 6 Months RV, DTaP, Hib, PCV, influenza 6 18 Months HBV, IPV 12 15 Months Hib, PCV, MMR, Varicella 12 23 Months 2 HAV 15 18 Months DTaP 4 6 years DTaP, IPV, MMR, Varicella 11 12 years Meningococcal, Tdap, 3 HPV Boosters Q10Y for Diphtheria, Tetanus

Vaccine Notes Allergy or sensitivity to yeast? No Hep B vaccine Common side effects include local tenderness, erythema, and swelling at the injection site; low-grade fever; behavioral changes (tired, fretful, decreased appetite, prolonged crying) Report a history of anaphylactic reaction to the practitioner before administering vaccine. Anticipatory Guidance Injury prevention: Birth 4 months Suffocation and Drowning Falls Burns Aspiration Poisoning 2011 AAP recommendation is rear-facing car seat til 2 yr. old or reached highest wt./ht by car seat manufacturer Health Problems Malnutrition Food sensitivity Milk, food, medication (abx) Allergies Regurgitation Colic (paroxysmal abdominal pain) Failure to Thrive (FTT) Diaper Dermatitis Atopic Dermatitis (Eczema) Sudden Infant Death Syndrome (SIDS) -Separation anxiety: develops between 4-8 months of age. Infants will protest loudly when separated from their parents -Stranger fear: develops between 6-8 months of age. Infant is able to discriminate between familiar and Unfamiliar people and when approached by a stranger will cling to caregiver and turn away from stranger. Pincer grasp & reflexes -Solitary play -Lead poisoning can cause: Anemia, hyperactivity, cognitive impairment, paralysis, blindness, convulsions, death (Houses before 1950/1978 renovations)

Pediatric Nursing
2 3 Months 3 4 Months 4 Months 7 Months 8 Months Posterior fontanel closes Begin sitting Can hold head erect Sit leaning forward on hand Sit unsupported Crawling 12 13 Months Walking 12 Months 6 8 teeth

*locomotion & language --walk up and down stairs by 2 years old -jump using both feet by 2 years old -social development: Friends *Parallel play: the toddler plays alongside other children -selecting toys: toys that involve pushing, pulling, rolling, and manipulation -5 markers signal a childs readiness for toilet training: bladder, bowel, cognitive, motor, and psychological readiness. If not nighttime potty trained by age 6 may require intervention -negativism (always no) -develop fears (dark, loud noises, etc) Psychosocial Development -differentiates self from others -tolerating separation from parent -coping with delayed gratification -controlling bodily functions -acquiring socially acceptable behavior -communicating verbally -interacting with others in a less egocentric manner Nonverbal expression with friends Imaginative play, dress-up Dress self Sleep: 12 hr./night Bedtime routine; no TV before bed leads to trouble sleeping Gain comfort from object: doll, blanket, etc. Anticipatory Guidance: Limit setting; resistance to parental authority Imaginative play, tall tales Security blanket Swim lessons

Pediatric Nursing
Limit TV to 1-2 hours of high-quality programming/day Dental caries to prevent, begin dental visits at 6 months of age Discipline Reinforce consistency and expectations Ritualism need a routine Deaths 1) Motor Vehicle Accidents (MVA) 2) Drowning 3) Burns Speech problems developmental stuttering or stammering, OK if lasts < 6mo. Nutrition: 100% Juice 4-6 oz/day max for 1-6yr 1 Tbsp of solid food per year of age or 25-33% the adult portion Strong taste preferences Physiologic anorexia 18 months old the appetite decreases and many become picky eaters Fads, Food jags accept such extremes and offer other foods in small portions Toddlers should NOT be forced to eat foods they are reluctant to eat as forcing foods could cause future eating problems Injury Prevention: Falls are the leading cause of nonfatal injuries in the child 1-4 yrs. old Reckless unaware that the environment is dangerous

Pediatric Nursing

1) Chickenpox S/S: 24hr fever, malaise, then rash Rash = macule- papule vesicle, surrounded by erythematous base, becomes umbilicated and cloudy, breaks and crusts 2) Fifth disease S/S: slapped cheek; then proximal distal rash on arms/legs 3) Pertussis S/S: Can last 4-6 wk. URI Sx at first for 1-2 wk. cough gets more severe and hacking cough > at night; whoop sound; flushed cheeks Sx during a coughing spell: tongue protrudes, can be cyanotic, eyes bulge These Sx last until cough up thick mucus plug; vomit after Pay attention to: Order of symptoms was fever first, or rash, etc. Measles ~ Koplik spots: fever then 3-4 days later a rash develops Fifth Disease ~ slapped face/cheek appearance Chickenpox ~ macule to vesicle Treatment/supportive care? rash descriptions? Koplik has bluish tint? Communicable Diseases (Table 16-1) *Chickenpox Diphtheria *Fifth Disease Roseola Infantum Mumps Measles *Pertussis (Whooping Cough) Poliomyelitis Rubella Scarlet Fever

-Handwashing helps prevent Giardiasis (common intestinal parasite) Ascariasis (common roundworm) Pinworms tape test

Pediatric Nursing