Professional Documents
Culture Documents
Chapter 1
Mortality vs. Morbidity
o Mortality (death)
The number of individuals who have died over a specific period
Presented in rates per 100,000 population
o Morbidity (illness)
Measure of prevalence of a specific illness in a population at a particular
time
Presented in rates per 1,000 population
Overall goal of pediatric nursing
o To promote and assist the child in maintaining optimal levels of health while
recognizing the influence of the family on the childs well-being.
o Involves the practice of health promotion and disease prevention as well as
assisting with care during disease or illness.
Characteristics of Pediatric Care (Children need access to care that is)
o Continuous
o Comprehensive
o Coordinated
o Family Centered
o Compassionate
Philosophy of Pediatric Nursing
o Focusing on the family
Providing family-centered care
o Providing atraumatic therapeutic care
Minimizing physical and psychological stress for children
o Using evidence-based practice
Using evidence-based findings to establish a plan of care
These 3 concepts represent the overarching philosophy of Pedi.
Pediatric nurses use these three concepts to provide quality, costeffective care that is continuous, comprehensive, and
compassionate.
o The pediatric nurse also serves as a collaborator, care coordinator, and consultant.
Nurses use the least invasive procedures with the children
Family-centered care is a mutually beneficial partnership between the child, the family,
and health care professionals.
Providing atraumatic care is important and involves providing therapeutic care through
interventions that minimize physical and psychological distress for children and their
families.
Evidence-based practice involves the use of research findings in establishing a plan of
care and implementing that care.
Primary Roles of the Pediatric Nurse
o Providing direct nursing care to children and their families
Chapter 2
A child begins to understand his or her culture at approximately 5 years of age.
Examples of cultures using alternative forms of healing:
o The curandero (male) or the curandera (female) of the Mexican American
community is believed to have healing powers as a gift from God.
o Asian Americans may consult a practitioner who specializes in traditional Asian
therapies such as acupuncture, acupressure, and moxibustion.
Chapter 14
It is encouraged that health care professionals assess pain every time that temperature,
pulse, respirations, and blood pressure are assessed and to institute measures to manage
the pain.
If pain is left unmanaged, it can lead to serious physical and emotional consequences,
such as increased oxygen consumption and alteration in blood glucose metabolism.
o The experience if untreated pain early in life may lead to long-term physiologic
and psychological consequences for the child.
o Preterm infants, due to long hospitalizations and numerous painful and invasive
procedures, are often at greater risk for experiencing memories of pain.
Effective pain management involves initial pain assessment, therapeutic interventions,
and reassessment for all children in any healthcare setting.
Classifications of Pain
o Duration
Acute or chronic
o Etiology
Nociceptive or neuropathic
o Source/location
Somatic or visceral
Pain threshold
o The point at which the person first feels the lowest intensity of the painful stimulus
Neuromodulators
o Substances that appear to modify the pain sensation and change a persons
perception of pain
o Examples of neuromodulators include
Serotonin,
Endorphins
Enkephalins
Dynorphins
Nociceptive pain
o Pain due to noxious stimuli that damages normal tissues or has the potential to do
so if pain is prolonged.
Described as sharp or burning, dull, aching or cramping, deep aching or
sharp stabbing.
Examples of nociceptive pain include chemical burns, sunburns, cuts,
appendicitis, and bladder distention.
Neuropathic pain
o Pain due to malfunctioning of peripheral or central nervous system.
Described as burning, tingling, shooting, squeezing, or spasm-like pain.
Examples of neuropathic pain include posttraumatic and postsurgical
peripheral nerve injuries, pain after spinal cord injury, metabolic
neuropathies, phantom limb pain after amputation, and post stroke pain.
Somatic pain (nociceptive pain)
o Pain that develops in the tissue.
Can be superficial somatic pain which involves cutaneous (skin) pain.
Can b deep somatic pain which involves the muscles, tendons, joints
fasciae, and bones.
Visceral pain (nociceptive pain)
o Pain that develops within organs such as heart, lungs GI tract, pancreas, liver,
gallbladder, kidneys, or bladder.
Factors Influencing Pain
o Age
o Gender
o Cognitive level
o Temperament
o Previous pain experiences (biggie)
o Family and cultural background
Children identify pain based on past experiences. These factors affect how children
perceive and respond to current pain:
o The number of episodes of pain
o The type of pain
o The severity or intensity of the prev. pain experience
o The effectiveness of treatment of pain
o How the child responded
Research suggests that neonates, especially preterm infants, especially preterm infants,
actually experience pain at a greater intensity than older-age children and adults.
Behavioral indicators of pain for newborns:
o Facial expressions
Brow contracting, chin quivering
Most common response to pain
o Body movements
o Crying
Physiologic signs of pain for newborns
o Change in heart rate
o Respiratory rate
o Blood pressure
o Oxygen saturation levels
o Intracranial pressure
o Vagal tone
o Palmar sweating
o Increase in plasma cortisol or catecholamine levels
Preschoolers may not verbally report their pain. Thinking that pain is something to be
expected or that the adults are aware of their pain.
The school-age child is usually able to communicate the type, location, and severity of
pain. Children older than the age of 8 years can use specific words, such as sharp as a
knife, burning, or pulling, to describe their pain. However, they may deny pain in an
attempt to appear brave or to avoid further pain related to a procedure or intervention.
The risk of adverse effects of narcotic analgesics is the same foe children and adults.
When caring for children in pain, the nursing process includes
o Nursing assessment
Subjective and objective using QUESTT
Question the child
Use reliable and valid pain scale
Evaluate the childs behavior and physiologic changes to establish
a baseline and determine effectiveness of intervention.
Secure the parents involvement
Take the cause of pain into account when intervening
Take action
o Nursing diagnosis
o Planning
o Interventions
o Evaluation
AD-PIE
Tools used to assess pain
o Wong-Barker FACES Pain Rating Scale
Self-report tool that can be used on children as young as 3 or 4. The nurse
asks the child to select the facial expressions that best describes the level
Chapter 3
Newborn/Neonatal = birth to 26 days
Infancy = birth t0 12 months old
Heredity influences growth and development by determining the childs potential while
environment contributes to the degree of achievement.
Maturation
o An increase in functionality of various body systems or developmental skills.
When assessing the growth and development of a premature infant, use the infants
adjusted age to determine excepted outcomes
o The determine adjusted age, subtract the number of weeks that the infant was
premature from the infants chronologic age.
Ex: a 6-month old boy born at 28 weeks gestation was born 12 weeks
early (3 months), so subtract 3 months from his chronological age of 6
months to obtain an adjusted age of 3 months.
Be familiar with the Denver II Developmental Screening Test
Measurements of Infants at Birth and 6 months and 12 months
o
o Measure weight, length, head circumference
Infants six states of consciousness
o Deep sleep: eyes closed, no movement
o Light sleep: eyes closed, rapid eye movement, irregular movement
o Drowsiness
o Quiet alert state: eyes open, baby calm
o As nervous system matures, infants realize they are separated beings from
caregiver. Over time infant learns to tolerate small amounts of frustration.
Piaget (Sensorimotor)
o Infant uses senses and motor skills to learn about the world
o Substage 1: uses reflexes (birth to 1 month)
o Substage 2: primary circular reactions (1 to 4 months)
o Substage 3: secondary circular reactions (4 to 8 months)
o Substage 4: coordination of secondary schemes (8 to 12 months)
Freud (Oral stage)
o Pleasure is focused on oral activities: feeding and sucking.
Gross motor skills are developed in a cephalocaudal (from head to tail) fashion.
o The baby learns to left head before leaning to roll over and sit
Warning signs that may indicate problem with motor development: arms and legs are
stiff or floppy; child cannot support head at 3 to 4 months of age; child reaches with one
hand only; child cannot sit with assistance at 6 months of age; child does not crawl by 12
months of age; child cannot stand supported by 12 months of age.
Fine Motor skills deal with the maturation of hand and finger use. Fine motor skills
develop in a proximodistal (from center to periphery) fashion.
o Infant first bats with whole hand, eventually progressing to gross grasping, before
being capable of fine fingertip grasping.
Chapter 9
Types of Vaccines
o Live attenuated vaccines = modified living organism that are weakened
o Killed vaccines = contain whole dead organism
o Toxoid = contain protein products by bacteria call toxins
o Conjugate = chemically linking the bacterial cell wall with protein
o Recombinant = genetically engineered organism
Immunization is the key disease prevention activity during childhood health supervision
visits.
When antigens are recognized by the immune system, the immune system responds by
producing antibodies (immunoglobulins) or directing special cells to destroy and remove
the antigen.
Passive immunity is produced when the immunoglobulins of one person are transferred to
another can be obtained by injection of exogenous immunoglobulins
o Immunity lasts only weeks or months
Active immunity is acquired when persons own immune system generates the immune
response.
o Immunity lasts for many years or for a lifetime due to immunologic memory.
o Vaccines mimic the characteristics of the natural antigen. The immune system
mounts a response and establishes an immunologic memory as it would for an
infection.
Family-centered care includes: respect for the child and family, recognition of cultural
diversity, identification of the familys strengths, assistance with emotional and other
support of the family, providing honest and unbiased information, and collaborating and
empowering families.
o
Using positions that are comforting to the child during painful procedures is an important
aspect of atraumatic care
Chapter 10
The health history in children includes more than just the chief complaint, history of
present illness, and past medical history; it is important to include the perinatal history
and developmental milestones.
The developmental history will warrant more attention in the younger child, while school
performance and adjustment will be more important in the school-age child and
adolescent.
Weight and length or height should be assessed at each well-child visit to determine
adequacy of growth
o Measure head circumference until age 3 years to monitor brain growth.
Perform intrusive procedures such as examination of the ears, mouth, and throat last in
the infant or young child.
Having the young boy sit cross-legged for a testicular examination may reduce the
cremasteric reflex.
The infants fontanels should be soft and flat; report a bulging fontanel immediately
Heart murmurs should be assessed for intensity, location, and duration. They may be
innocent or may indicate a congenital heart defect.
Substernal or xiphoid retractions indicate that the child is laboring to breathe, whereas a
fixed, depressed sternum (pectus excavatum) is a structural abnormality.
Using an accurate cuff size is important: a wider cuff yields a lower reading and a
narrower cuff yields a higher reading
Accommodation
Absence of pupillary reflexive action after age 3 weeks may indicate blindness
Indicators of problems with the endocrine system include increased thirst, excessive
appetite, delayed or early pubertal changes, and problems with growth.
For the genitourinary system the nurse would assess urinary patterns and genitals.
For the hematologic system the nurse would assess lymph nodes, skin color, and
bruising.
Chapter 11
Respiratory system, such as asthma and pneumonia, account for the majority of
hospitalizations in children younger than 5 years of age,
Separation anxiety consists of three stages protest, despair, and detachment.
To prevent otitis externa, the nurse would teach parents and children to wear earplugs
when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair
dryer on a low setting can be used to dry the ear canals.
Bacterial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid
discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge
suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis.
hot, moist compresses to the eye is an intervention for conjunctivitis
Viral conjunctivitis is characterized by lymphadenopathy, photophobia, and tearing. Mild
pain is associated with bacterial conjunctivitis. Itching and watery discharge are
associated with allergic conjunctivitis
Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark
greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in
folate