Pediatric Nursing Considerations

Pediatric Nursing Considerations

• Hospitalization stressors are a significant factor for families.
• Family-centered care is crucial to understand family dynamics.
• Atraumatic care is essential to prepare patients for unfamiliar treatments or procedures
• Developmentally appropriate communication with children and families is key.
• Anticipatory guidance is important for children and families regarding growth and development, diseases, procedures, and surgeries.
• Prioritizing nursing interventions related to mortality and morbidity across different age groups is vital.
  • Birth to 1 month: congenital abnormalities
  • First year: Sudden Infant Death Syndrome (SIDS), childhood accidents
  • Adolescents: Accidents, homicide, suicide (male adolescents at higher risk than females).

Newborns

• Growth and development: Weight loss initially, then regain by 2 weeks, doubles at 6 months, and triples by 1 year.
• Milestones include rolling, lifting head, sitting, and pincer grasp.
• Neonatal respiratory distress syndrome is related to lack of pulmonary surfactant.
• Risk factors for newborn jaundice include bruising, early delivery, poor feeding, and sibling history of jaundice.
• Prevent Jaundice with frequent feedings.
• Congenital hip dysplasia is a concern, especially for breech births.
• Newborn screenings typically include CHD, hearing, metabolic, and jaundice testing.
• Cleft lip and cleft palate require careful monitoring of feeding and weight gain.
• Neonatal hypoglycemia is associated with factors such as small gestational age (SGA), prematurity, large for gestational age (LGA), gestational diabetes mellitus (GDM), and perinatal stress.
• Apgar scores are used to assess vital signs at one and five minutes. A score of 7 or more is considered normal.
• Sepsis, Chorioamnionitis (chorio), premature rupture of membranes (PROM) are potential risks
• Meconium passage within the first 24 hours of birth is normal, delayed or absent passage should trigger further investigation of Hirschsprung's disease, cystic fibrosis, and imperforate anus.

Infants

• Safe sleep practices include supine positioning, preventing overheating, and avoiding objects in the crib.
• Plagiocephaly is a concern that can be prevented with changing positions.
• Pyloric stenosis is a condition requiring surgery, characterized by projectile vomiting
• Vaccination schedules include Hep B for newborns.
• Influenza vaccination is annually recommended but recommended age is 12 months.
• Hydrocephalus is characterized by bulging fontanels and dilated scalp veins.
• Tracheoesophageal fistula: feeding difficulties and respiratory concerns, often requiring surgery
• GERD: Frequent feedings and upright positioning are essential as needed.
• Hirschsprung's disease involves absence of nerves (no ganglion cells) in the bowel and leads to constipation and vomiting.
• Diaper dermatitis is characterized by satellite lesions-yeast infection is common. Monitor mouth for thrush.

Childhood Conditions

• Otitis media, risk factors, smoking, cleft palate, day care attendance.
• Bronchiolitis/RSV symptoms: monitor frequently to prevent risks of respiratory distress syndrome, nasal flaring, retractions, grunting, and rapid breathing.
• Airway obstruction, inability to speak, difficulty breathing.
• Poisoning issues-immediate medical attention & contact with poison control.
• Reye syndrome– avoid aspirin.
• Allergic reactions– epinephrine preparation.
• Epiglottitis– do not swab throat; urgent medical attention.
• Scabies and lice: contagious infections needing treatment for patient and their home environment.
• Burns: Degrees of burns, essential treatment measures include pain control, maintaining homeostasis, monitoring thermoregulation, and replacing fluids and electrolytes.
• Eczema/Dermatitis, treat dryness/infections with frequent baths, mild soaps and emollient.
• Head injury: frequent monitoring, assessing Glasgow Coma Scale, and addressing possible increased intracranial pressure (ICP).

Childhood Conditions (cont'd)

• Seizures, various types (generalized, complex partial, absence).
• Shingles – painful rash along dermatomes
• Diabetes Type 1 – rapid onset characterised by increased thirst, frequent urination, weight loss, and increased appetite.
• Scoliosis – if indicated bracing for 23 hours of the day
• Sickle cell anemia – inherited hemoglobin disorder; concerned for stroke.
• Osteomyelitis – bone infection with fever and bone pain, requiring IV antibiotics.
• Measles, symptoms (Koplik spots, rash, fever, cough, inflamed eyes, runny nose).
• Group A strep, symptoms (sore throat, fever, vomiting, rash)
• Appendicitis - acute abdominal pain, guarding, fever, vomiting increased white blood cell count (WBC)

Childhood Conditions (cont'd)

• Duchenne muscular dystrophy: progressive muscle weakness evident in preschool years.
• Leukemia - unrestricted proliferation of immature blood cells
• Hemophilia - deficiency of a clotting factor.
• Dehydration – weight loss of 10%, requires immediate IV replacement; increase of 1.5X for maintenance
• UTIs: frequent urination, pain, abdominal pain, fever, enuresis. Treatment includes adequate fluid intake prevention of constipation.
• Hypospadias – surgical repair.
• Following kidney transplant: monitor for signs of rejection, increased blood pressure.
• Nephrotic syndrome: weight gain, facial edema, irritability, decreased output.

Fractures

• fractures occur; torn blood vessels and blood clots, pain, swelling, deformity, decreased movement, change in sensation, color change, altered pulse/quality are symptoms.
• Initial management: immobilize, apply ice, loosen restrictive clothing, maintain NPO status, assess neurovascular status, and elevation.
• Simple vs. Compound fractures and education on cast care
• 5 Ps to assess ischemia (pain, pallor, pulse, paralysis, paresthesia).

Cardiac

• Congenital heart defects: increased risk for babies exposed to rubella during pregnancy.
• Coarctation of the aorta: lower blood pressure in the legs compared to arms
• Tetralogy of Fallot (a congenital heart defect)– Tet spells, squatting.
• Kawasaki disease: inflammatory condition with symptoms of fever, rash, and inflammation of the blood vessels.
• Cardiac catheterization post-procedure care – assessing for complications and maintaining patient stability.
• Digoxin administration: considerations related to missed doses.

Advocate and Educate

• Terminally ill patients: support families, provide pain relief and symptom relief, improving communication.
• Children with disabilities: promote independence and safe choices.
• Parental experience when dealing with chronic diseases – common: shock, denial.
• Child abuse: nurses are mandatory reporters.
• Shaken Baby Syndrome: prevention education.

Autism and Down Syndrome

• Autism Spectrum Disorder (ASD) – neurodevelopmental disorders, difficulties with social communication and unusual restricted behaviors, there is a genetic link of recurrence for the affected child.
• Down Syndrome: physical characteristics – protruding abdomen, broad short feet and hands, hypotonia, and developmental level-based activities.
• Increased risk of leukemia with Down syndrome, particularly in older women.

Explore vital aspects of pediatric nursing through this quiz, focusing on hospitalization stressors, family-centered care, and the importance of communication with children and families. Understand the developmental milestones and nursing interventions necessary for various age groups, from newborns to adolescents.