Pediatric Nursing Study Notes PDF

Growth & Development ​ Types of Play ○​ Parallel Play (Age 1-2) – play next to each other but not with each other ○​ Symbolic Play ( Age 5-7) – group taking turns, secret clubs, secret codes ○​ Competitive Play Age 7-10) – begging to accept competition with rules and...

Growth & Development ​ Types of Play ○​ Parallel Play (Age 1-2) – play next to each other but not with each other ○​ Symbolic Play ( Age 5-7) – group taking turns, secret clubs, secret codes ○​ Competitive Play Age 7-10) – begging to accept competition with rules and physical activity ○​ Cooperation Play (Age 3-5) – children play with each other in creative way, each taking a specific role ​ Weight ○​ Birth weight doubles usually by the age 5-6 months, and triples by the age 1 year ​ Teeth ○​ To asses the number of teeth a child under age 2 years is expected to have, use the following formula: (Age in months) - (6) = # of teeth ​ Piaget’s Stages of Development ○​ Sensorimotor (birth to age 2) – primary means of cognition is through senses ○​ Preoperational (ages 2 to 7) – development of motor skills, language ○​ Concrete operational (ages 7 to 11) – organizing thoughts into logical order ○​ Formal operational (ages 11 to 15) – abstract thinking to handle difficult concepts ​ Erikson’s Stages of Development ○​ Trust vs. Mistrust (4 weeks to age 1) – getting needs met ○​ Autonomy vs. Shame & Doubt (age 1 to 3) – trying out speech ○​ Initiative vs. Guilt (age 3 to 6) – questioning ○​ Industry vs. Inferiority (age 6-12) – learning to win recognition, exploring, collecting ○​ Identity vs. Role diffusion (adolescents) – beginning separation from family, integrating personality The Child’s Experience of Hospitalization ​ Separation Anxiety ○​ Three stages of separation anxiety ​ Protest – toddlers may call out “mommy” repeatedly ​ Despair – children appear sad or depressed ​ Denial or detachment – deny need for parent and focus on their toys Health Care Adaptation for the Child and Family ​ Infants medication response factors ○​ Age & Infants may have immature organ function ​ Administering Ear Drops/Exam ○​ 3 years = up and back ​ Lumbar puncture position ○​ Older child = side-lying with knee to chest  ○​ Infant = sitting bending forward The Child with Sensory or Neurological Condition ​ Otitis Media ○​ S/S = fever, pain in ear (otalgia), inflammation of middle ear space, rubbing or pulling affected ear, restlessness and irritability ​ Otitis Externa ○​ “Swimmers ear” ○​ S/S = pain and tenderness, feeling of fullness, muffled sound ○​ Tx = irrigation & Abx or antivirals ​ Amblyopia ○​ “Lazy eye” ○​ Vision favors one eye ○​ Tx = glasses, or patching of good eye forces use of weaker eye ​ Strabismus ○​ “Cross eye” ○​ Inability to direct both eyes into same direction or same object ○​ S/S = eye squinting or frowning to focus, reaching for object and missing, covering one eye, tilting head to see, dizziness and/or headache ​ Conjunctivitis ○​ “Pink eye” ○​ Inflammation of conjunctiva or mucous membrane ○​ S/S = edema, itching, crusting of eyelids, inflamed pink conjunctiva, tearing and purulent drainage ○​ Contagious until 24hrs after first dose of Abx ○​ Wipe from inner eye to out ​ Febrile Seizure ○​ Seizure caused by having a fever. Common between ages 6 months and 5 years ​ Head Injury ○​ S/S = asymmetrical pupils ​ Medical Emergency Pediatric Cardiac ​ Cyanosis ○​ S/S = Clubbing of fingers and toes, polycythemia (Increased RBCs in the body to compensate for lack of oxygen), unoxygenated blood in the circulation ​ Congenital Heart Defects ○​ Atrial Septal Defect – Blood flowing from Left Atrium to Right Atrium ​ Acyanotic ​ Also known as Persistent Foramen Ovale (PFO) ​ Murmur ○​ Ventricular Septal Defect – Blood flowing from Left Ventricle to Right Ventricle ​ Acyanotic ​ Loud harsh murmur  ○​ Patent Ductus Arteriosus – Blood flowing from Aorta to Pulmonary Artery ​ Acyanotic ​ Machinery sounding murmur ​ Typically closes within 3 days after birth ○​ Tetralogy of Fallot – Four abnormalities that result in insufficient oxygenated blood pumped to body ​ 1) Stenosis (narrowing) of the pulmonary artery ​ 2) Hypertrophy of the right ventricle ​ 3) Dextroposition of the aorta (dextro=right) ​ 4) Ventricular Septal Defect (opening between Left and Right Ventricle ○​ Coarctation of Aorta – Obstruction of blood flow from the ventricles due to narrowing of a vessel ​ Elevated BP and bounding pulses in UEs ​ Decreased or absent pulses and decreased BP in LEs ​ Heart Failure ○​ When heart is unable to pump blood effectively ​ S/S = tachycardia at rest (earliest indicator), fatigue during feedings, sweating ○​ Left sided failure is most seen in children ​ Failure that results in the backup of blood into the lungs ​ S/S = tachypnea, cough, dyspnea and crackles, orthopnea (SOB when lying down), exertional dyspnea (Ex. feeding), blood-tinged sputum, tachycardia, cyanosis, fatigue ○​ Right sided failure ​ Failure that results in the backup of blood in the systemic circulation ​ S/S = enlarged liver, weight gain/dependent edema, distended jugular veins, anorexia and complaints of GI distress, tachycardia, cyanosis, fatigue ​ Kawasaki ○​ Acute febrile disease causing vasculitis ○​ S/S = high fever, red conjunctiva without discharge, pharynx & oral mucosa inflammation, strawberry tongue, non painful lymph node swelling, swelling of hands, peeling skin, swelling of weight bearing joints, increased platelets & coagulation ○​ Tx = IV immunoglobulin (suppresses immune system so postpone immunizations for next 11 months), low dose aspirin Pediatric Respiratory ​ Asthma ○​ Obstruction of airway to due to swelling and mucus ​ Leading cause of school absenteeism, ER visits and hospitalization ○​ S/S = wheezing and difficult breathing, chin neck or chest itches, restlessness ○​ Status Asthmaticus ​ Medical emergency  ​ Continued severe respiratory distress that is not responsive to drugs, including epinephrine and aminophylline ​ RSV/Bronchitis ○​ Caused by virus, begins in fall peaks in winter ○​ Spread by direct contact with respiratory secretions ​ gown/gloves and hand hygiene! ○​ S/S = tachypnea, low-grade fever, cough, rhinorrhea, may develop into respiratory distress = chest retraction, nasal flaring and use of accessory muscles ​ Epiglottitis ○​ Swelling of tissues above vocal cords – Emergency ○​ Cough is absent ○​ Caused by H. influenzae B (HIB) ○​ Trach kit at bedside prior to examining throat ​ Tonsillectomy ○​ Preoperative Care ​ Age appropriate explanations ​ Check for loose teeth ○​ Postoperative Care ​ Observe for bleeding (frequent swallowing or clearing of throat) ​ Avoid coughing, clearing throat, blowing nose ​ Give clear liquids (popsicles) ​ No purple, red or brown dyes ​ Cystic Fibrosis ○​ Life-threatening genetic disease that causes sticky, thick mucus to build up in organs, blocking & damaging them ​ Respiratory System – obstructed secretions ​ Digestive System – secretions prevent digestive enzymes from flowing to GI tract, results in poor absorption of food ​ Bulky, foul-smelling stools that are frothy because of the undigested fat content ​ Skin – loss of electrolytes in sweat causes “salty” skin surface. (free access to salt) ​ Reproductive System – secretions decrease sperm motility; thick cervical mucus can inhibit sperm from reaching fallopian tubes ○​ Inherited recessive traits with both parents carrying a gene for disease ​ Croup Syndrome (Acute Croup / Laryngotracheobronchitis) ○​ Viral condition manifested by fever, barky cough, and congestion ​ Congestion in the upper airway can lead to respiratory distress (stridor) ○​ Tx = cool mist humidification, symptomatic care, increased fluids Pediatric Hematology ​ Anemia ○​ Reduction in amount of circulating hemoglobin  ​ Hemoglobin contains iron and is responsible for O2 transport ○​ Hgb