Pedi Mod 1 Study Guide PDF

CHAPTER 21 ❖ Stages of growth & development:. Fetus – 9th gestational week to birth ▪ Neonate – Birth to 4 weeks ▪ Infant – 4 weeks to 1 year ▪ Toddler – 1 to 3 years ▪ Preschool – 3-6 years. ▪ School-age – 6-12 years. Adolescence- 12-18 years ❖ Daily routine of the pedi...

CHAPTER 21 ❖ Stages of growth & development:. Fetus – 9th gestational week to birth ▪ Neonate – Birth to 4 weeks ▪ Infant – 4 weeks to 1 year ▪ Toddler – 1 to 3 years ▪ Preschool – 3-6 years. ▪ School-age – 6-12 years. Adolescence- 12-18 years ❖ Daily routine of the pediatric unit:. Parents are encouraged to room-in ▪ Strive for consistency with caregivers ▪ May wear own clothes/bring toys ▪ Flexible schedules ▪ Designed to meet the needs of growing children ▪ Familiar rituals and routines must be incorporated into the plan of care. Communicate at EYE LEVEL! ❖ Factors that affect a child's reaction to hospitalization:. Childs age. Amount of preparation given. Previous hospital experiences. Support of family and medical staff. Childs emotional health. Security of home life  ❖ Separation Anxiety:. Occurs in infants 6 months or older, most pronounced in toddler age. (ages 1-3) - 3 Stages: - Protest: 1st stage Infants: crying, screaming, looking for parent Toddlers: verbally or physically attacks strangers, continuous crying, try to escape - Despair: 2nd stage All Ages: Withdraws from others, sad, uninterested in environment, uncommunicative regresses to earlier behavior. - Denial or Detachment: 3rd stage I. All Ages- ncreased interest in surroundings, interacts with caregivers and strangers, appears happy. *These behaviors represent a superficial adjustment to loss* *Children are adaptable, so permanent issues are possible but rare* ❖ Pain:. If untreated, pain can increase healing time or compromise wound healing. o Ways to Relieve pain for children:. Drawling. Distraction. Guided imagery. Relaxation. Thought- stopping. Music therapy. Medications ❖ Pain Medications: (Have to know a weight before administration). NSAIDS- Ibuprofen given at MAX dose of 8 to 10 mg Q6h & Ketorolac is parenterally Administered given at MAX dose of 5 days.. Opioids- Fentanyl is a potent analgesic given for short surgical procedures, it has RAPID onset with short duration of action. (Narcan should be on hand in case of an opioid overdose). Local anesthetics- EMLA cream is a mixture of lidocaine and prilocaine is applied topically. Topical anesthetics are used for skin sustures, IV, and lumbar punctures.. PCA- Parents and children as young as 7 years old can be taught to use PCA. Consciousness Sedation- IV drugs to a patient to impair consciousness but retain protective reflexes, the ability to maintain a patent airway and the ability to respond verbally. ❖ Cultural Concerns: o Differences may include:. Diet. Reaction to Illness. Interaction With staff members. Expectations ❖ Clinical Pathways:. Interdisciplinary or Multidisciplinary plan of care ▪ Displays progress of the entire treatment plan. ▪ Broader focus than the nursing care plan ❖ Reaction to hospitalization of a toddler:. Separation anxiety at its peak ▪ regression due to anxiety ▪ Displays intense emotions ▪ Speak to them in terms they will understand ▪ They have no sense of time ▪ Need structure, rituals, familiar items ▪ May have negativism/temper tantrums. ▪ Reactions worse with prolonged illness ▪ After discharge child may be “clingy” *Toddlers who have a continuous, secure relationship with their mothers react more violently to separation because they have more to lose. * ❖ Reaction to hospitalization of a Preschooler:. Egocentric ▪ Concrete thinkers which can combine with “magical” thinking  ▪ May think hospitalization is a form of punishment ▪ Afraid of bodily harm ▪ Need to explain in realistic terms...be honest ▪ Be concise ❖ Reaction to hospitalization of a School Aged child:. May be depressed, hostile or frustrated ▪ Forced dependency, loss of control ▪ Allow to make simple choices. ▪ Need: consistency, continuation of education, outlet for feelings ❖ Reaction to hospitalization for an adolescent:. Early – threat to body image ▪ Middle – peer group important, trying to emancipate from family ▪ Keep in contact with friends ▪ Late – threat of postponement of career/future plans. *May respond by withdrawal, anger, noncompliance* *Staff may characterize as difficult* ❖ Confidentiality & Legality: o HIPPA Regulations:. Emancipated Minor- Generally refers to an adolescent younger than 18 years of age who is no longer under the parents' authority.. Receiving medical care without parental consent such as:. STI’s. Contraception. Drug abuse CHAPTER 22 ❖ Restraints: o Mummy Restraints:. Short-term restraint that might be necessary for examination or treatments like a Venipuncture or nasogastric tube placement. o Elbow Restraints: -. Used for when placing Scalp IVs. Used post-op cleft lip surgery. Used to prevent scratching *Any restraint needs to be removed at least every 2 hours for thorough skin and circulatory assessment. ❖ Physical Survey:. Vital Signs- Apical pulse younger than 5 years of age. Pain. Weight. Height. Head Circumference (Infants) ❖ Physical Assessment: o Respirations:. Newborn: 40-60 Infant: (1 month to 1 year): 25-55 Toddler: (1 year to 3 year): 20-30 Preschool: (3 year to 6 year): 20-25 School Age: (6 year to 12 year): 14-22 Adolescent: (12 year to 18 Year): 12-18 o Heart Rate:  - Newborn: 110-160 Infant: 80-150 Toddler: 70-110 Preschooler:65-100 School age: 60-95 Adolescent: 55-85 o Temp: 97.5- 100.4 ❖ Specimen Collection: o Urine: Stool:. External collection devices. Younger children- Gather from the diaper. Catheterization. Older children- Use a “hat” in the toilet. Clean catch U/A. 24hr Urine *Specimen must be sent ASAP* o Blood:. Venipuncture. Draw from H.L. (may be difficult). Capillary sample- finger or heelstick. From central line **Keep track of amount of blood drawn/discarded especially in anemic or small children* o Lumbar Puncture:. Nurse Role: Explain to family what to expect, restrain appropriately, label and send lab specimens ❖ Considerations for Medication Administration in children:. Gastric influences. Intestinal influences. Topical medications (Ointments). Parenteral medications. Immature liver. Immature kidneys  ❖ Medications:. Calculate dosage to determine safety for administration.. Verify Your Pations. Document appropriately. Parent teaching *Always check the HCP prescription* ❖ Oral Route/Medications:. Do NOT mix with formula, food, or water.. Use Syrup or Jelly. Shake well before giving. Praise Children when they took meds. Offer juice or popsicle after meds. NEVER refer to meds as candy *When giving infants oral meds, use an oral syringe to place medication on the side of the mouth.* ❖ Other Medication Routes:. Eye- Apply in the Conjuctival sac. Ear- Children= Back & Down (For children under 3), Adults= Back & Up. Nose- Restrain appropriately (Usually mummy restraint). Rectal- Identify Contraindications. SubQ- Rotate sites and refrain from vigorous exercise to affected site before and after injection. IM- Infants & Toddlers= Vastus Lateralis, 3yrs or older= Ventrogluteal (Adolescents & Adults). IV- Start as DISTAL as possible (Assess hourly for signs of infiltration, and Strict Is & Os) ❖ Needle Size & Max volume for IM administration: Type of Needle Volume/ Amount Location of Injection injection size/Guage SUB Q 23-35 Guage, 5/8 inch needle IM 22-25 Guage, ½- Infant= 0.5ml Vastus Lateralis 1 inch needle Toddler= 1ml Vastus Lateralis School aged or adolescent= Deltoid (1ml) & Vastus 1ml-2ml Lateralis (2ml or more) ❖ NG Tube or G button Medications:. Check for proper placement. Flush tube with water BEFORE & AFTER. Chart I’s & O’s ❖ Enema & Gavage/Gastrostomy:. Use ISOTONIC solution ONLY. Insert tube 1-4 inches. 50ml, 500-750ml of solution. Tube or button (Report vomiting or abdominal distention) ❖ Oxygen Therapy:. Isolette. Nasal Canula/Mask. Oxyhood (mostly seen in NICU). Tent. Oximeter *Oxygen therapy is usually regulated by RT, but the nurse must be aware of early signs of distress. ❖ Airway Obstruction: o Infants:. If conscious- Back blows/ Chest thrusts- 5 each. If unconscious- 30 compressions, look and remove, 2 breaths o Older Children:. If conscious- Back blows/ Abdominal Thrusts- 6 to 10 each. If Unconscious- 30 compressions, look and remove, 2 breaths ❖ Surgery: o Pre-Op:. Prepare the child physically and emotionally. Infants should NOT be kept NPO for more than 4-6 hours. Provide infants with pacifier. Encourage parents to stay with their child postop. CHAPTER 15 ❖ Growth:. Growth rate varies with individual child. Growth spurts are often followed by plateaus. Must understand normal to recognize deviations from this ❖ Development: - Cephalocaudal development – Head to toe - Proximodistal development – Midline to periphery - Maturation- Refers to the total way in which a person grows and develops as dictated by inheritance. * Development is from the general to the specific*. ❖ Physiologic Processes (Pedi):. Metabolic rate= Higher. Respirations= Irregular, Small airways. Cardiovascular= Higher HR, Anemia. Immunity= Passive (from mom). Kidneys= Immature less than 2yrs of age.. Nervous system= Reflexes replaced by purposeful behavior. Sleep patterns= Varies with age. Body surface area (BSA)= greater than an adult therefore higher increase in loss of fluids thru lungs and skin ❖ Factors influencing Growth & Development:. Hereditary Traits. Sex. Environment. Nationality/Race. Position in family. Health/Nutrition status. Parental attitudes/Relationships ❖ Growth percentiles & Development Screening:. 5%, 10%, 25%, 50%, 75%, 90%, 95%. Height & Weight 2% difference needs to be investigated o Denver 2 Test:. Tests for social, fine motor adaptive, language, and gross motor skills. This test is done within the first 6 years of life. NOT an intelligence test ❖ Family Structures:. Nuclear. Single parent. Extended. Polygamous. Foster parent. Homosexual. Alternative. Cohabitation. Dual career. Homeless. Blended ❖ Family APGAR:. Adaption. Partnership. Growth. Affection. Resolve ❖ Nutrition:. Be aware of cultural differences. Infants require more calories, protein, minerals, vitamins and fluids than adults. Fiber needs are less for a small child. Serving size for a child 1tbsp/year of age. Starts prenatally o Childhood Obesity:. 1/3 overweight. Related to adult obesity. Health concerns. Elevated BMI ❖ Tooth Develpment:. First tooth usually erupts at 6-7 months By 1 year, baby usually has 6 teeth First dental appt. between 1-3 years Bottle-mouth caries – seen most often at 18 months – 3 years of age Children are at risk for trauma to teeth Adolescents are at risk for gingivitis, TMJ ❖ Play:. Provides a sense of accomplishment Understanding of child-parent relationship can be gained by observing play Encourages self-expression Therapeutic play Art play  Computer games CHAPTER 32 ❖ Review of terms: Communicable disease— can be transmitted from one person to another Incubation period— time between exposure to pathogen and onset of clinical symptoms Prodromal period— time between earliest symptom and appearance of typical rash or fever Vector— an insect or animal that carries and spreads disease Pandemic— a worldwide high incidence of a communicable disease (H1N1 influenza, COVID 19) Epidemic— sudden increase of disease in localized area Endemic— an expected continuous incidence of disease in a localized area Opportunistic infection— caused by organism normally present in the environment that the immune-suppressed person cannot fight Health care associated infection— an infection acquired after admission to a health care facility ❖ Rashes of the Skin:. Erythema. Macule. Papule. Vesicle. Pustule. Scab. Pathognomonic ❖ Pediatric Immunization Schedule: ❖ Chickenpox (Varicella): o Signs & Symptoms:. Macules. Papules. Vesicles. Pustules. Scabs o Nursing Interventions:. Trim fingernails. Calamine lotion. Airborne isolation. Varicella vaccine ❖ Fifth Disease: o Signs & Symptoms:. Slapped cheek (Red rash on the face). Generalized rash subsides, and reappears if irritated by sun or heat o Nursing Interventions:. Standard precautions. Oatmeal baths for itching ❖ Whooping Cough (Pertussis): o Signs & Symptoms:. Fever. Cold. Cough (Spells of coughing accompanied by a noisy gasp for air that creates a “whoop”) o Nursing Interventions:. Droplet precautions. Bedrest. Observe for airway obstruction and Oxygen stat. DTaP Vaccine ❖ Hepatitis B: o Signs & Symptoms:. Fever. Abdominal pain. Headache. Anorexia. Malaise. Jaundice. Dark urine. Chalklike stools o Nursing Interventions:. Prevent contact with blood. Hepatitis B vaccine (First dose within 12 hours of birth) ❖ Types of immunity: - Natural - Acquired - Active - Passive ❖ Allergies & Toxicities:. Epinephrine should be available in units where immunizations are given. Child should be observed for 20 minutes after immunization. Do not administer vaccine if the patient is allergic to – Baker’s yeast: avoid recombinant hepatitis B – Eggs: Avoid influenza vaccine and MMR – Neomycin: Avoid IPV, MMR, and Varicella ❖ Contraindications:. Compromised immune system. Pregnancy. Serious infection. Immunocompromised caregiver in the home. Steroid therapy. History of very high fever with previous vaccine (over 105 degrees) ❖ Bioterrorism:. Immature immune systems. Closer to the ground. New drugs not tested in children o Initial observation. Airway. Breathing. Circulation. Mental status ❖ Sexually Transmitted Infections: o Infections can spread through:. Sexual activity. Pregnant mother to fetus. Sexual abuse of a child. Use of contaminated needles or exposure to blood *Nurses are required to report STI’s to the local Public Health Department* ❖ HPV:. Most common STI in adolescents. Increased incidence with multiple partners o Manifestations:. Flesh colored, cauliflower shaped warts in the perineal area o Prevention:. Vaccines given in a 3 series dose o Treatment:. Cryotherapy. Electrocautery ❖ Pediatric HIV/AIDS: o Symptoms:. Failure to thrive. Enlarged lymph glands. Chronic infections (Sinusitis, pneumonia, UTIs that dont respond to treatment) o Diagnosis:. ELISA Western Blot o Medications:. AZT (ZDV) given during pregnancy significantly reduces transmission to baby