Peds Test 1 Notes PDF

**Notes for Test 1 (Module 1 & 2)** *Pediatric Nursing Today Engage* - Pediatric nurses care for patients that are of newborn age-adolescence (19 yrs old) - Nurses must have strong assessment and communication skills since most patients are not able to communicate for themselves -...

**Notes for Test 1 (Module 1 & 2)** *Pediatric Nursing Today Engage* - Pediatric nurses care for patients that are of newborn age-adolescence (19 yrs old) - Nurses must have strong assessment and communication skills since most patients are not able to communicate for themselves - Why the need for pediatric care? - Vital signs, physiological changes, and developmental needs all change during the first years of life. - Nurses need to know these ranges to indicate any abnormalities that can be related to an illness or disability - Developmental delays are important to notice so interventions can happen early/quickly - Atraumatic Care - Atraumatic Care: therapeutic method of using interventions focused on reducing physical and psychological harm, distress to prevent fear - [Benefits of atraumatic care] - Reduces stress - Supports clients feelings of control - Reduces fear and anxiety - Promotes faster healing - Ways to implement atraumatic care - Ways can be altered depending on age - Children of different ages will vary in amount of information they know about procedures - Ask a parent to assess the best way to communicate the procedure to the child - Use of restraints is NOT encourages - Be truthful and honest about what is going on to improve trust and reduce fear - Nurses can be advocates for parents and the patients - Nurses should suggest the use of topical anesthetic medications, such as a eutectic mixture of local anesthetics (EMLA) cream, for pain management - Systemic sedative medications may only be used if necessary - Allow the child to make as many choices for themselves as possible to decrease fear/anxiety - Anticipate, recognize, and address pain using pain assessment tools - Use numbing medication before injections or starting IV - Have parent hold child - Use age-appropriate distraction techniques (ex. Blowing bubbles) - Using skin-to-skin contact - Play Therapy: use of therapeutic play to assist clients to achieve ideal growth and developmental outcomes (ex. Using dolls or stuffed animals) - Help children deal with difficult emotions - Promotes development - Educates parents and children on health conditions - Prepares families for medical events/procedures - Plan and rehearse useful coping and pain-management strategies - Help children work through feelings about past or impending experiences - Partner with families to establish therapeutic relationships - Family Centered Care - Establishes a collaborative relationship among family, clients, and providers - Values the patient and family as an integral part of the healthcare team - Core concepts - [Respect and dignity] - Nurse listens to client and family and honors their wishes and preferences.knowledge, beliefs, practices, cultures and values are woven into care and planning - [Information sharing] - Timely, accurate and complete communication is provided - [Participation] - Clients and families are invited to participate in client care - [Collaboration] - Clients and families collaborate with providers in their own care. Like education, revisions, and research. - Provides a child-focused environment - Therapeutic relationship: beneficial relationships built on trust, care, open communication, and respect - Types of pediatric nursing - Primary care clinics - Day care facilities - Emergency room - School nurse - Specialty hospitals - Advocacy - Advocate: Person who works on the behalf of others - Social Determinants of Health (SDOH): Specific conditions in a person\'s environment that affect their health, functioning and quality of life - Human Trafficking: unlawful practice of using people for commerce, often through forced labor or sexual exploitation - Mandated reporters: Health care providers are legally obligated to report any suspected or confirmed child abuse or neglect to legal authorities - Therapeutic communication: communication techniques used to enhance physical, mental, and emotional wellbeing of clients and families - Therapeutic Relationships - A challenge is to address and prioritize the care of a child while also educating and empowering the parent to care for the child. - The nurse can foster a therapeutic relationship with a child by providing atraumatic care - Health Promotion - Resilience: ability to overcome challenges through mental, emotional, and behavioral adjustment and thrive despite difficulties - Examples: good balanced diet, vaccinations, routine check-ups, appropriate sleep etc. - Injury Prevention: - Unintentional injuries are the number one cause of death for children! - Support, Counseling, and Collaboration - A nurse must also provide emotional support - Trauma-informed care: Care focused on prevention of and assessment for traumatic experiences that impact health; focus on building safe, nurturing relationships - Parent support: should do this by initiating conversations, listening for fears/concerns etc. - Ethics - Justice: right of each patient to be treated fairly and equally - Beneficence: obligation to protect others from harm, promotes health - Maleficence: avoiding doing harm - Autonomy: freedom and ability to make one\'s own decisions - Decisions are often made by parents instead of patient, so it is important to educate the parents to prevent causing harm to patient - Remember to consider cultural differences - Ethical dilemma: Situation when two conflicting concerns without a clearly superior choice: also called moral dilemma - Can lead to moral distress - Moral distress: condition of suffering due to moral conflict or distressing event that conflicts with personal values and beliefs (common events: traumatic clinical events, end-of-life conversations, safety concerns etc.). Can impact nurses personally - Complex problem! - Moral Injury: violation of deeply held values, morals, or beliefs either by authority or self that causes trauma (ex. Shame, guilt, anger etc.) - Moral resilience: ability to deal with distressing moral or ethical events and circumstances; an antidote to moral distress - Child life specialists - Promote the emotional and social well-being of children and their families during illness and hospitalizations - Use developmentally appropriate play and other therapies to help children and their families understand and prepare for any medical treatment and procedures - [Types]: play therapy, dance therapy, art therapy, cognitive behavioral therapy, and applied behavior analysis - Family Structures - Each family has a different set of practices, beliefs, and values about health and wellness. - These learned attitudes and habits can both directly and indirectly affect the health of a child. - Single Parenting - children of these households have an increased risk for negative social, emotional, financial, and physical impacts and have a higher likelihood for mental health disorders, emotional distress, academic difficulties, and obesity. - Pediatric nurses can offer support, resources, and a multidisciplinary network to assist single-parent families to minimize these risks. - Divorce & Coparenting - Parental divorce and family instability can have detrimental effects on children such as increased risk for academic struggles, adjustment issues, and mental health concerns - [Education Tips] - Create a clear parenting plan - Set clear boundaries - Allow children to share emotions and listen - Make time for open communication - Resolve conflict in private - Show empathy - Show children love - Adoption and Foster Care - Trauma-informed care: care focused on the prevention of and assessment for traumatic experience that impact health; focus on building safe, nurturing relationships - Childbearing styles - Authoritarian: strict rules, noncompliance leads to discipline - Outcome: well-behaved children with fear of consequence - Authoritative: parents set clear expectations, disciplinary action is carried by explanation - Outcome: close, nurturing relationship, leads to better outcomes compared to others - Permissive: very nurturing and supportive, little rules or expectations - Outcome: unhealthy habits and long-term consequences - Neglectful/uninvolved: low support and are detached from child - Outcome: resilient and self-sufficient out of necessity - Social influences - Adverse childhood experiences (ACES): traumatic experiences in a child\'s life that can impact development and have long-term health consequences - Culture - Cultural competence: ability to deliver care that values the differences in others and includes preferences in care - [Attributes:] - Cultural awareness: initial step, self-reflection - Cultural knowledge: second step, building education of different cultures - Cultural skills: third step, nurses provide culturally sensitive holistic care to build skills - Cultural humility: cultural empathy, desire, and compassion for other cultures. - To enhance clear communication, the nurse should assess for communication barriers and avoid the use of medical jargon and acronyms. - Economic - Having sufficient and nutritious food, safe housing, and health care require financial resources, and negative health impacts are found in children without these basic health necessities. - For example, poor nutrition in children of all ages contributes to obesity and increased risk for diabetes and heart disease. - Nurses should ask if the client's needs are met regarding the SDOH domains including housing, food, transportation, employment, education, financial strain, and personal safety. - Levels of Prevention - [Primary]: vaccinations - Herd immunity: means of controlling the spread of infectious disease within a community through vaccination or recovery from infection - [Secondary]: early detection of disease (screening) - [Tertiary]: care of symptomatic patients, meds/rehab - Social Determinants of Health (SDOH) - Income, education, unemployment/job security, working conditions, food security, housing, early childhood development, social inclusion, structural conflict, healthcare access/affordability. - Bullying - Bullying: repeated aggressive behavior that inflicts physical or psychological harm often due to imbalance of power. - increased risk for depression, irritability, anxiety, sleep disturbances, academic difficulty, and dropping out of school. - [Ways to prevent bullying:] - Promoting healthy family environments and parenting skills - Resources about quality preschool programs - Promote school-based programs to strength interpersonal skills - Connect adolescents with safe, caring mentors - Promote positive community environment - Identify and intervene to decrease harm from violence - Gender identity - Gender: an individual\'s identity as masculine, feminine, both, or neither - A client's overall identity is shaped by many factors, including their family, society, culture, religion, education, peer groups, and media. - Human Trafficking - The second fastest growing criminal activity globally is human trafficking - [Indicators:] - Delayed medical care - Signs of physical, emotional, or sexual abuse - Appearance of neglect or malnourishment - Avoidance of eye contact and closed body language - Inconsistencies in clients history - Will not answer for themselves - Obesity in Children - [Effects of obesity on children] - Cardiovascular (chronic inflammation, heart disease, blood clots, dyslipidemia, hypertension), Endocrine system ( diabetes, early puberty, PCOS), Renal (fatty liver, gallstones, acid reflux), musculoskeletal (bone and joint disorders), pulmonary (asthma, exercise intolerance, sleep disorders), psychological (poor self-esteem, stress/anxiety, depression, eating disorder) - Epigenetics: study of how environment, habits, and behaviors impact gene expression rather than alteration of the genetic code itself - Microbiome: collection of microorganisms that live in the environment; variety of bacteria in the gut now linked with health - Vaccine Hesitancy - Nurses role in promoting vaccines - Build relationships - Coordinate care - Professional outreach - Facilitate programs *Health Assessment of Pediatric Clients Engage* - Establishing report - Therapeutic communication: communication techniques used to enhance physical, mental, and emotional wellbeing of clients and families - Autonomy: freedom and ability to make one\'s own decisions - [Strategies for therapeutic communication:] - position body at eye level - Make eye contact - Active listening - Use noticing statements by recognizing an interest (stuffed animal) - Use reflective listening - Avoid medical jargon - Interact in calm manner - Be positive - Interviewing the client and support system - Use open-ended questions - Age-appropriate communication - Active listening and allow patient to speak - Communicating with the pediatric client across a lifespan - Developmental milestones: defined activities or behaviors that children should be able to perform by a certain age - [Birth-6 months:] - Emotional milestones: reassured when talked to or held, smiles when sees parents, laugh - Language milestones: cries to communicate needs, begins to coo - Communication techniques: eye contact, age-appropriate movements (waving, crawling) - [12 months] - Emotional: face expresses emotions, responds to name, looks for or cries when parents leave - Language: makes more sounds, uses movement to express concerns, "no" - Communication Techniques: give praise and encouragement, patience - [18 months:] - Emotional: mimics other children, shows objects they like - Language: says more than 3 words, follows directions - Communication techniques: allow for questions - [24 months:] - Emotional: notices when others are upset - Language: recognizes items, puts 2 words together - [36 months:] - Emotional: plays near/with other children, follows directions - Language: vocab around 50 words, engages in conversation - [4 years] - Emotional: engages in imaginative play, wants to play with others - Language: says sentences of 4 or more words, repeats songs/rhymes - [5 years] - Emotional: follows rules, takes turns, sings/dance, does chores - Language: makes up stories, can recall details of story - Assessment of nutritional intake - Nutritional assessments should be inclusive of the client's clinical history, dietary assessment, physical examination, anthropometric evaluations, and diagnostic tests - Physical examination: systemic assessment of the body and system functionsusing inspection, palpation, percussion, and auscultation - Anthropometric evaluations: non-invasive quantitative body measurements such as length/height, weight, and head circumference - [Head circumference]: measured up to 2 yrs old, should be performed twice, between 0.2-0.25 cm. - [Length/height]: use an infantometer is patient cannot stand, use stadiometer for patients who can stand, repeat task twice - [Weight]: use calibrated infant scale for patients younger than 2, balanced or electric scale for patients older than 2, kg - The diagnostic tests ​​​​should include laboratory tests, such as serum electrolytes, blood glucose levels, creatinine, blood urea nitrogen, complete blood count, liver enzymes, and a lipid profile that evaluates nutritional, metabolic, and hydration status. - Cultural beliefs and practices influence diet - Nutritional needs upon the lifespan - [Birth-12 months] - Breast milk/formula, introduce water and nutrient dense food at 6 months, 700-1,000 cals per day - Can introduce different kinds of milk by 12 months - [After 12 months] - 2-5 yrs: 1,000-1,600 cals - 5-8 yrs: 1,200-2,000 cals - 9-13 yrs: 1,400-2,200 cals - Adolescents (14-18 yrs): 1,800-3,300 cals - Nutritional examination - Nurse collects data and assesses the client's status and health by performing a history interview and physical examination - A dietary history interview explores the client's eating habits, dietary restrictions, cultural norms, food allergies, and any known conditions that impact their eating habits.​​ - For children younger than 5 years old, stunting, wasting, and weight (under or over) are primarily used to assess nutritional status or imbalances \**Like the charts we used in lab*\* - General survey, growth charts and vital signs - Subjective data: what patient tells you - Objective data: what is observed by provider - The general survey notes the client's overall appearance, behavior, abilities, and vital signs - As part of the physical examination, the nurse will use growth charts and vital signs to evaluate general health, nutritional status, and system functions. - Vital Signs - [Temp]: 36.1-37.2 C or 97-99 F, rectal is most accurate but most invasive, can use tympanic (older than 6), axillary, and oral (older than 4) - [Pulse]: carotid, apical, brachial, and radial, crying can increase rate - Newborn (birth-4 weeks): 110-160 bpm - Infant (1-12 months): 90-160 bpm - Toddler (1-2 yrs): 80-140 bpm - Preschooler (3-5 yrs): 70-120 bpm - School aged (6-12 yrs): 60-110 bpm - Adolescent (13-18 yrs): 50-100 bpm - [Respiratory]: newborns and infants have irregular rhythms - Newborn (birth-4 weeks): 30-60 min - Infant (1-12 months): 25-60 min - Toddler (1-2 yrs): 25-30 min - Preschooler (3-5 yrs): 20-25 min - School aged (6-12 yrs): 20-25 min - Adolescent (13-18 yrs): 16-20 min - [BP] - White coat syndrome: condition when clients have high blood pressure reading in health care settings and expected readings at home, due to anxiety around health care professionals - Newborn (birth-4 weeks): 64/41 - Infant (1-12 months): 85/50 - Toddler (1-2 yrs): 85-91/37-46 - Preschooler (3-5 yrs): 91-98/46-53 - School aged (6-12 yrs): 96-106/55-62 - Adolescent (13-18 yrs): less than 120/80 - Systemic assessment: - [Integumentary system] - Eczema: general term for skin inflammation - turgor: ability of skin to change shape and return to normal; measures elasticity of skin - [Head and neck] - For all pediatric clients, the nurse inspects head shape, size, symmetry, and facial movements - For infants, the nurse notes head control and palpates the skull and fontanels for smoothness - By 4 months, infants should be able to hold their head steady without support. - [Eyes] - Conjunctiva: thin, clear membrane that covers the surface of the sclera and inner lining of eyeballs - use the Snellen eye chart (far vision) and Ishihara plates (color) to assess vision. - [Ears] - For infants and toddlers, ear infections can be a common experience, and this may have an impact on hearing and language development. - All infants receive a hearing screening prior to discharge from birth and no later than one month after birth - On visual assessment, the ear structure should be free of drainage and ​​​​cerumen impaction - [Nose, mouth and throat] - Patency: quality or state of being open or unobstructed - Teeth eruption: breaking of teeth through gum line - first to erupt between 6 to 12 months; by 3 years of age, the average pediatric client will have 20 deciduous teeth - The nose is inspected for patency and drainage - [Chest] - Crepitus: assessment of air trapped under the skin; nurse palpates chest to hear and feel crackles and popping - Thrills: unexpected vibration felt on the skin that overlays a murmur or fistula - [Lungs] - Stridor: unexpected high-pitched respiratory sound produced by an irregular or narrowed airway - Pleural rub: audible, raspy respiratory sound in addition to expected breath sounds that results from inflamed or roughened pleural surfaces - [Heart] - A murmur may be heard in the first few days after birth as the ductus arteriosus closes - [Abdomen] - [Musculoskeletal] - Back - Around 1 year old, infants pull to stand up and begin to walk with support - At 2 years old, toddlers run and climb stairs. - Any imbalances or curvatures should be reported to an advanced practice provider for further evaluation - Extremities - In a sitting position, the nurse should inspect extremities, noting size, symmetry, and contour of muscles. - The nurse can evaluate range of movement through active or passive movement, depending on the client\'s age and ability to follow instructions - [Genitalia and Anus] - In male pediatric clients, the scrotum shape should be assessed, and testicles may be palpated noting size, shape, consistency, and symmetry - In female pediatric clients, the nurse should note the presence and characteristics of vaginal discharge - The anus should be inspected for location and presence of musculature. - Pathophysiology and types of pain - Nociceptive pain: pain that arises from the tissues due to damage caused by physical (trauma) or chemical (burns) agents - ACUTE PAIN (SHORT TERM) - Centralized pain: can be due to chronic pain (LONG TERM) because of prolonged exposure to pain - ​​Neuropathic pain: results due to a dysfunction of the somatosensory tract of the nervous system causing pain to be experienced - Acute on chronic: situation in which a client who has a chronic condition experiences or develops an acute condition - Assessment of pain - Pain is subjective! - [Pain scales:] - Premature infant pain scale (PIPP-R): preterm and infant patients, 21 total points - Face, legs, activity, cry consolability (r-FLACC): 2 months-7 yrs, or nonverbal patients, Five items scored from 1-2, total 10 pts - Pain word scale: 3-7 yrs, uses words such as "little", "non", or "a lot" - Faces pain scale: 5-12 yrs, picture-based scale of faces from 1-5 - Numeric rating scale: 7 yrs-older - In addition to quantifying pain, the nurse should assess pain quality, characteristics, location, onset, duration, factors that aggravate or relieve pain, and the impact of the pain on function and physiological parameters. - Interventions - [Nonpharmalogical] - Massage, warm or cold compress, position changes etc. - [Pharmacological] - Acetaminophen - Non-steroidal anti-inflammatory medications (NSAIDS) - Anticonvulsants - Skeletal muscle relaxants - Don't forget about ADPIE! *Communicable Diseases and Immunizations Engage* - Infection Control - educate both pediatric clients and their families about proper hygiene practices, including handwashing, cough etiquette, and maintaining a clean environment - Effective communication ensures that families are well-informed about the importance of immunizations, helping to prevent the occurrence of vaccine-preventable diseases among children. - provide screening and assessments for the pediatric population to identify potential infections and help with the immunization of the pediatric population. - ensure vaccines are administered according to recommended schedules - monitor for any adverse reactions and maintain accurate records of immunizations - ensure children are on schedule with their immunization regimen - Educate parents about the importance of vaccines, the recommended schedule based on the child\'s age, and the specific vaccines required - Precautions - Education, assessment, communication, and compassionate care contribute significantly to preventing the spread of infections - Kids usually use mouth-to-mouth activities and have an immature immune system leading to increase risk of illness - Hand washing is the most effective - [Types of precautions] - Standard precautions: used for all clients - Use of PPE, hand washing, treating all body secretions as "contagious" - Transmission-based precautions: added for further protection for contagious agents - Contact: spread through direct or indirect contact - Wear gloves, ex. C DIFF, MRSA - Airborne: transmission of infectious microorganisms in the air - Negative pressure room, N-95 mask, ex. TB - Droplet: respiratory secretions are contagious (cough, sneezing) - Special air ventilation required, wear surgical mask, ex. Pertussis, flu, meningitis - [Correct order of PPE application] - Hand washing, gown, mask, goggles/face shield, and gloves - Chicken Pox (**Varicella**) - [Etiology and risk factors] - Contracted by inhaling the infected aerosolized virus or coming into contact with fluid from open vesicle - Viremia: presence of viruses in the bloodstream. Occurs when virus enters bloodstream and circulate throughout the body, leading to systemic infection and affecting tissues and organs - [Treatment] - Pruritus: itchiness - Rhinorrhea: secretion of mucus from nose - Acetaminophen for fever - Hydration - Diphenhydramine - [Nursing Interventions] - primarily focus on alleviating pruritus, reducing fever, and ensuring rest and hydration - Over-the-counter antihistamines or calamine lotion can help soothe the pruritus associated with the chickenpox rash - placed on airborne and contact precautions - Diphtheria - Patho: affects the respiratory and integumentary system - Exotoxins: what diphtheria produces; peptides that are mostly secreted by gram-positive bacteria - Results in inflammation of throat - Clinical presentation - Flu-like symptoms - Lymphadenopathy: enlargement of lymph nodes - gray-colored pseudomembrane covering the throat and tonsils - Treatment: - isolating the client and treating them with antibiotics (penicillin) and the diphtheria antitoxin (DAT) - booster diphtheria toxoid for those with an unknown immunization status - Nursing interventions: Soft diet with plenty of liquids - Mumps - Patho: - inflammation of the salivary glands, testes, ovaries, and, although rare, even the central nervous system, highly contagious - Risk factors: - Orchitis: inflammation of one or more testes - Fomites: items in the environment that might carry infectious materials - Clinical manifestations: - Parotitis: inflammation of the parotid gland - Anorexia: lack of appetite - Myalgia: enlargement of the lymph nodes - Treatment: - Booster immunizations - Rest, hydration, hot & cold compress - Nursing intervention: - Applying a cloth-wrapped cold compress to swollen areas provides relief - Soft diet, hydration - Prevention: MMR Vaccine - Measles - Flu like symptoms with bumps all over skin - Placed on airborne precautions, no antiviral treatment - Hydration, use humidifiers - Herd immunity: group immunity that is achieved by exposure to a virus or disease; once enough people are immune, it reduces or stops the spread - **Poliomyelitis (polio)** - Transmitted through fecal-oral route - Muscle weakness/paralysis - Treatment: PT, mechanical ventilation, adequate nutrition and hydration - Contact precautions, use occupational therapy aids (wheelchair etc), pain management techniques - Polio vaccine - COVID-19 - Direct contact or droplet precautions - Can be asymptomatic or symptomatic - Antiviral medication - Get vaccine - Ramdesvir - Viral meningitis - Flu-like symptoms - Treatment: lumbar puncture, Empiric antibiotic therapy - Droplet precautions - Acyclovir - Bacterial meningitis - Brudzinski sign: passive flexion of the neck that produces involuntary flexion of knees while client is in supine position - Kernig sign: Pain or resistance while extending the knee of client when they are supine and knees are flexed - Flu-like symptoms - Hospitalization, antibiotics - Prevention: meningococcal, pneumococcal, and Hib vaccines. - Hepatitis - unsafe sexual practices, intravenous drug use, inadequate sanitation, and exposure to infected blood or bodily fluids. - Jaundice: yellowing of skin and sclera, increased amounts of bilirubin circulating in bloodstream - Antiviral meds, immunomodulators, liver transplant - Lamivudine, Interferon alfa-2b (meds) - Mononucleosis - Direct contact with saliva - Splenomegaly: enlarged spleen - Hepatosplenomegaly: enlargement of spleen and liver - anti-inflammatories and antipyretics for pain and fever. - Focus on prevention: good hygiene - Roseola Infantum - Contact of saliva, cough, sneezes - Periorbital edema: swelling around eyes - Otalgia: pain in one or both ears - Treatment is to relieve manifestations - Fifth disease ( erythema Infectiosum) - Flu-like symptoms, rash on face - Arthropathy: disease of joint - Treatment is to relieve manifestations - Avoid contact with others - Hand, foot,mouth (HFM) - Transit by contact and droplet - spots/blisters, flu like symptoms - Exanthem: widespread rash on body - No treatment - pain meds - Impetigo - Contagious lesions on face - Bullous impetigo = blisters - Honey crusted impetigo - Treatment: antibiotics - Satellite lesions: additional lesions that develop from original lesions - Conjunctivitis - Pink eye - Fluoroquinolone Antibiotic eye drops - Don\'t come into contact with anyone and use proper hygiene - Viral conjunctivitis - Upper respiratory viral infection and inflammation of conjunctiva - Redness/discharge of eye - Specific antiviral treatment - Proper hygiene and no contact with anyone - Allergic conjunctivitis - Inflammation of eyes caused by allergies - Antihistamines for treatment - Conjunctivitis caused by foreign body - Damage of eye - Flush item out - Wear protective eyewear - Herpetic Gingivostomatitis - Viral infection of mouth and gums - Sores - antiviral medications, such as topical or oral acyclovir - Provide oral care - Aphthous stomatitis (canker sore) - Inflamed sores/ulcers in mouth - Topical analgesic agents or oral analgesics may be recommended to alleviate pain - Good oral hygiene practices - Eat well balanced diet - Immunotherapy terms - Antibody: known as immunoglobulins, y-shaped proteins, neutralize pathogens by binding to them - trigger the complement system, enhancing the immune response, and some antibodies stimulate immune cells - Immunoglobulin G (IgG): is the most abundant in the bloodstream, contributing to long-term immunity - IgM is the first antibody produced in response to an infection. - IgA predominates in bodily secretions, providing localized immunity - IgE is involved in allergic responses and defense against parasites - IgD\'s precise function is less understood but is found on the surface of B cells​​​​​​​. - Antigen: provoke immune response in body - recognizes antigens as potential threats and mounts a response to eliminate or neutralize them. - Trigger antibodies - Activate t-cells - Antitoxin: produced by the immune system in response to toxins released by bacteria, plants, animals, or other organisms - Antitoxins bind to the toxin molecules - Attenuate - Attenuation is the process of reducing the virulence or potency of a pathogen while retaining its ability to induce an immune response. - One attenuation method involves passage through different hosts or cultures, allowing the pathogen to adapt to new conditions. - The objective of attenuation is to strike a balance. - Cocooning: public health strategy used to protect vulnerable individuals, such as newborns, infants, or those with compromised immune systems, from infectious diseases by creating a protective barrier through the immunization of close contacts and parents. - Immunity - [Natural immunity]: innate immunity - It is the first line of defense and is a rapid, nonspecific response to various infectious agents, providing immediate protection - Given at birth - physical barriers like the skin and mucous membranes, inflammatory response - [Acquired immunity] - Active immunity: arises when the body\'s immune system generates its response upon exposure to antigens, whether naturally (through infection) or artificially (through immunization) - [Passive immunity]: occurs when antibodies or immune cells are transferred from one individual to another, providing immediate but temporary protection. - Natural passive immunity: Natural passive immunity occurs during pregnancy as a developing fetus receives protective antibodies from the mother through the placenta. Infants acquire antibodies through breast milk, providing crucial defense against infections - Artificial passive immunity: involves administering pre-formed antibodies obtained from external sources, such as immune globulin derived from human donors or animals - [Herd immunity]: provides individual protection from infectious diseases indirectly. - occur through immunization or infection - Immunization campaigns are one of the primary methods to achieve herd immunity. - Can cause vaccine hesitancy or limited supply of vaccines - Immunobiologics - Medical treatments derived from biological sources, including cells, tissues, and immune system components, harness the body\'s immune response or modify its function to prevent, treat, or manage various diseases and conditions. - Vaccines - Immunomodulators: modify or regulate the immune system\'s activity - Monoclonal antibodies: laboratory-produced antibodies designed to target specific proteins or cells in the body, bind to specific antigens on cancer cells, pathogens, or even immune system components involved in autoimmune diseases - Immunization - triggering the immune system to develop immunity against specific pathogens - elicits an immune response, causing the production of antibodies and memory cells specially designed to combat the pathogen in question - Barriers include vaccine hesitancy, limited access to vaccines in certain regions, and misinformation about vaccine safety - Immunoglobulin therapy - utilizing immunoglobulins retrieved from healthy donors to treat numerous medical diagnoses ranging from Kawasaki disease to severe combined immunodeficiency disorders (SCID) - Toxoids - chemically modified versions of these toxins that have been rendered non-toxic while still retaining their ability to stimulate an immune response. - examples of toxoid-based vaccines include those against diphtheria and tetanus - Vaccine types - Combination: combine multiple vaccines into a single formulation, providing protection against several diseases with a single injection - Conjugate: involves attaching the polysaccharide antigen from the pathogen to a carrier protein. - Monovalent: focus solely on inducing immunity against a single pathogen or variant (ex.flu). - Polyvalent: protect against multiple strains or serotypes of a particular pathogen or against different but related pathogens. - Commonly administered vaccines - Vaccine considerations - Contraindication: condition that excludes a client from receiving a further dose of vaccine due to risk of a poor outcome - Precaution: condition that places a client at risk for an adverse reaction but does not permanently exclude client from getting further doses - Haemophilus Influenzae Type B - Hepatitis - A: 2 doses, IM injections - B: 3 doses, IM injections - Polio - Starts at 2 months, IM injection - Pneumococcal - pneumococcal conjugate vaccine (PCV): for first 3 doses - pneumococcal polysaccharide vaccine (PPSV): people with immunocompromising conditions - Rotavirus - Oral drops at 2-4 months - Varicella - First dose at 12-15 months - Second dose at 4-6 yrs - DTap or Tdap - Need booster every 10 yrs - MMR - 12-15 months (first dose) - 4-6 yrs (second dose) - Subcutaneous injection - Human papillomavirus (HPV) - 9-45 yrs - 2-3 IM doses - Meningococcal: preventing infections caused by the *N. meningitidis* bacteria, which is known to cause severe meningitis and bloodstream infections - 11-12 yrs (first) - At 16 (second) - Flu - 6 months and older - Need booster every year, IM injection - Check for medication allergies! - COVID-19 - Based on clients age - Can start at 6 months - Parasitic diseases: encompass a broad array of illnesses caused by various parasites that thrive at the expense of their hosts, including humans - contaminated food or water, insect bites, contact with infected individuals, or exposure to contaminated soil (ex. malaria). - Preventive measures include proper sanitation, access to clean water, vector control, and health education to reduce exposure to parasites - Parasitic infections affecting integumentary system - Scabies - Mites survive under the skin for 1 to 2 months, with eggs hatching within 2 to 3 weeks - Cellulitis: bacterial infection affecting the skin, often causing pain and redness, and most often affecting legs - Treatment: - Eradicate: declaration that a disease or condition is no longer present in an area - Permethrin cream (topical antiparasitic agent) - No contact and good hygiene - Lice - Infestation, can create sores and pain - over-the-counter or prescription-strength medicated shampoos, lotions, or creams that contain insecticides - Topical permethrin is commonly utilized as a first-line treatment - Looks like dandruff, use tooth comb to get rid of eggs - Parasitic infections affecting the gastrointestinal system - Pinworms (enterobiasis) - Worms travel to anal opening and hatch contacted through direct contact - Irritability, disturbed sleep, abdominal pain - Treatment: anthelmintic meds - Hygiene, wash clothes, do not come into contact - Giardiasis - diarrhea and impaired absorption are caused by alterations to the epithelial cells of the intestine. - watery diarrhea, abdominal cramps, bloating, gas, fatigue, and weight loss. - Treatment: amebicide and/or antiprotozoal - Good hygiene, hydration (clean water) *Pediatric Clients in a Hospital Setting* - Stress - Early Childhood (birth-6 yrs) - may experience increased anxiety due to the pain and discomfort associated with hospitalization - scary for pediatric clients are intravenous lines (IVs), needle sticks (such as for drawing blood for laboratory tests), and medical equipment - Enuresis: urinary incontinence, also known as bedwetting - Some preschoolers believe their pain is punishment - Separation anxiety: fear and anxiety an infant feels when they are separated from loved ones - Child-life specialist: educated, clinically trained health care professionals who help children and families navigate the hospitalization process - Later Childhood (6-12 yrs) - understand more about their hospitalization and may express anxiety through their emotions - Adolescence (12-20 yrs) - If these interventions disrupt their sense of identity in how they look and appear to others, however, they can experience great anxiety - express their anxiety by acting out and participating in dangerous activities, such as substance use. - shield their emotions - Separation anxiety - Early Childhood (birth-6 yrs) - Young children do not understand why they need to be in the hospital setting, and possible separation from their parents is frequently the source of their distress - Later Childhood (6-12 yrs) - peers are important and pediatric clients become more independent - not only feel the separation from their home environment during hospitalization, but also from their friends, school, and activities, such as sports. - Adolescence (12-20 yrs) - Similar to later childhood, adolescents also feel separation from their home environment, friends, school, and other activities when in the hospital. - Loss of control - Early Childhood (birth-6 yrs) - They may undergo too much stimulation or not enough - Their routines are disrupted, and inconsistency in care and caregivers can lead to more stress. - Hospitalization stressors are often described by them in terms of fear of pain and discomfort. - Later Childhood (6-12 yrs) - hospitalization can spark feelings of fear of the unknown, pain, and loss of their safe environment - fear about losing opportunities to practice developing skills, such as through school and physical activity. - Adolescence (12-20 yrs) - stressors during hospitalization also include confusing communication, inadequate sleep and rest, and not having privacy - experience withdrawal, regression of behaviors, and aggression depending on their hospitalization experience - Responses of support systems - It is expected that how families respond to hospitalization will influence how well their children cope - Bowen family systems theory - Responses of siblings - hospitalization of a pediatric client can lead siblings to feelings of resentment and anxiety - Common responses of siblings include jealousy, sadness, loneliness, and even guilt. - promoting family communication is still important - parents should let them ask questions and provide honest answers - Therapeutic communication - Therapeutic communication: Communication techniques (such as active listening, repeating information, and using open-ended questions) used to enhance the physical, mental, and emotional well-being of clients and their families. - [AIDET:] - A = acknowledge - I =introduce - D = duration - E = explanation - T = thank you - Minimizing stress and loss of control - Nurses can help decrease client and family stress by including the family in the treatment plan - nurses should explain information and instructions clearly, take time to listen, and offer opportunities for questions - When working with pediatric clients, it is helpful to give them choices when appropriate (not all the time) - Parental absence - When parents cannot be present, they should let their children and the health care staff know where they are going and when they will return - Nurses should encourage parents to call for updates and to visit as often as they can - Teaching - Nurses can help relieve stress by promoting family involvement and understanding about what is going on - Activities and play - Play is a great way to help children cope and increase their resilience - Helpful play interventions for infants include providing music, such as lullabies, and age-appropriate toys (for example, rattles and stuffed animals) that promote infants' involvement (moving, kicking, crawling) - Nurses can interact directly with older infants by playing games, such as peek-a-boo. - Play options for toddlers include listening to music, stacking blocks, painting, coloring or scribbling with crayons, and bouncing, throwing, and kicking a ball - Preschoolers can be offered the same activities as toddlers - For school-age clients interacting with peers is helpful, and activities such as arts and crafts and games (for example board games, card games, and video games) are therapeutic - For adolescents, peer engagement is very important Adolescents may also benefit from games as well as the opportunity to journal and scrapbook - Support - Child life specialists help provide psychosocial support, especially through the promotion of therapeutic play - Some facilities also offer animal-assisted therapy - Discharge and teaching - discharge planning should begin as soon as possible during the hospitalization - Nurses should coordinate teaching opportunities whenever possible during the hospitalization, - Health literacy: degree in which a person can find, understand, and use health-related information to make healthcare decisions for themselves - Nurses should inquire ahead of time how the client and family learn best whether that be through verbal or written information - client's hospitalization, diagnosis, medications, follow-up appointments, and reasons to call the provider. - teach-back method: nurses have clients and families repeat back what they have learned in their own words. - show-me method: parents demonstrate the skills they need to know - Intensive care unit (ICU) - Pediatric intensive care unit (PICU): area in hospital dedicated to caring for children with critical illnesses and diagnoses - Social work: service that provides financial and emotional support to clients and families - Physical therapy - Occupational therapy - parents can stay at the bedside with their child who is in the PICU, but there will be lots of equipment and monitors so sometimes space is limited and only one parent can stay at a time - clients who are in the PICU is that a longer stay means pediatric clients cannot attend school and parents may miss work - Children may require school support while they are in the hospital as well as after discharge - Health perception/health management - Direct admission: when a patient is admitted for care without first being seen in the ER - Vital signs, height, weight, head circumference (if warranted), body systems (cardiovascular, respiratory, gastrointestinal, genitourinary, neuromuscular, integumentary), and pain will all be assessed - During the admission process, the nurse must assess the parent's ability to manage care at home. - families are at home caring for their children's medical needs, they can experience a different kind of stress than during hospitalization - Because health care professionals are in charge of care - important for nurses to assess other potential barriers to the recovery of the pediatric client following discharge. - Nutrition/metabolism - Infants: 100cal/kg/day - 1-3 yrs: 80kcal/kg/day - 4-5 yrs: 70kcal/kg/day - 6-8yrs: 65kcal/kg/day - 9+ yrs: 35-45kcal/kg/day - Elimination - Stress of hospitalization may cause regression in toilet training progress, and toddlers may experience accidents, such as bedwetting - Resolve when returned home - Toilet training pants available through the hospital can be used instead of using diapers or expecting children to wear underwear - Rest - Dim lighting can be used during quiet hours during the day and throughout the night, and natural light can be used during the day hours - Newborns: 14-17 hrs - Infants: 12-16 (including naps) - Toddlers: 11-14 (including naps) - Preschoolers: 10-13 (including naps) - School-age: 9-12 - Adolescents: 8-10 - Activity/exercise - Children under 1: activity throughout day; tummy-time - Children 1-5 yrs: activity throughout day through play - Children 6-17 yrs: 60 min or more of moderate to vigorous activity - Cognitive/perceptual - [Do not ask families and clients to interpret!] - Role/relationship - Be open and honest to clients/families - Use appropriate language depending on age - [Nurses should NOT:] - Tell family everything will be okay or that a procedure will not hurt - Refer to medication as "candy" - Make up an answer to a question - Sexuaqlly/reproductive - Adolescents may be undergoing puberty while in the hospital, facing the physical and emotional changes that accompany the stage of development in a new and unfamiliar setting - Nursing interventions - Orientation to the room - show them around the hospital unit and their hospital room - If parents cannot stay at the bedside, or only one parent is allowed to stay at one time, units should have access to a family lounge that parents and family members can use - Use of procedure room for invasive interventions - nurses can use a procedure room, often called a treatment room, on the unit to complete procedures that may be scary or cause pain, such as starting an IV - help them to not associate these procedures with their personal room - Initiating IV access - Nurses should assess the IV site every hour - Infiltration: when iv fluids or medications leak out from the clients veins into surrounding tissues - Phlebitis: redness or irritation around IV site - Some pediatric clients may have central line access instead of peripheral line access - Used for long term use - Clients who have certain CVLs can return home with these access devices, whereas peripheral lines are removed before the client is discharged. - Safety - Handwashing is a priority for safe, clean care. - Orienting the client and family to their hospital room is a great way to prevent injury and falls - Keep potentially harmful items (needles, syringes, antiseptic wipes) out of a client's reach - use a sharps container in the room for needles and glass medication vials - IPASS handoff tool - I: illness severity - P: patient summary - A: action items - S: situational awareness - S: synthesis - SBAR handoff tool: - Situation, background, assessment, recommendation - Latex allergy - Latex: product derived from sap and rubber trees - can appear as a rash, with itchy and bumpy skin - During the admission assessment, nurses should inquire about client allergies and sensitivities - Sudden infant death syndrome (SIDS): unexpected death of an infant under 1 yr old, unknown cause - Appropriate bed for age - Infants: open crib - Toddlers: enclosed crib "cage crib" - Preschoolers-adolescents: normal beds - Play - Hospitals generally have a designated playroom on the unit for pediatric clients during their hospital stay - activities can still be brought to the client's room for them to participate and play. - Facilities may also offer a room or lounge for adolescents - Hospital policies - a common hospital policy is for each pediatric client to wear an identification band, which includes their name, birthdate, and medical record number (MRN) - Some pediatric units are locked; parents and visitors may need to check in and be approved for entry - Health Insurance Portability and Accountability Act (HIPAA): law that protects clients health care information - Do not post or take pictures of kids! - Feeding the sick client - sometimes pediatric clients have procedures that require them to not eat or drink beforehand - Aspiration pneumonia: form of pneumonia that occurs when food or liquid enters the lungs - After procedures, clients start on clear liquid diet (water, coffee, tea, fruit juice, soft drinks, hard candies, popsicles - Then move onto full liquid diet (milkshakes, creamy soups, ice cream, pudding) - Fever - Sometimes children can have a fever for other reasons, such as teething, overdressing (for example, when infants are wrapped in blankets), or following childhood vaccinations. - If the child is still able to eat, drink, play, and void adequately, it is usually recommended to let the fever run its own course - Temporal : 100.4, 38c - Oral: 100, 37.8c - Axillary: 99, 37.2c - Restraints - frequent checks of their physical status (including vital signs, skin integrity, and range of motion \[ROM\]) - psychosocial status (including their dignity and rights as a client) - Informed consent - patients/families should know these things before giving consent - The client's diagnosis - The name of the procedure or treatment - What the procedure or treatment is and why it is recommended - The risks and benefits of the procedure - Any potential alternative procedures available - The risks and benefits of the alternative procedures - The risks and benefits of not pursuing the planned procedure/treatment - Consent for procedures and treatment will be provided by the parent or legal guardian for children under 18 years old - Some minors may be emancipated, meaning they are legally responsible for themselves and do not need parental consent prior to procedures and treatment - Implied consent - Emergency situations - implied consent may be enabled for life-saving procedures - Assent: agreement or approval for participation in healthcare activities, such as clinical trials or treatments - Dissent: disapprovement or rejection for for participation in healthcare activities, such as clinical trials or treatments - Preparation for diagnostic procedures - If children are younger than 5 years old, it is best to begin preparations a day or two before the procedure - children are older, preparations can begin a few days or even a week in advance, if applicable. - Laboratory collections - Most common to a pediatric unit are blood, urine, and swab tests - Intermittent catheterization: urinary catheter to obtain a urine specimen wherein it is removed after the specimen is collected - Medication administration - Calculating medication dosages - Determined based off weight (kg) - 1 kg = 2.2 lbs - 1 lb = 16 oz - Different kinds of administration - oral (PO), sublingual (SL), rectal (PR), intravenous (IV), intramuscular (IM), subcutaneous (subcut), ophthalmic, otic, inhalation, and topical or transdermal. - Oral - Less than 4 months: Slowly instill medication using a graduated dropper or syringe into the side of the oral cavity. Provide a pacifier or bottle with breast milk or formula for the infant to suck on between and following medication administration. - 4 months-1 yr: Use a graduated syringe, dropper, or cup to administer liquid medications. Provide 15 milliliters of diluted juice or baby food following medication administration. - 12 months +: Use a graduated syringe, dropper, or cup to administer liquid medications. Provide food or drink between medications and following medication administration. - Oral tablets, capsules, wafers, or films, cups, dosage spoons - Medications given via inhalation are inhaled into the client's lungs using devices such as metered dose inhalers or nebulizers. - Ophthalmic medications for treating infections or injuries to the eyes are available as drops or ointments - Intravenous (IV) medication is given into a client's vein - Medication reconciliation - all the client's current medications, herbal supplements, and vitamins are documented - Gavage feeding - alternative methods, such as a gastrostomy tube (G tube) or a nasogastric tube (NG tube), are used for feeding and medication administration. - Stoma Care - Opening made through surgery or internal organ or other body part to be accessible outside the body, sometimes called ostomy - Colostomy: stoma made from colon - Ileostomy: stoma made from small intestine, specifically from ileum