Introduction to nursing care of children.docx

**INTRODUCTION TO NURSING CARE OF CHILDREN** **Evidence-Based Practice** Nurses must participate in research and use evidence that is based on current research to improve patient-centered care. Evidence-based practice is used to improve patient outcomes Evidence-based practice is always consider...

**INTRODUCTION TO NURSING CARE OF CHILDREN** **Evidence-Based Practice** Nurses must participate in research and use evidence that is based on current research to improve patient-centered care. Evidence-based practice is used to improve patient outcomes Evidence-based practice is always considered recent if within 5 years. **What is patient- and family-centered health care?** Patient- and family-centered care is an innovative approach to planning, delivering, and evaluating healthcare grounded in mutually beneficial partnerships among healthcare patients, families, and providers. Patient- and family-centered care applies to patients of all ages and may be practiced in any healthcare setting. **Nurses Role in Helping Families Deal with Stress** Help family identify strengths and resources Help family develop strengths and use resources **Types of Families** Childless family Cohabitation Nuclear Multigenerational Single Parent Blended Foster/ Adoptive LGBT **Factors that interfere with family-centered care** Divorce Adolescent parenting Violence Substance abuse Poverty Homelessness The chronically ill child/the child with special needs **Cultural Influences on Pediatric Nursing** One of the most significant factors that influence parenting, health beliefs, illness, and aging is culture. **Parenting Styles** Authoritarian- very strict, parents make rules and kids obey them Authoritative- parents have control, kids obey the rules and have choices Permissive- parents have no control, kids rule the house **Parent-Child Relationships** Key characteristics that can be used to assess the quality of parenting: Emotional availability Control Psychiatric disturbance Knowledge base Commitment **Types of Discipline** Infants: -Distraction -Comfort measures Toddlers/Preschoolers: -Time out/Time in (1 minute per year of age) -Redirection School Age: -Reasoning -Consequences All ages: -Offering restricted choices -Diversion -Distraction/Redirection -Comfort **COMMUNICATING WITH CHILDREN** **Components of Effective Communication** Touch Environment Physical proximity- approach the child at the door Listening Tone of voice Body language Eye contact- eye contact while listening, being at eye level Timing **Family-Centered Communication**\ Emphasizes that families are an integral component of childcare Includes the following components: Establishing rapport Availability and openness to questions Family education and empowerment Effective management of conflict Evaluation of care Spirituality Keeping the child connected with the family **Transcultural Communication** Nurses must consider and elicit information regarding the culture of the family for which they are caring Decision-making practices Child-rearing practices Family support Communication practices Health and illness practices **Communication Approaches for Children** The communication approach should be based on the child's age and developmental abilities Play Storytelling Explaining procedures and treatments **Key Elements for Communicating Complete and Accurate Information** Learn the procedure Determine what information to share with the child and family Provide sensory information Explain the sequence of events Explain how long the procedure will last Monitor the accuracy of information **Communicating with children with special needs** In working with children with special needs, the nurse must carefully assess each child's physical, mental, and developmental abilities and determine the most effective methods of communication. **PRINCIPLES OF GROWTH AND DEVELOPMENT** **Stages of Growth** Neonate: first 28 days of life Newborn: Birth to 1 month Infancy: 1 month to 1 year Toddlerhood: 1 to 3 years Preschool age: 3 to 5 years School-age: 6 to 12 Adolescence: 13 to 17 Late Adolescence: 18-21 **Growth and Development** Each child displays a definite, predictable pattern of growth and development -Cephalocaudal and proximodistal -General to specific (motor skills are very general and become specific as they get older) -Simple to complex (simple thoughts and understanding when young, become more complex as they get older) **Factors Influencing Development** Genetics Nutrition Prenatal and environmental factors Health status Family and culture **Growth Patterns** Infants\' birth weight should [double by 6 months] Infants\' birth weight should [triple by 1 year] Toddlers birth weight should [quadruple by 2.5 years] Weight, Length/height, and head circumference are plotted on a growth chart to assess growth patterns **Theories of Development** Erikson- psychosocial development Piaget- cognitive development Kohlberg- moral development **Screening Tools Used for the Assessment of Children** Dubowitz/Ballard Examination for gestational age Denver Developmental Screening Test II **The Work of Play** Functions of Play Classification Social aspects of play **Childhood Immunizations** Get the greatest number of vaccines at 2 months of age (6 vaccines) Pediatrician provides handouts on vaccines to families **Nutrition and Obesity** Diet for Americans 2 years of age and older should be low in fat, saturated fat, and cholesterol Obesity has become an epidemic in American children and its reduction is one of the goals of Healthy People 2030 Obesity rates have skyrocketed in the last 5 to 6 years **Current Dietary Guidelines and Resources** Excellent resources for parents, children, and health care professionals. **Nutrition** Infant Toddler Preschooler School Age Adolescent **Physical Activity** Less active and more sedentary lifestyle The prevalence of overweight children ages 6-11 and adolescents has nearly tripled in the past 30 years. **CDC Recommendations** Children should be physically active for at least one hour daily Aerobic exercise should be the major component Make exercise fun and a habitual activity Encourage them to participate in physical education Encourage families to research and utilize community physical activity programs. **NURSING CARE OF A FAMILY WITH AN INFANT** **Health Promotion for Infants** Immunizations Newborn infants require a medical visit with a provider within 72 hours of discharge (for a weight check to make sure they aren't losing weight) **Reflexes Present at Birth** Moro Tonic neck Gag, cough, blink, pupillary Grasp Rooting Babinski **Critical Milestones: 2 Months** Smiles spontaneously; looks at faces Follows face or object to midline Vocalizes, making "oohs and "aahs" or short vowel sounds; responds to a bell Lifts head when prone Tummy time is very important and should be started by 2 months of age **COLIC** Usually happens around 3 months of age Babys swallow air and can\'t burp it out which causes gas pains Clinical manifestations: The infant cries loudly and continuously, often for several hours The infant's face may become flushed The abdomen is distended and tense Infant draws up legs and clenches hands Episodes often occur at the same time each day (late afternoon or early evening) Crying may stop only after the infant is exhausted or has passed flatus or stool Putting them on a warm dryer or noise louder than their cry like a vacuum can help **Critical Milestones: 4 Months** Grasps rattle; follows past midline; brings hands to the middle of the body Laughs and squeals out loud; vocalizes with "ooh" "ee" and "ah" sounds Holds head steady when sitting Increase interest in parents Turns from prone to supine position **Critical Milestones: 6 Months** Reaches for a toy that is out of reach; looks at hand; smiles spontaneously Turns to sound that is out of vision on each side; squeals; laugh Rolls over in both directions; no head lag; lifts head and chest off a surface completely (this is why tummy time is important) Uses palmar grasp (whole hand grabbing) **8 Months** Sits without support Fear of strangers Enjoys manipulating rattles **Critical Milestones: 9 Months** Feeds themself finger foods; tries to get toys; looks at hands Transfers objects from one hand to another; raking grasp; picks up and holds a small object in each hand Imitates sounds; says single syllable; begins to put syllables together Stands holding on to furniture **10 months** Pull themselves up Begins to use the pincer grasp Enjoys playing patty-cake and peek-a-boo **Critical Milestones: 12 Months** Pincer grasp fully developed Jabbers; combine syllables; "mama" and "dada" First steps Waves bye-bye; explores the environment Birth weight triples by 12 months of age **Erickson: Trust vs Mistrust** Infants must form a sense of trust. To form a sense of trust the infant's needs must be met when they arise, and their discomforts removed. How do we do this? Inconsistent, inadequate care or rejection fosters mistrust. Infants become fearful and suspicious of their world. **Infant Safety** Aspiration Prevention Suffocation Unintentional Injuries **Infant in Hospital Setting** Separation Anxiety Stages of separation anxiety **Critical milestones: 15 months** Able to say 4-6 words Repeat what they hear, they learn from their parents Stacks blocks Scribbles Begins to feed themselves, but turn the spoon upside down when put in their mouth **18 Months** No longer rotates spoon Able to go up and down stairs with help 7-20 words **Critical Milestones: 2 years** Removes one article of clothing; feeds a doll (very imaginative); uses a fork or spoon Parallel play is very evident here Can open doors **Psychosocial Development Toddler** Erickson Autonomy vs shame or doubt Parents should encourage independence but maintain consistent rules for safety to develop a sense of autonomy Toddlers recognize they are separate individuals **Other Issues Related to Toddlers** Temper Tantrums- occur when kids are overly tired and when they feel like they aren't in control of the situation, ignore the tantrums, they occur from age 2 to preschool Obesity Toilet Training **Toilet Training** 3 Developmental Characteristics Must have control of the rectal & urethral sphincter Must understand what it means to: Must have a desire to delay immediate gratification for a more socially acceptable action **Toddler Safety** Motor vehicle injuries (car seat safety) cause more accidental deaths in all age groups after 1 than any injury/disease Water safety Drowning Burns Poisoning (keep medications locked up) Aspiration and suffocation Bodily damage (falls, being struck, bites or stings) **Toddler in Hospital Setting** Separation Anxiety (usually have a lot of separation anxiety from their caretakers when they leave) Fear of pain and injury Loss of control **NURSING CARE OF A FAMILY WITH A PRESCHOOL CHILD** **Critical Milestones: 3 years** Imaginative Egocentric Throws a ball overhand; jumps; kicks a ball forward Knows sexual identity Undresses self Capable of sharing The hardest skill to learn is skipping **Critical Milestones: 4-5 years** Puts on a T-shirt; washes and dries hands; names a friend Fear of dark Knows two adjectives (e.g., tired, hungry, cold, hot) Balances on each foot for 1 second; jumps forward; throws a ball overhand **Developmental Milestones: 5 years old** Self-esteem through skill acquisition and task completion; peer group becoming primary socializing force Ties shoelaces; dresses and undresses without help; can print, draw, color well, model clay, and cut with scissors **Preschooler in Hospital Setting** Separation Anxiety Fear of injury and pain Loss of control Guilt and Shame **Preschooler Safety** Childcare focus shifts from protection to education Bicycle safety Animal bites Community safety  Poisoning **NURSING CARE OF A FAMILY WITH A SCHOOL-AGED CHILD** **Developmental Milestones: 5 or 6-8 years** Vocabulary expands; improved long-term memory; organizes concepts and classifies in several ways Loves sports and games (a lot of their play now is teamwork) **Developmental Milestones: 9-13 Years** Peers' opinions are more important than parents' opinions; clubs with secret codes and rituals; hero worship; girls may become boy crazy; ready for away-from-home experiences such as sleep-away camp Eye-hand coordination is fully developed; fine motor control approximates adults Reads more and enjoys comics and newspapers; understands fractions and conservation of volume and weight May begin to be more awkward as the growth spurt begins **Safety** Car safety Bicycle safety (biggest safety concern) Pedestrian safety Water safety **Components of Sex Education** Basic anatomy and physiology Body functions Expected changes related to puberty Menstruation, nocturnal emissions Reproduction Teenage pregnancy HIV prevention Sexually transmitted diseases **Issues Related to the School-Age Child** Adjustment to school Self-care children (latchkey kid)- at least 10 years old Obesity/Activity Stress **Peer Victimization- Bullying** Types of bullying in school-aged children: Manifestations of a bullied child: **School-aged child in Hospital** Separation anxiety Fear of injury and pain Loss of control **Anticipatory Guidance: Care of Families** Parents adjust to the child's increasing independence Parents provide support as unobtrusively as possible Child moves from narrow family relationships to a broader world of relationships **Safety** The most common cause of severe injury and death in school-aged children is motor vehicle crashes, pedestrian and passenger Bicycle injuries (common safety concern) Appropriate safety equipment for all sports Community safety Social media safety **NURSING CARE OF A FAMILY WITH AN ADOLESCENT** **Developmental Milestones: 13-18 Years** Emotional and social turmoil associated with rapid changes in development, hormones, and altered body image; interest in opposite-sex relationships Adult fine motor control **Developmental Milestones: 11-20 Years** Becomes future-oriented; thinks and reasons abstractly Early growth-related awkwardness develops into coordinated muscle control **Health Promotion for the Adolescent** Age-related nutritional challenges Hygiene Dental care Sleep and rest (need more sleep and rest because of growth) Exercise and activity **Growth and Development** Psychosexual development Hormonal changes Sexual maturation Sexual Activity **Selected Issues Related to Adolescents** Body piercing Tattoos Tanning **Cognitive Development** Abstract thinking Think beyond/outside the present Ability to use the scientific method. Imagine how a sequence of events occurs. They can view the world from other people's perspectives. **Emotional Development** Erickson: Identity vs Role Confusion Early to Mid-adolescent Late adolescent **Identity vs Role Confusion** Identity Role Confusion **Anticipatory Guidance: Care of Families\ **Parents need support and guidance Information needs regarding developmental changes and process of gaining independence Help "letting go" and promoting independence **Safety** Car safety Water safety (cliff jumping) Suicide Violence toward others Sports injuries Firearm and weapons Poisoning, drugs, alcohol **Adolescents in Hospital Setting** Separation (separation from friends) Fear of injury and pain Loss of control