PEDIATRIC

PEDIATRIC NURSING
NURSING
•Growth and Development
•Psychosexual
•Psychosocial
•Cognitive
•Moral
•Hospitalized Child
•Common Complications in Pediatrics
•High risk Newborn
Growth and Development
• Growth- increase in physical size of a structure or whole.
• -quantitative change.
• Two parameters of Growth
• weight- most sensitive measure of growth, especially low
birth rate.
• Wt doubles 6 months
• 3x 1yr
• 4x 2-2 ½ yrs
• 2. Height- increase by 1”/mo during 1st 6 months
• - average increase in ht - 1st year = 50%
• stoppage of ht coincide with eruption of wisdom tooth.
• Development- increase skills or capability to
function
• qualitative
• How to measure development
• Observe child doing specific task.
• Role description of child’s progress
• DDST- Denver development screening test.
• MMDST (Phil) Metro Manila Developmental
Screening Test.
• DDST measures mental
 INFANT- 0-12 months
• Fears- Stranger Anxiety
• Type of play- Solitary
• Toys- rattle and others
 TODDLER- 1- 3 years
• Fear- Separation Anxiety
• Type of play- parallel
• Toys- Push pull toys
 PRESCHOOL 3-6 years

• Fear- Ghost/Mutilation
• Type of play- Housekeeping
toys,puzzles
SCHOOL AGE 6-12 years
• Fear-Failure at school
• Type of play- competitive
• Toys- TV, video, bicycles
 ADOLESCENCE 12- 18
years
• Fear- relationship with opp.sex
• Play- competitive
THEORIES IN GROWTH
AND DEVELOPMENT
• SIGMUND FREUD
• ERIC ERICKSON
• PIAGET
• LAURENCE KOHLBERG
 Psychosexual Development
( Sigmund Freud)
• Sigmund Freud 1856-1939 Austrian
neurologists. Founder of psychoanalysis
• - offered personality development
• Psychosexual theory
– Id – pleasure principle
– Ego – reality testing- out in contact reality-
distorted ego – during toddler
– SE
 Psychosexual theory
a.) Oral Phase 0-18 months
- Mouth - site of gratification
-activity of infant- biting, sucking crying.
-why do babies suck?- enjoyment and release of tension.
-provide oral stimulation even if baby was placed on NPO.
-pacifier.
-never discourage thumb sucking.
b.) ANAL- 18 months-3 years
-site of gratification- anus
-activity- elimination, retention or defecation of feces make take
place
- principle of holding on or letting go.
-mother wins or child wins
-child wins- stubborn, hardheaded anti social. (anak pupu na, child
holds pupu, child wins)
-mother wins- obedient, kind, perfectionist, meticulous
-help child achieve bowel and bladder control even if child is
hospitalized.
• c.) Phallic- 3-6 years
• site of gratification-genitals
• activity- may show exhibitionism
• -increase knowledge of a sexes
• -accept child fondling his/her own genitalia as
normal exploration
• -answer Childs question directly.
• Right age to introduce sexuality – preschool
• d.) Latent- 7-12 years
• -period of suppression- no obvious
development.
• -Childs libido or energy is diverted to
more concrete type of thinking
• -helps child achieve (+) experience so
ready to face conflict of adolescence
• e.) Genital- 12-18 years
• -site of gratification -genitals
• -achieve sexual maturity
• -learns to establish relationships with
opposite sex.
• -give an opportunity to relate to
opposite sex.
 PSYCHOSOCIAL/
PSYCHOANALYSIS -
ERICKSONS
T-rust VS. Mistrust
A-utonomy VS. Shame and Doubt – offer choices
I – nitiative VS. Guilt
I – ndustry VS. Inferiority – sense of control - teacher
I – dentity VS. Role confusion – WHO AM I?
I – ntimacy VS. Isolation – love, work and play
G – enerativity VS. Stagnation – guiding next generation
E – go integrity VS. Despair - late adolescent
 STAGES OF
PSYCHOSOCIAL
Trust vs mistrust – 0-18 months.
• -foundations of all psychosocial task
• -to give and receive is the psychosocial theme
• -know to develop trust baby
• 1. satisfy needs on time
• - breastfeed
• 2. care must be consistent and adequate
• -both parents- 1st 1 year of life
• 3.) give an experience that will add to security-
touch, eye to eye contact, soft music.
• Autonomy vs shame and doubt 18-3
years --- independence /self gov’t
• develop autonomy on toddler
• give an opportunity of decision making like
offer choices.
• encourage to make decision rather then
judge.
• set limits
• industry vs inferiority 7-12 yrs
• -child learns how to do things well
• -give short assignments and projects
• Identity vs role confusion or
diffusion 12-18 yrs
• - learns who he/she is or what kind
of person he/ she will become by
adjusting to new body image and
seeking emancipation form parents
• -freedom from parents.
• Intimacy vs isolation 20-40 yrs
-looking for a lifetime partner and
career focus
• Generatively vs stagnation 40- 60
45-65 yrs
• Ego integrity vs. despair 60-65
 COGNITIVE DEVT. –
JEAN PIAGET
• JEAN PIAGET- Swiss psychologist
-develop reasoning power
• 0-2 sensory motor-“practical intelligence”- words and
symbols not yet available baby communicates through
senses and reflexes
• 2-7 pre–operational – intuitive phase-concept of dying i
• 7-11 –concrete operational – start to sort, make an order,
collect items, sorting cards
• 11-19 – formal operational- stage of abstract and logical
thinking, stage of irreversible –activity -will sort out
opinions and current events.
 MORAL DEVELOPMENT
- kOHLBERG
• KOHLBERG- recognized the theory of moral dev’t as
considered to closely approximate cognitive stages of dev’t
• -sabay with cognitive dev;t
• P – unishment reward
• I – nstrumental exchange
• G –ood boy/ Good girl
• L – aw and Order
• S – ocial Contract – welfare of others
• U – niversal Ethics – principle conscience. Welfare of
universe
HOSPITALIZED CHILD
Separation Anxiety

• 3 phases of separation anxiety (in order)

• 1. P- protest
• 2. d despair
• 3. d- denial
• -don’t prolong goodbye
• -say goodbye firmly to develop trust- say
when you’ll be back
Hospitalized Adolescent
Child
• Fear of physical - body image
disturbance
• Fear of rejection from peers –
lack of confidence; privacy
 Communication
Approaches
• Make the child feel comfortable with
the nurse
• Let the child play with objects (play
tx)- effective; but not needles
• Offer choices – obey the choice and
respect the choice
 Developmental
Characteristics
• Infants – 1-12 months –oral phase
• Anterior fontanel – annum 12-18 mos.
• Posterior fontanel 2-3 mos.
• Safety – aspiration, choking –age app. Toys, no
raisins, hotdog, grapes, nuts
• Car seat – 20 lbs – center backseat rear facing
• Crib – measurement 2.375; away from curtains
and blinds
Toddlers- 1-3 yr. old (12-
36 mos) -Anal phase
• Weight gain – slow growth, slower than infant 2x
22-27 lbs
• Child seat – 20-40 lbs front facing
• Bowel and bladder control – toilet training- how?
Baby is dry for 2 hrs
• Safety – explore the world, supervised play, prone
to accidents MVA, falls,burns,drowning,
poisoning.oral ingestions – locked all cabinets!
 Preschooler – 3-6 yrs
• Magical thinking
• Bowel and bladder control – normal bedwetting
age & 4 accidental bedwetting; enuresis- cont.
polyuria- IDDM, post traumatic exp/stress (rape/
violence)
• Mimic superheroes
• Carseat – booster seat
 School Age Child – 6 y
• Safety – car safety belts, use of
helmets when biking, roller blades,
skateboards
• Biking – parallel to the flow of
traffic
 Adolescent
• Risk takers – 1. motor VA 2. suicide
• Safety –effects of drugs + alcohol –
head and spinal cord injury
 COMMON
COMPLICATIONS
• Head injury – (hemorrhage, hematoma,accident)
• Assessment – ICP cerebral hypoxia-
• Early – restlessness
• Late – bradycardia – irreg breathing , widening
pulse pressure, decorticate, decerebrate
• Interventions – check airway, breathing, CSF leak,
dec. secretions – suction as ordered, Mannitol,
decadron,
 HYDROCEPHALUS
• Neural tube defects and anomalies of
head
• Increased head circumference; sunset
eyes
• Increased ICP
• Positioning – unoperated
• Assessment – check ICP; HOB elevated 15-
30 degree
• Shunt for older children
 Spina Bifida
• Neural tube defect
• Sac
• Positioning
• Meningocele – meninges, CSF, Sac,
• Myelomeningocele – spinal cord,
meninges, CSF,sac
• After surgery, position prone –
tension in the sac
 Reye’s Syndrome
• Acute encephalopathy
• Etiology – intake of aspiration
after viral illness or fever
with unknown origin children
below 18
 Meningitis
• Inflam. of meninges –
bacterial or viral – resp. inf
• Increased ICP – fever -
seizure
 Seizure
• Cerebral hypoxia – dec. blood
supply
• Priority – airway and safety,
placed on side, slide on the floor
• Drug- Phenobarbital
 ADHD Drug
• Aggressive, impulsive, hyperactive, dec.
concentration, inc. motor coordination
• R italin - effect: inc. concentration
• D exadrin side effects: insomnia + loss
of appetite
• S tranera AM or last dose 2 pm or 6
hrs prior to bedtime
• C ylert AM just after breakfast
• C onserta Monitor ht. and wt. – failure to
thrive - active
 Child Abuse- mandatory
report
• Assess – transcultural nrsg., physical, neglect,
sexual
• Physical – burns, bruises, cigarette burns, belt
bruises
• Sexual – inspect genital swelling, anal perforation
• Neglect – malnutrition, poor hygiene
• Nursing Responsibility – child protective agency
• Safety- report! – place in havens support group
 Otitis Media
• Cause poor feeding technique
– s/s: lead to meningitis
• Feeding Technique – upright position
• Head pain, rolling, ear tugging
• Ear medications – ABT tx completed; side
of ear canal to prevent dizziness
• Ear plugs – equalize pressure in the inner
ear, prevent infection
• Swimming. Take a bath, shampooing
• No submerging or diving
 Tonsillectomy
• Positioning – prone/ side lying-post op
• MGT.
– Liquids – clear, cool, non-citrus, non
carbonated, non-red
– No kool aid – cherry and
strawberry
• Frequent swallowing – s/s of bleeding
• No clearing of throat
 Epiglotitis - Croup
• Bacterial or viral
• Emergency
• Assessment-inspiratory, stridor,
nasal flaring
• Positioning-wt. dependent- arms –
tripod position
• Avoid- no tongue blade, throat
culture, do not visualize
pharynx
• Don’ts – No restraints
• Vaccine – HIV conjugated vaccine
 LTB/Group- viral
laryngotracheo bronchitis
• inflam.of larynx, trachea upper
bronchi
• Assessment- bronchospasm –
barking cough
• Priority- maintain patent airway
• For hospitalized child-humidified
O2 via cool mist tent
• Hypoxemia - vaporizer
 Bronchiolitis
• Mode of Transmission –
hands/contact transmission –
inanimate objects
• Room Precaution- contact
isolation – private-same org.
cohort – 3 ft -36 in
• Positioning- 30-40°angle
• Antiviral-Ribavirin- Virazole –
Acrozole- mist tent/hood
• Nurse- wear goggles
 Pneumonia
• Streptococcal
• Primary Atypical- mycoplasma
• School aged
• Viral- no meds.
• Med dx: C+S
• group B beta-haemolytic
• Streptococcus, which only
occurs in the newborn
 Status Asthmaticus
/ bronchospasm
• Emergency/vigorous mngt. – obstruction
– silent chest- diminished resp. distress
• Positioning for younger children- tripod
• Complication – ventillatory failure,
asphyxia
• Medications- beta agonist, steroids
• Allergen Control- no to allergens,
weather changes
• Home Care Measures- eliminate
allergens
 Cystic Fibrosis
• Mucovisciodosis- thick, tenacious sputum
body fluids
• Most common symptoms- early meconium
ileus, sticky, greenish to black stool (small
intestine)
• Common respiratory problems –
bronchopnea, bronchitis
• Skin-salty when kiss, malabsorption,
steatorrhea
• Diagnostic Test- sweat chloride test,
• Priority Intervention – patent airway, chest
physiotherapy, bronchodilator,pancreatic
enzymes, meds, inc. vit ADEK, increase
sodium in the diet
 SIDS/ Sudden Infant
Death Syndrome
• CRIB death
• Age- 3-6 mos peak/ under age 1
• Prevention-supine pos. never prone,
avoid bed sharing, no large stuff toys
• Cause- cocaine during preg., effect
of season – winter with adults
 CHF
• Failure to the heart to pump
blood in response to venous
• Assessment of early signs-
eyebrow sweating; dec. cardiac
output – tachycardia and profuse
cough
• Interventions- monitor V/S, I &
O, small frequent feedings
• Medications- digoxin,Ace
inhibitors, lasix, K supplements-
hypokalemia
 Defects with Increased
Pulmonary Blood Flow/ L
Acyanotic
• ASD-Atrial septal defect – L to R
shunting- inc. pressure @ the R side
of heart, inc. pulm artery
• VSD-ventricular SD – L to R shunting,
inc. pressure @ the R ventricle, inc.
pulm artery
• PDA- inc. aortic blood flow –
machinery murmurs
 Obstructive Defects
• Coarctation of Aorta-narrowing
of the aorta – dec. O2 upper R-
w/ O2 lower R – no O2
• check temp, check V/S
• Aortic Stenosis- Marpan
syndrome
Defects with Decreased
Pulmonary Blood Flow
TOF-tetralogy of Fallot
• PS – pulmonary stenosis
• VSD-vent. Septal defect
• OA – overriding of the aorta
• RVH- complete repair
TA-tricuspid Atresia- creation ASD
TOGV- transfer of great vessel; aorta –R
vent. Pulm. Artery – R ventricle
• Intervention- Prostaglandin E
• Complication- CHF
 Vomiting
• Major Concern- Resp/GI,
neurological alkalosis-
hypokalemia – weakness - DHN
• Position- side lying - aspiration
• - pyloric stenosis- non bile stain
– Projectile vomiting – with
altered LOC
•I&O
 Diarrhea
• Diarrhea – acidosis
• Acid base Imbalance
• Fluids
 Cleft lip/palate
• Interventions – post op – use rubber
tipped/ dropper
• Positioning – side lying or supine, logan bar,
sterile
• Cheiloplasty- 2 mos.
• Cleft palate – interventions – palatoplasty
12- 18 mos
• Positioning – abdomen, prone, use CUP
• Restraints – soft elbow, jacket restraint,
no formula with NSS, elbow restraint
Esophageal Atresia/ TEF
• Polyhydramnios- inc. in amniotic fluid-
blind pouch- obstruction
• Assessment – drooling, frothy mouth
and nose
• Intervention-pre op- resp. distress,
NPO, IV fluids
• Intervention-post op- gastrostomy
tube – ABC
 PYLORIC STENOSIS
• Narrowing in pyloric region-projectile
vomiting
• Assessment – olive-shape mass, non
bile stain, visible peristalsis
• Pyloromyotomy – removal of stenosis
• Pre-op – fluids, I&O, NGT
• Post op- airway, I&O, IV, pos. after
feeding-upright for 30 min - GERD
 Celiac disease
• Gluten Sensitive Enteropathy –
profused watery diarrhea
• no to BROW
• Intervention -Gluten free diet
• Diet- rice, corn, small seed crops-
certain type of cereal
• Exposed to infection and ingesting
of gluten
 HIRSCHSPRUNG
DISEASE- child
• Megacolon
• Aganglionic
• Ribbon like stool- constipation
• 50 y/o-Colorectal CA
• Mgt; Colostomy- temporary
• OLDER- Colostomy- permanent