1
Chapter 30
Basic Pediatric Nursing Care
Chapter 30
NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages
Concepts of Child
Development
• Infancy: birth to 1 year
– Trust versus mistrust
• Toddler: 1-3 year-old
– Autonomy versus shame and doubt
• Preschool: 3-5 year-old
– Initiative versus guilt
• School age: 6- 12 year old
– Industry versus inferiority
• Adolescence: 13-18 year old
Pediatric Nursing
• Purpose of Pediatric Nursing
– Preventing disease or injury
– Achieving and maintaining an optimum
level of health and development
– Treating and rehabilitating children who
have health deviations
NCLEX Test Plan
Categories
Pediatric Nursing
• Family-centered Care
– A philosophy of care
– Family as the constant in the child’s life
and holds that systems and personnel
must support, respect, encourage, and
enhance the strengths and competence
of the family
Pediatric Nursing
• Partnerships with Parents
– Parental involvement
– Parents are treated as equals
– Parents of special needs children often
become experts
Pediatric Nursing
• Future Challenges for the Pediatric
Nurse
– Shift from treatment of disease to
promotion of health
– Technological advances
– Adolescent medicine
NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages
Pediatric Nursing
• Nursing Implications of Growth and
Development
– Measurement of physical growth
• Percentiles on growth charts
– Anticipatory guidance
• Psychological preparation of a patient for an
event expected to be stressful
NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Screening Programs
Physical Assessment of the
Pediatric Patient
• Growth Measurements
– Length
• Measurements are taken when children are
supine until 2 years of age.
– Height
• Measurement is of a child standing upright.
See Christensen Box
30-3 & 30-4
Figure 30-1
Measurement of head, chest, and abdominal circumference and
crown-to-heel measurement.
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003].
Wong’s nursing care of
infants and children.
[7
thed.]. St. Louis: Mosby.)
Physical Assessment of the
Pediatric Patient
• Growth Measurements (continued)
– Weight
– Head circumference
– Skin Thickness
Figure 30-2
A,
Infant on scale.
B,
Toddler on scale.
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003].
Wong’s nursing care of
infants and children.
[7
thed.]. St. Louis: Mosby.)
NCLEX Test Plan
Categories
7. Reduction of Risk Potential
Vital Signs
Physical Assessment of the
Pediatric Patient
• Vital Signs
– Temperature
• Reflects metabolism
• Routes: oral, rectal, axillary, and tympanic
• Normal findings approximately 97
°
F to 99
°
F
– Heart Rate/Pulse
• Apical pulse: infants and young children; radial
pulse: children 5 years of age and older
Physical Assessment of the
Pediatric Patient
• Vital Signs (continued)
– Respirations
• Rate, depth, and quality should be assessed.
• 1 full minute in infants
• Rate may be as rapid as 40 to 50 breaths per
minute, gradually slowing to 25 to 32 per minute.
– Blood Pressure
• Children 3 and older.
NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Data Collection Techniques
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment
– Skin
• Pallor: anemia, chronic disease, edema, or
shock.
• Erythema: increased temperature, local
inflammation, or infection.
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Accessory Structures
• Hair
• Nails
• Handprints and footprints
– Eyes
– Ears
• Inspect for general hygiene.
• Advise parents and children to clean the ears
with a washcloth; wipe only the outer portion of
the canal with a swab.
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Nose, Mouth, and Throat
– Lungs
• Not crying.
• Have them “blow out.”
– Chest
• Asymmetry may indicate serious underlying
problems.
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Back
• Newborn is C-shaped.
• Older child typically has S-shaped curve.
• Marked curvature in posture is abnormal.
– Abdomen
• Inspection: cylindrical and flat
Figure 30-7
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Extremities
• Examine for symmetry, range of motion, and
signs of malformation
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Anus
• Check the anal sphincter
• History of bowel movements
• Assess for perianal itching; may be pinworms.
NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages
Normal Development
• Infancy
– Gross Motor
• Head control
• Locomotion
• Toddler
– Parallel play
– Gross Motor
• Running/skipping/hopping/jumping
– Fine Motor
• Scribble/draws circle
• Preschool
– Refines gross motor and fine motor skills
– Cooperative play
Normal Development
• School age
– Learns work habits, organization,
goals
– Refines gross/fine motor skills
– Socialization skills
• Adolescent
– Peers important
– Develop value system
– Philosophy of life
Factors Influencing Growth
and Development
• Nutrition
• Metabolism
NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages and Transitions
Factors Influencing Growth
and Development
• Speech and Communication
– Crying at birth
– Cooing, laughing, or babbling.
– By 9 months, infants practice and repeat the noises
they can make
– A 1-year-old has a three- to four-word vocabulary; by
18 months, they usually know 25 to 50 words; by 2
years, they may know more than 250 words.
– Rule: # words in sentence = age + 1
NCLEX Test Plan
Categories
1. Coordinated Care
Advocacy
Client Rights
Informed Consent
Legal Responsibilities
Hospitalization of a Child
• Preadmission Programs
– Child’s level of understanding and stage
of development
– An emergency admission thrusts the
child into an unknown environment
surrounded by strange equipment,
frightening sounds, and unfamiliar
adults.
Hospitalization of a Child
• Hospital Policies
– Parental involvement
– After a child is admitted, a nursing
history is obtained; an identification
bracelet is usually worn on the wrist.
– Vital signs and weight are measured and
recorded.
– Blood samples drawn by a laboratory
technician
Hospitalization of a Child
• Developmental Support for the Child
– Interruption of normal routines and
threatens normal developmental process
– Children to regress when hospitalized
NCLEX Test Plan
Categories
5. Physiological Integrity: Basic Care
and Comfort
Hospitalization of a Child
• Pain Management
– Wong-Baker Faces Scale
NCLEX Test Plan
Category
8. Physiological Adaptation
Perform care for client before and
after surgical procedure.
Hospitalization of a Child
• Surgery
– Anticipatory guidance
– Six Common Stress Points
• Admission, blood tests, the afternoon of the
day before surgery, injection of
preoperative medication before and during
transport to the operating room, and return
to the postanesthesia care unit
NCLEX Test Plan
Categories
Physiological Integrity
5. Basic Care and Comfort
ADLs
Common Pediatric
Procedures
• Bathing
– Use dry hands to pick up the infant.
– Allow play and splash.
– Toddlers love to be placed in a tub for their
bath.
– Toys should be provided.
– Never be left in a tub without supervision.
– School-aged children may be reluctant to
NCLEX Test Plan
Categories
Physiological Integrity
5. Basic Care and Comfort
ADLs and
Common Pediatric
Procedures
• Feedings
– Breastfeeding
• If the mother is unable to be present for every
feeding, encourage her to use a breast pump;
bottles of breast milk can be frozen and given
later by bottle or tube feeding.
– Solids
– Gavage
NCLEX Test Plan
Categories
2. Safety
Common Pediatric
Procedures
• Safety Reminder Devices
– Types
• Elbow safety reminder
• Mummy safety reminder
• Clove-Hitch safety reminder
• Jacket safety reminder
Figure 30-10
Mummy restraint.
(From Lowdermilk, D.L., Perry, S., Bobak, I.M. [1997].
Maternity & women’s health care.
[6
thed.]. St. Louis:
NCLEX Test Plan
Categories
Physiological Integrity
7. Reduction of Risk Potential
Diagnostic Tests
Common Pediatric
Procedures
• Urine Collection
– Methods of Collection
• Suprapubic bladder tap
• Plastic urine collection bags
• Catheterizations
Figure 30-12
Application of a urine collection bag.
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002].
Maternal-child nursing care.
[2
nded.]. St.
Figure 30-13
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002].
Maternal-child nursing care.
[2
nded.]. St.
Figure 30-14
Position for femoral venipuncture procedure.
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002].
Maternal-child nursing care.
[2
nded.]. St.
Figure 30-15
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002].
Maternal-child nursing care.
[2
nded.]. St.
Louis: Mosby.)
Lumbar
Puncture
NCLEX Test Plan
Category
Safe and Effective Care Environment
1. Coordinated Care
Resource Management
Recognize client need for materials
and equipment
Common Pediatric
Procedures
• Oxygen Therapy
– Methods
• Hood and incubator
• Mist tents
Figure 30-16
Oxygen is administered to an infant by means of a plastic hood
(Oxy-Hood).
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002].
Maternal-child nursing care.
[2
nded.]. St.
NCLEX Test Plan
Category
8. Physiological Adaptation
Intervene to improve client
Common Pediatric
Procedures
• Suctioning
– Bulb syringe, straight suction catheter
– Depth: approximately 1/4 to 1/2 inch
– Timing: not more than 5 seconds
– Frequency: allow 30 seconds between
attempts
NCLEX Test Plan
Categories
Common Pediatric
Procedures
• Intake and Output
– All fluids given to a child are
documented on a record kept at the
bedside
– All urine voided is measured before it is
discarded; weigh diapers
NCLEX Test Plan
Categories
Physiological Integrity
Common Pediatric
Procedures
• Medication Administration
– Compute the dose correctly
– Dosages must be checked by a second nurse for
safety
– The
right
amount of the
right
medication must be
given to the
right
child at the
right
time and via
the
right
route.
– Observe and document a child’s response to the
drug.
Common Pediatric
Procedures
• Medication Administration
(continued)
– Routes of Administration
• Oral
• Intradermal, subcutaneous, and
intramuscular
• Intravenous
• Optic, otic, and nasal
• Rectal
Figure 30-17
Intramuscular injection sites.
NCLEX Test Plan
Category
Safe and Effective Care Environment
2. Safety
Safety
• Protect child from harm
• Anticipatory guidance
• Health teaching
• Injuries cause more deaths and disabilities
in children
• Parents and children should talk and listen
to each other to prevent many accidents.
• The adult who is a role model can influence
•
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