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Principles of care for a child

and common illness in the
acute setting
168.362

Learning outcomes:
• At the end of the session the student can:
• Explain principles of care of children in the
acute setting
• Understand why children are not to be
treated like small adults due to their
physiological, psychological and social
differences
• Understand the relationship between
effective communication and safety when
caring for children

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Family-Centred Care
What is it again?
• Based on the tenets of Attachment Theory
• Recognises family as constant in child's life
• Systems must support, respect, encourage and enhance the
family’s strength and competence
• Needs of family must be addressed

Stressors of Hospitalisation
Separation anxiety
• Protest phase
• Crying and screaming; clinging to the parent
• Despair phase
• Crying stops; evidence of depression
• Detachment (denial) phase
• Resignation but not contentment; superficial
adjustment
• May seriously affect attachment to the parent
after separation

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Loss of control: Infants needs

• Trust
• Consistent loving caregivers
• Daily routines

Loss of control: preschoolers

• Egocentric and magical thinking is typical of this age
• May view illness or hospitalization as punishment for
misdeeds
• Preoperational thought

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Loss of control: school-age children

• Striving for independence and productivity
• Fears of death, abandonment, permanent injury
• Boredom

Loss of Control: Adolescents

• Struggle for independence and liberation
• Separation from the peer group
• May respond with anger and frustration
• Need for information about their condition

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“Normalising” the Hospital Environment

• Maintain the child’s routine, if possible
• Time structuring
• Self-care (age appropriate)
• Schoolwork
• Friends and visitors
• Introductions to other patient’s and their families
• Helping out the staff

Children are different

• There are many

physiological differences
in children compared to
adults, when caring for
them it is important you
recognise these.

• Work in groups of 6-8

and list 4 differences in
the area assigned and
consider the nursing
implications

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Children react differently when sick

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Normal Values
Age Respiratory Pulse rate Systolic BP
rate
Birth – 1 week

1-6 weeks
6 months
1 year
3 years
6 years
10 years

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Normal Values
Age Respiratory Pulse rate Systolic BP
rate
Birth – 1 30 -60 100-160 50-70
week
1-6 weeks 30-60 100-160 70-95
6 months 25-40 90-120 80-100
1 year 20-30 90-120 80-100
3 years 20-30 80-120 80-110
6 years 18-25 70-110 80-110
10 years 15-20 60-90 90-120

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Normal Values
• The patients normal should always be considered
• HR, BP & RR will increase during fever and stress
• RR on infants count for 60 seconds
• In clinically decompensating child BP last to
change
• Bradycardia in children OMINOUS SIGN – usually
from hypoxia. ACT QUICKLY

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Communicating with children and their families

• Listening to the parent – are they concerned?
• Parental involvement
• Developmental age of language development

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Preparation of Child

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Copyright © 2017, Elsevier Inc. All Rights Reserved.

16

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Preparation for Procedures

Goal is to decrease anxiety, promote cooperation, and support
coping skills
A. Psychological preparation
Age-specific guidelines for preparation
Based on developmental characteristics

B. Establish trust and provide support

C. Parental presence and support
D. Explanation to the child
17 Copyright © 2017, Elsevier Inc. All Rights Reserved.

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Performing Procedures
• Use of the treatment room for procedures
• Expect success – best person for the job
• Involve the child – let the child help if able
• Provide distraction; use of play in procedures – age appropriate of
course!
• Encourage expression of feelings
• Provide positive support & encouragement through procedure;
rewards help.
• Prepare the family
18 Copyright © 2017, Elsevier Inc. All Rights Reserved.

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Common illnesses

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Age
• In infants younger than 3 months, maternal antibodies offer
protection
• In infants age 3 to 6 months, the infection rate increases
• In toddlers and preschoolers, there is a high rate of viral
infections
• In children older than 5 years, there is an increase in GABHS
and Mycoplasma pneumoniae infections
• Increased immunity develops with age

20 Copyright © 2017, Elsevier Inc. All Rights Reserved.

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Size
• Diameter of airways is
smaller
• Distance between structures
is shorter, allowing
organisms to rapidly move
down
• Short and open eustachian
tubes

21 Copyright © 2017, Elsevier Inc. All Rights Reserved.

21

Respiratory problems in children

• Croup syndromes
• Bronchitis
• Bronchiolitis
• Asthma
• Epiglottitis

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Clinical Manifestations of Respiratory

Infections
• Vary with age
• Generalized signs and symptoms and local manifestations
differ in young children
• Fever
• Anorexia, vomiting, diarrhea, abdominal pain
• Cough, sore throat, nasal blockage or discharge
• Adventitious respiratory sounds

23 Copyright © 2017, Elsevier Inc. All Rights Reserved.

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Nursing Interventions for Respiratory

Infections
• Ease the respiratory effort
• Manage fever
• Promote rest and comfort
• Control infection
• Promote hydration and nutrition
• Provide family support and teaching

24 Copyright © 2017, Elsevier Inc. All Rights Reserved.

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Croup Syndromes - URTI

• Characterized by hoarseness, barking cough, inspiratory
stridor, and varying degrees of respiratory distress
• Croup syndromes affect the larynx, trachea, and bronchi
• Epiglottitis, laryngitis, laryngotracheobronchitis (LTB), tracheitis

Problematic in infants and small children due to smaller

diameter of airways

25 Copyright © 2017, Elsevier Inc. All Rights Reserved.

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https://youtu.be/nkiAXnDEMa0 8:31

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Acute Epiglottitis
• Clinical manifestations
• Sore throat, pain, tripod positioning, retractions
• Inspiratory stridor, mild hypoxia, distress

• Therapeutic management
• Potential for respiratory obstruction

• Nursing considerations
• Prevention requires Haemophilus influenzae type b (Hib)
vaccine
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Therapeutic management
• A presumptive diagnosis of epiglottitis constitutes a medical
emergency
• SHOULD NOT be examined until anaesthetist present as
immediate intubation or tracheostomy may be indicated for
airway obstruction
• Keep patient calm, comfortable & minimize any distress

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Bronchiolitis
• Respiratory syncytial virus (RSV)
• Causes childhood pneumonia as well
• Acute viral infection – bronchiolar level
• Rare in children over 2 years; usually 3-6 months old
• Spread by hand to eye, nose and other mucus membranes

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Starship Clinical Guidelines

https://www.starship.org.nz/for-health-professionals/starship-clinical-
guidelines/b/bronchiolitis/

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https://youtu.be/d1mv4VZ4HiM 8:11

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Febrile Convulsion/ seizures

• Affects 4% of children
• Most occurs 6 months to 3 year (6 years); 18mths is peak time
• Boys affected twice as often as girls
• Most febrile seizures generalised, last < 5 minutes (tonic-clonic)
• 30% to 30% of children have one occurrence
• Cause uncertain, rarely any long-term effects and are relatively
harmless
• >38.8c and occurs during temperature rise
• Accompanying illness: otitis media, respiratory infections

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Nursing management
• STAY CALM!!
• Think safety during and after seizure
• Call for help
• If lasting > 5 minutes – Dr consultation
• Observe and examine for origin of fever
• Parental support and education – don’t put anything in the
mouth, don’t put them in a cold bath or shower; loosen
clothes around face and neck

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When to use
Antipyretics &/or
Analgesia
-Starship
Guidelines
(2019)
https://www.starship.org.n
z/for-health-
professionals/starship-
clinical-guidelines/f/fever-
investigation-and-
management/

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Assessment
• Group work

• What are key assessments you need to consider when caring

for a child

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Image from:

Horeczko, T.,
Enriquez, B.,
McGrath, N. E.,
Gausche-Hill, M., &
Lewis, R. J. (2013).
The pediatric
assessment triangle:
Accuracy of its
application by
nurses in the triage
of children. Journal
of Emergency
Nursing, 39(2),
182-189. doi:
10.1016/j.jen.2011
.12.020

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Paediatric CUPS – illness severity

Condition Examples
Critical Absent airway, breathing or circulation
(cardiac or respiratory arrest or severe traumatic
injury)

Unstable Compromised airway, breathing or circulation

(unresponsive, respiratory distress, active bleeding,
shock, active seizure, significant injury, shock, near
drowning)

Potentially unstable Normal airway, breathing, & circulation but significant

mechanism of injury or illness (post-seizure, minor
fractures, infant <3months with fever)

Stable Normal airway, breathing & circulation. No significant

mechanism of injury or illness
(small lacerations abrasions, infant >3months with
fever)

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