Pediatric

Nursing
Joshua W. Atienza, USRN
Developmental Theories
Theory of
libido = Natural drive
Sigmund Freud →
* Psychosexual =
How you deal with it
psychological crisis =

Erik Erikson
→ Theory OF
* Psychosocial =

1. Infancy ( 0-18 Mons ) If not met smoking

→ Alcoholism
* Freud = Oral stage fixation Nail biting
Over talking

Trust us Mistrust overeating

Erikson
-

* =

↳ can
↳ can cause Paranoia
cause Gullible

•
play solitary play:

to stimulate senses (CN 8)

Toys : Rattle Mobile Music box
=

• , ,

•
Fear : stranger Anxiety
•
Important Mom :

person

> No conscience do not know wrong / right

2. Toddler ( 18m05 3410 )
= =
-

training Goal : Discipline * Criteria for readiness ;

Freud Anat stage - 1> offer toilet / Potty

*
I stand alone
=
1- Can

* Erikson Autonomy = vs -
Shame and doubt Guided by parents 2. can delay impulses
↳ Sense Can control sphincters
of independence •
strict = OCD 3-

•
Play Parallel play
:
•
Lax = Antisocial 4- has an idea

•
Toys : Building blocks push ,
and pull toys
•
Fear : Separation anxiety
management :

Orientation
•
Important : Mom 1- Dad
person
Temper tantrums * Ritualism
•
special Traits :*
-
Objects
Management :
-

Bring during hospitalization

-

timeout
but not the toddler
Ignore the condition
-

* Negativism
management :
-

Offer choices

(Development of conscience)
school (3-6410)
3. Pre
-

* Freud phallic stage :

=
Age of curiosity
's
= Mama's boy / Daddy girl
(Oedipus) (Elektra)
=
Showing OF Genitals
* Erikson : Initiative vs Guilt -

↳ cant ↳ Can t,
creativity self esteem
: Cooperative play
•
Play
puzzle Board games
Kit , Teacher Kit ,
Toys : Play house Doctors
,
•
,

•
Fear Body
mutilation
:

Traits : * Magical thinking

Special * sensitive to criticism
•

"
Why ?
"
* Ask question
+ siblings (Immediate Family)
•
Important person :
mom + Dat
↳ Role model
puppet and toys
* During Hospitalization = use
4. School Age ( 6- yrs )
12 old

libido due to extracurricular activities

* Freud : Latent stage =L
* Erikson : Industry us Inferiority .

↳ sense ↳ Iv self
esteem
OF competition
•
Play Competitive play
:
"
rules
Sports By the
"
•
Toys : ,

•
Important : teacher
person
Achiever oriented mindset
Special Traits
• : *
* Collections
* sensitive to humiliation
* concept of Death
Irreversible
* During hospitalization
↳ simple diagrams /pictures / illustration

5. Adolescent (12-19410)
* Freud Genital stage
=
- 1> T Libido toward other person
* Erikson = Identity Role confusion
us .

↳ ↳ Emotional
Immaturity
Emotional
Maturity -
short term goals
-

Long term Goals -

rebel
-

Following the rules

•
Important : Peers
person
Invite the whole squad
During Hospitalization
•
:

: * promote privacy
•
Special traits
 Milestones
Developmental
skills
Fine Motor Gross motor
months head lag
reflex grasp
=

o months = o

hands held open 2 months Lifts head up

3 months
=
=

5 months =
palmar grasp 4 months =
Full head control
7- months
= transfer object g- months = Roll over

q months Pincer grasp 6 months sit with support

sit
= =

to months points at object

=

8 months = sit without support

container
11 months =
put object in the q months =
Crawling
/ 2 tower blocks
b. months
Throws object stand with support
Tayo
=

to months =

3 yrs old
= unbutton

4 yrs old = button UP 11 months =

Cruising
6 yrs old = Tie shoelace 12 months =
stand without support
3410 = Tricycle

4410 =
bicyle

Live vaccines
Immunization schedule
MMR
1st stanza
:
× ) varicella
↳ Birth to 1
month Hepa B
polio
↳ Happ baby gelatin and
* Allergic eggs
2nd stanza :
* No to pregnant
and Immunocompromised
DR HIP
4,6 month
.

↳ 2,

↳ Happy baby I¥aviws type B

-

Hemophilvs Influenzae
- Inactivated polio vaccine
-
Pneumococcal vaccine

Bridge :
12-15 months MMR
[3×3
Varicella t Hepa A

Nutrition principles
Breastfeeding ( E.
0.51)
Exclusive
6 months / pvrae
→
I '

mashed
Introduce solid Foods prep
:

6 months →
cerials Iron
fortified
{
=
2. "
Sma
and dates
veggies meat
•

quantity Fruits , ,

•
One Food
3- her old group

↳ introduction OF egg '

Ii lectin 1- Riboflabin
>

↳ egg yolk
2¥ Albumin
Sippy WP egg while
-
,>

↳ weaning OF
eggshell
bottle feeding
-
First visit to dentist
 Disease
Pediatric
1. Tonsil itis
tonsils
-
Inflammation OF

cause : GABHS /
Staphylococcus
-

Infectious disease
Precaution Droplet :

PPE 's : surgical mask

Distant : 3-6 Feet
SISX
-

Fever
-

sore throats
odor
Foul breath
-

-
Dysphagia
Management tonsils
-removal of
-

criteria : 5-6 ✗ episodes per year

* WOF :
> Frequent swallowing
> Trismus → (
t) periodontal abscess
> Avoid dark colored Foods
line
> Avoid pressure in the suture

2. Neural tube defects

Malnutrition
-

acid)
Vita Bq (Folic
-

types
ocoulta
spina bifida
•

- sacral dimple or tuff hair on flank pain

•
Spina bifida cystic a
-

Fluid Filled sac

-

Types :

a) Meningocele -
Not painful
b) Myelomeningocele
-

painful

management -
Do not touch
affected part
maneuver
prone No valvalra
-
-

standard precaution -
cover with
sterile gauze
-
WOF : latex allery
-
WOF : T ICP - ☐ If not resolved HydwcephaWs__

3- Hydrocephalus
-
T accumulation OF Fluids in the brain

Risk Factors :
•
Infection
• Neural tube defects Management :
ventriculi peritoneal shunt
•
Autoimmune
-

• Heriditary

slsx : ( VP shunt )
triad)
- 1^1 CP ( Cushing
-
projectile vomiting
-
Nuchal rigidity
-

photophobia
Hallmark sign : Sunset eyes
other Hallmark
:
Macewen sign
sign
 Pediatric Nursing

Neurological problems
school
1- Cerebral Palsy =
age
cause : Multifactorial
motor movement
main problem : Abnormal
slsx :
-
Unstable gait
-

Delayed Growth and Development

-

Respiratory problem
-

Dysphagia
Management :
1. Assistive Devices : wheelchair
2. Muscle relaxant
Doc: Multiple sclerosis
-

Baclofen
-

Flexiril

2. Seizure
cause : multifactorial
*
High grade fever
* meningitis
* Head trauma
* Genetics
* sodium imbalance
* too much exposure to flasher of light
stages :

1. Aura
lead to
feelings that
seizure
-
unusual may
common : • smell OF a burning wire
metallic taste
•

Flashes light Management :

•

of
•
GI upset
rails
2. Unwusuousness 1 Raise side
at bedside
.

priority :
place the client in side lying g. suction machine
3- Tonic stage 3 Oxygen
.

muscle stiffness 4 .
note the duration of seizure

4. clonic stage
involuntary muscle jerking or twitching
5- Post total
reorientation
management :

and Feed the diet

medications :
I. Levetiracetamckeppra )
↳ maintenance
2. Carbamazepine = SIE : agranulocytosis 4. Diazepam ( Valium)
maintenance Administered Rectal route
phenytoin C. Dilantin )
= :
3.
therapeutic level : 10
-

aomcgldl
Anemia Pancytopenia
Toxicity effect : Aplastic
=

↳ Bone mamrw
:slsx =
Hematopoiesis
suppression
-
Infection ↳ Blood creation
gwmponents
* oxygenation
-

= 5- I
-
6m
-
RBC
" K
-

Bleeding - W Bc
= 5k -

150K 450K
platelets
-

-
=

SIE :

Gingival hyperplasia
-
oral care
Musculoskeletal Problems

1- Scoliosis
-

lateral curvature of the spine

" "
-
S shape
common in school adolescent
age and
-

types : > Inborn

> Positional
Risk Factor : Heavy lifthing
spinal deformities (
torticollis)
Complication of inborn
SIS ✗
shape
" "
-

standing shape S
-
uneven heam line
-
U heron shoulder

Management
1. milwakie Brace
-

to correct deformity
0h : 23hm

OFF :1hr During shower

=

- with Colton under cloths

of the
Hip
2. Developmental Dysplasia
dysplasia
congenital Hip
cause :
inborn
Hip fracture
slsx
- movement [ early sign)
limited
-

gwtial Folds
Assy metrical Galea2- zi Sign
shortening of the affected leg
=
-

Ortho lani 's

-

clicking sound sign

=

Management :
1 .
Pavlik harness
Diaper rash
-

wear with diapers WOF :

No use OF powder and lotions

-

-
check time to time
-

sponge bath on

3- Osteomyelitis
-
Infection of the
bone

cause : bacteria

slsx :
-

vomiting
-

Body malaise
-

Fever and sore throat

-
Redness / tenderness
management :
1. Antibiotics
2. Bed rest
3. Fluids
Debridement
4- IF possible pus Formation
=

4 '
Duchenne muscle Dystrophy
Rtt X linked recessive disorder
Management
-

- :

Common in school age

-

slsx I '

DMARD : Modifying Anti Rheumatic Dwgv

Disease

> limited movement - Methotrexate

> Gower 's sign = inability to stand pnperly From phone position 2.
physical therapist
>
Respiratory problem z . corticosteroids
> cardiac problem
 5- Osteogenesis Imperfecta
I t,
t,
Bone creation Not perfect
DIO
Description : Autosomal recessive
4
Results in Fragile or brittle bone

slsx : Blue sclera

density
-

in bone
-

problem
-
easily b. wishing
-
Oto sclerosis
Laboratory Test
DEXA ( Dual energy x-ray Absorption etry )
check bone density
=
>

Damaged bones
>
Roentgenograms
=

Management :
-
NO core
-

Diet therapy Tca TV it D

Complication :
Fracture ( Rib)

( Paget 's Disease)

6- Ostitis Deformants
-
Abnormal bone metabolism
osteoclast bone destruction
} T
=

mosaic -
like appearance
osteoblast = bone building weak skeletal system
skeletal muscle pain
management :

Bi phospho nates
-
Normalized osteoclast =
Giving -
Alendwnate ( Fosamax)
- Pain medication
-
No cold compress
-
Assistive Devices
Platy basia Imagination of the skull
WOF :
=

test
New born screening ( Guthrie test)
Specimen : Blood in the heel prick
Ip treated
IF not screened
Table Disorder normal
severe mental retardation
1. cretinism norma ,
Adrenal
2. Congenital Death
but mild Altered too
hyperplasia normal
severe mental retardation and
g. pku
normal but mild delayed gtrwth
bilirubin in the brain)
severe anemia ( Kern icterus T
4- GUPD daewpment

Poisoning
Commonly occurs Toddlers and preschool
-

Less than 6 yrs old * Breath Odor

SISX
-

Common DOB moth balls =

Nepthtmlehe
Agents
- -

:
Abd pain oral mucosa
whitish plaques on
-

-
-

Fruity = Acetone
1. medications -

Anorexia cyanide
soethwath WW"° Bitter almonds =
-

* =

a. bleach
-

Diarrhea rat poison

peanuts =
-

meds
3. muriatic acid -
Nausea / wmiting * RUQ =

4. Cosmetics
-

swelling of lips
level
more than 20
report
Lead poisoning
=
5- mothballs
*
6- Pestesides Management :

7- toys 1- assess patient status 1 .

WOF : Brain problem Cecephalilis )
8.
plants 2 .
call poison control center
1- Liver problem
Dextran)
Management Defend ✗amine (
9. Foods 3
'

Decontamination 2 .
:

> Activated charcoal = chelation therapy = Tx For thalassemia

> Milk of Magnesia old houses
3 sources OF lead : -
-

spices
lavage
'

> Gastric
crayons sewage system
-
-
water
paints cosmetics
-
-

Toys
-

-
Thinners
 4. Pyloric stenosis

Distended
-

narrowing *
P¥¥¥n%?¥¥¥
abdominal ↓ Abnormal signs during palpation
" Distention →
Vein
severe abdominal ↳ Olive shaped mass
String sign
-

↓
Projectile Vomiting
←
HCL acid ↓ Hypokalemia = V wave

out
Dehydration
↓ loss
weight
-

Metabolic -

Thrist
Alkalosis
-
Hemo concentration
-
Sunken fontanels and eyeball
Management :

¥¥¥÷y
Sx : Fredet -
Ramstedt
↳ repair OF pyloric sphincter
Tips :
-
140
-

small frequent Feeding

-

weight monitoring

5- Intussusception
-

telescoping
$"
OF the intestine ,
-
Blood t mucus stool ☆ Currant jell stool 7

:
-
Sausage shape mass
-
Severe abdominal pain
↳ Knees
drawing up to the chest
Management :

-
Air enema
↳ sign OF effectiveness normal bowel movement

6- Hirschprongs Disease
and absorbs water

ftp.rgqie.inntegyin#--
-
Abnormalities in the anatomical structure To mobilize stool

Basic unit

↓
Decreased ganglionic cell Function
Bite
V°m"" ↓
severe constipation → severe abdominal distension
← ↓
Fecaloid
vomiting Ribbon like stool
( Red)

Management :

-
resection OF colon (endorectal pull)
WOF : severe abdominal 1- Fever

pain
 Phenylketonuria
-
T production of phenylalanine
pathophysiology :

When T toxic
to the Body → Kidney Damage =
Mvstyodorvrine
phenylalanine (④ 1.2 -3.4mg D=
Id
)
f - averting Enzyme
Phenylalanine : *
will disapeare ! ! !
Normal GI Function hydroxylase
Tyrosine =
• lntvssvceptioh
↳ No normal GI function Hirspwngs Disease
Development ( DHA )
•

Brain
↳
t
3- 4 Dioxy phenylalanine
Albinism
-

→
↳ ⑧ skin color

Management :
•
T intake of Foods high in tyrosine
but not :
Anything
-
red meat
-

beans
-
Dairies
•
special Formula : Milk * Wfenalau

Disease :
Pedi a cardio

Kawasaki Disease
Cause : I do phatic
Risk factors :
• related to Hereditary
•
Autoimmune

St " " 's Correct Febrile seizure

* Fever report * NSAID
= For
Fever
=
-

Dry skin
↳ can lead to seizure
-

Conjunctivitis
Hallmark sign : Strawberry
Tongue

Management :
-
Corticosteroids
-
IV Immunoglobulin
-
Interferone bets
-
Immunosuppressant / Cyclosporine

Rheumatic Heart Fever

related to GABHS :

Tonsillitis
endocarditis
AGN
Impetigo

SISX -

Fever
-

sore throat
-

Body pain
-
Joint pain ( poly arthritis)
Management :
• Non pharmacologic " "

↳ Quiet play = clustered care

=
Non physical activity
warm compress
Antibiotics =
Aminoglycosides " "

with mycin except vancomycin

ends
"
mucin
"
anything
WOF : tinnitus / OH toxic
-
 Congenital heart detects
cause : rerouting ot-b-odt-wint-heheartdue.to shunting
VN OXYGENATED

superior Pulmonary →
vena cava
→ Right → Right → Lungs
ventricle Artery

!
Inferior vena cava Atrium

Left Left
Aorta ←
ventricle ← Atrium
← Pulmonary Vein

G OXYGENATED
> Systemic Circulation

Normal Blood Circulation

right shunting CHF Cacyanotic type)

Left
- =

Types : ↳ related to Four shunting

* Congested
=
Fluid volume
murmur
excess Loud machinery
patent ductus Arteriosus =
Extremities
T Blood Flow in Upper
•

coartmtion of Aorta
=

Extremities
•

to Blood Flow in lower

• Ventricular septal Defect

•
Atrial Septal Defect

1st collection
VN OXYGENATED
Pulmonary
superior vena cava
→ Right → Right -1> - ☐ Lungs
Inferior vena cava Atrium
-
ventricle Artery

'֥
•
2nd Collection
Backflow in the heart

no blood at the system

Left Left
Aorta ←
ventricle ← Atrium
← Pulmonary
G OXYGENATED
> Systemic circulation

Tetralogy OF Fallot
CHF Carano )
to =

Right shunting
=
-

left Normal Oz of 80%

hypercyanotic spells to (Tet spells)

* Blue baby related
Feeding -

crying
-

* management :
Knee chest position / Squat
positioning =

Polycythemia Report
* TRBC expected =

VN OXYGENATED

superior vena cava Pulmonary →

→ Right → Right → Lungs
Inferior Ventricle Artery
•••y f.
Vena Cava Atrium

^µd• Blood Flow

•o••
•••

Left Left
Aorta ←
ventricle ← Atrium
← Pulmonary Vein
G
OXYGENATED
> Systemic circulation
 Fibrosis
Cystic
-
Autosomal disorder
vision
problem : T mucus production powered Pruritus
to I →
Decreased ADEK → Bleeding
Lungs ← Thick
mows dislodgement → Liver →
t
f
↳
|
weak
t Bones
pancreas -y small
Emphysema intestine
y
t NO pancreatic Juice
y
t, Insulin
t
pneumonia d malnutrition
Malabsorption f
Diabetic f
V Mellitus
Kwashiorkor
Marasmus
Repro system
-
Delayed
growth and development
-
Infertility

Management :

-
Flutter mucus device
-
Teal , 'T Chon Tcho
,

Oz
-

with meat
-

pancrealipasegie
 Abuse
-
Intentional act of physical neglect
* Associated factors
victims abused
1. parents / guardians were of
2. Lack OF parenting skills
*
child characteristics
1- Aloof merit
2. withdrawn
3. Habitual absentism
4. unusual injuries

Types of Abuse

1. Physical Abuse
adequate needs
-

failure to provide
-

Neglect
manifestations :
Inadequate weight
•
how
•
poor hygiene
•
Lack OF immunization

2. Emotional abuse '

damage to Childs behavioral status

manifestation
•
shaming
•
Embarrassment
•
a self esteem
•
Guilt

3- Sexual Abuse

Management :

Safety
services
Report to child protective
heedv
physiologic
Complication of
Abuse

t Failure to thrive
2. Antisocial
3. Substance Abuse