Pediatric Study Guide

Family Centered Care Role of the Pediatric Nurse

Recognizing the family as the constant in a child's life Advocating, teaching, supporting, and counseling
and delivering care that promotes empowerment for the families in a therapeutic way that does not impede
family proper judgement and care

Biological Development
Infant Birth-1yr
1 mo- Can turn head side to side 7mo- transfer objects from one hand to other, "Stranger danger"
2mo-Infant
Social smile, distinct cry 8mo- sits unsupported
3mo- Turns head to sounds, Coos 9mo- pulls self to stand, cruise furniture
4mo- No head lag, primitive reflexes gone, rolls 10mo- Develops object permanence
from back to side 11mo- cruises or walks with hands held
5mo- rolls from abdomen to back 12mo- Walks with one hand, says 3-5 words besides "mama",
6mo- imitates sounds, birth weight doubles "dada". Birth weight triples

Toddler 1yr-3yr Pre-School 3yr-6yr School-Age 6yr-12yr Adolescent 12yr-18yr

Imitates lines, can Copies a square Dress self completely

Improved abilities to
draw a cross Rides a tricycle Develops concept of
communicate their
Feeds self with spoon uses 4-5 word number
Writes brief stories thoughts and ideas
and drinks from cup sentences
Jumps with both feet Understand concept of Good finger dexterity
Jump rope time, space, cause and
Knows 300 words by
24 months Sing simple songs effect, and conservation

Erikson
Trust V Mistrust- Birth-1yr: Basic needs of infant need to be met in order
for them to feel sense of trust.
Autonomy V Shame/Doubt- 1yr-3yr: Toddler's want the ability to control
their body and environment. If not encouraged to or scolded then they
feel shame/doubt
Initiative V Guilt- 3yr-6yr: Strong imagination and conscience warns and
threatens. If not allowed or choices conflict with parents then they feel
guilty
Industry V Infereority- 6yr-12yr: Need to accomplish tasks and work on
things. If not allowed to carry out tasks they feel inferior
Identity V Role Confusion- 12yr-18yr: Rapid body changes, attempting to
figure out their role in life and peer acceptance.
Piaget
Sensorimotor- Birth-2yr: Simple learning takes place,
Learning through trial and error. (aware that objects have
permanence)
Preoperational- 2yr-7yr: Egocentric thinking (the world
revolves around only them), thinking is concrete and tangible.
Ex. Anybody with a big belly must be pregnant
Concrete operations (7-11 years)Thoughts becoming logical
and coherent; able to classify and sortProblem solving is
concrete and systematicLess self-centered
Formal Operations- 11yr-15yr- More abstract thinking versus
concrete. Ex. There are many reasons why someone could have
a bigger belly.
 Types of Play:
Onlooker- Not playing but watching other children play

Solitary- Playing alone with all of their attention focused on their own toy/activity

Parallel- Playing in the same area as others but not the same activity (Ex. Kid A plays with car, Kid B plays with blocks)

Associative- Children playing together but no goal or task to complete (Ex. Playing with dolls and exchanging clothes)

Cooperative- Playing together with specific goal and possible winner (Ex. Finishing game of Sorry or Trouble)

Feelings about hospitalization and Loss of Control

Infant- Reliant on parent and needs to be assigned a primary nurse, sticking to routine is important

Toddler- Hospitalization gets in the way of autonomy and can cause regression (potty training, sleeping). Needs to
follow a daily routine while in the hospital

Pre-School- Egocentric thinking can lead them to think hospitalization is a punishment, fear of being harmed or body
mutilation, needs a lot of reassurance that things are going to be okay.

School- Age- Need to be able to have some freedom/independence. Fear of abandonment, injury, and death. Needs
reassurance and the ability to make some of their own choices while in the hospital (Ex. Doing homework, Self-care)

Adolescent- loss of independence and contact with peers while hospitalized, may become angry. Contact or
conversations with peers can help (Ex. Calling peers and encouraging them to visit)

Nutritional Assessment

Infants need iron supplementation at 4-6

months if breast-feeding because breast

milk is low in iron

**Formula or breast milk primary source of

food until 12 months **

Additional Notes:
 Cardiac Dysfunction in Pediatrics
Indicators of Cardiac Dysfunction
Poor feeding
Low energy
Tachypnea/ Tachycardia
Developmental Delays
Prenatal history
Family history of cardiac disease

Nursing Care for Cardiac Cath

Consent
H/H, PT, PTT, INR, Type and Cross for blood products
BMP
Post Op- Monitor vitals especially distal pulses to cath site, keep patient flat, monitor site for bleeding

Atrial Septal Defect- ASD

Hole in between the two atria

Left- to- Right shunt

Acyanotic Heart Defects
Usually no symptoms but if severe
Increased pulmonary blood flow
child will have poor feeding, shortness
of breath, fatigue, and FTT

Ventricular Septal Defect- VSD Patent Ductus Arteriosus- PDA

Hole in between the two ventricles Extra blood vessel found at birth that
typically closes on its on
Left- to- Right shunt
Left- to- Right shunt
Symptoms include rapid heartbeat,
difficulty feeding, and possible heart Symptoms include rapid heartbeat,
murmur difficulty feeding, and bounding pulse,
poor growth, easily fatigued
 Cardiac Dysfunction in Pediatrics

Cyantotic Heart Defects

Coarctation of the aorta

Most common occurrence is in the Aorta but can happen anywhere

Common to see heart failure symptoms in an infant
decreased pressure to lower extremities
Increased pressure to head and upper extremities

Tetralogy of Fallot
Pulmonic stenosis causes more pressure in the right ventricle
VSD lower pressure in the left ventricle (stress on right ventricle)
Right ventricular hypertrophy
Overriding aorta- the body is receiving blood from both sides
"Tet Spells" Nursing Care
Knee-chest position during “Tet” spell to increase blood flow
Sudden tachycardia/tachypnea
Give O2 to prevent spell from happening
Keep patient calm and comfortable
Triggers are pain, stress, and anxiety

Additional Notes:
 Cardiac Dysfunction in Pediatrics
Congestive Heart Failure
Heart unable to pump enough blood to supply the circulatory system
Right: Systemic problems
Left: Lung problems

*If left untreated the heart muscles become damaged *

Clinical Manifestations Treatment Goals

Tachypnea/Tachycardia at rest Improve Cardiac function
Retractions Give Digoxin (DO NOT GIVE IF HR <90
Activity intolerance (poor feeding) ACE Inhibitors
Weight gain (edema) Beta Blockers
Increased pulmonary blood flow "Pacing"
ECG that shows ventricular hypertrophy Remove accumulated fluid & Sodium
Diuretics
Decrease cardiac demands
Improve tissue oxygenation (only when necessary)

Rheumatic Fever
Inflammatory disease that takes place after Group A strep infection
Affects the skin, joints , heart, and brain
If not managed well can lead to Rheumatic heart disease

Clinical Manifestations Treatment Goals

Inflammation of the joints Treat the strep infection with Penicillin

small painless nodules under the skin prevention to help recurrence
Heart inflammation (Carditis) Prevention of serious cardiac damage
Unusual facial movements that can affect speech
Abd pain
Fever

Additional Notes:
 Cardiac Dysfunction in Pediatrics
Kawasaki Disease
Acute vasculitis and extensive inflammation of the vessels with unknown cause
Risk for coronary aneurysm
Diagnosed based on clinical findings

Clinical Manifestations Treatment Goals

Fever over 102.2 High-dose IVIG within the first 7 days of illness
Strawberry tongue/ Red lips Y-globulins
Red soles and palms Promote rest, quiet environment
Peripheral edema Treat symptoms
Conjuctival redness Assess for any signs of heart failure
Lethargy
Irritability **Goal is to prevent coronary aneurysm**
Colicky ABD pain
**Usually seen in children under 5 yr**

Respiratory Dysfunction in Pediatrics

Respiratory dysfunction is often seen in younger infants because they are most
susceptible to viral illness
Younger than 3mo have lower infection rates because of maternal antibodies
Viral infections highest in toddlers and preschool children

Tonsillitis
Clinical manifests as inflammation
After 6-7 episodes of infections PCP will recommend removal
this surgery is called a Tonsillectomy and Adenoidectomy or T & A

T&A
Post-Op Care
Cool clear liquids
No citrus flavor or carbonated drinks
No milk or milk products
Soft foods to help prevent coughing
Pre-Op
Doctor has to explain procedure
Only witness signature on consent
Labs; H&H, Type and cross, Coag studies
 Respiratory Dysfunction in Pediatrics
Otitis Media
Two viruses most likely to cause OM- RSV and influenza
Pre-school age boys are at greater risk than girls
Passive smoke causes an increased risk of developing OM
AOM- Acute ear pain and fever- wait 72hrs for spontaneous resolution unless child is less than two years old
and has a fever w severe pain
OME- Rhinitis, cough, or diarrhea- Not treated if persisted more than 3 mo

Therapeutic management Nursing Care

Analgesic drugs (Acetaminophen/Ibuprofen), Codeine may be
Amoxicillin for 10-14 days used for more severe pain
Surgical- Tube placement and adenoidectomy Ice compress over affected ear
Occurence Educate family that child may experience temporary hearing
loss
Keep water out of ear
Prevent OM by holding child upright during feedings
Take ALL ANTIBIOTICS

Croup Syndromes
Characterized by: Epiglottitis
Drooling because not able to swallow
Hoarseness
Up-right posture
Barking Cough
Throat pain
Inspiratory stridor
Never use a tongue blade- can cause resp. distress
worse at night

Epiglottitis Clinical Manifestations Epiglottitis Therapeutic Management

Sore throat, pain, tripod positioning Airway management

Potential for respiratory obstruction Maintain hydration, Oral or IV
High humidity w cool mist
Nebulizer treatment
Epinephrine
Steroids