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*Children continued to be looked on as little adults as they worked in factories. 12-14hrs/day. They had no legal rights, & no work laws.
*Children's health care needs were not considered to be different from those of adults until 1860. At that time Dr. Abraham Jacobi, ('father of pediatrics,) 1st lectured on special diseases and health problems of children. establishment of milk stations where infants were weighed & mothers taught to prepare milk. before giving it to their babies.
Characteristics of a Pediatric Nurse.
*1st requirement is that you enjoy working with children of all ages.
*Pediatric nursing is family centered nursing in it's truest sense.
*Your keen observation skills are a must, especially when caring for infants and toddlers or children who are critically ill or cannot communicate n the traditional language-based sense.
*Often you will be involved in supporting, a child through a difficult procedure or serious illness.
related to family center care is the concept of partnerships with parents.Parental involvement in childrens care has evolved since the days when they relinquished their role to institutions; today parents play the role of planners, in addition to recipients, of service.Parents are respected as equals, and enjoy their rightful role in deciding what is important for themselves in their family. Parents of children with special needs also often become experts on their child's condition.
*1 of the nurses primary responsibilities to identify an infant or child who is demonstrating cognitive impairment.
*Knowledge of child development will allow you to use a developmental rather than a chronologic approach to pediatric nursing care.
*Understanding normal growth and development will enable you to select age-appropriate toys for the infant or young toddler and devise activities that appeal to the school age child or adolescent
*knowledge of growth and development
-Psychological preparation of a parent for an event expected to be stressful, as you do when preparing a child for surgery by explaining what will happen and what it will feel like; also used to prepare parents for normal growth and development of their children.
*Measurement of physical growth is a key element in evaluation of the health status of children.
*You will plot the child's measurements by percentiles on growth charts and compare them with those of the gen. ped's pop. to determine deviations from the norm.
refers to measurements taken when children are supine.
-until children are 2 yrs old you will measure recumbent height.
*A childs weight will reflect fluid loss and inadequate calories, especially in the infant and the toddler.
*Use the same scale and weigh the child at the same time every day.
Determine skinfold thickness at one site, taking at least two measurements for the greatest reliability.
Arm circumference measures muscle mass.
*Body temp. reflects metabolism is fairly stable from infancy through adulthood.
*The primary purpose of measuring body temperature is to detect abnormally high or low values.
*The oral, rectal, and axillary sites are all common ones in clinical practice.
*Apical beat of a newborn sometimes reaches 152/min, the heart rate gradually slows to 72-75/min by adolescence.
*The presence of infection increases the heart rate, as does physical activity.
*Take note of the rhythm and any irregularities in rate. Count the pulse rate for 1 full minute.
*You will take an apical pulse on infants & young children, w/children 5yrs and older you will often take a radial pulse.
*In children younger than 7yrs, respiratory movements are abdominal or diaphragmatic.
*In older children, respirations are chiefly thoracic.
*The resp. rate also slows as a child progresses from infancy to adolescence.
*Assess the rate, depth, & quality of respirations. The rate in the newborn will sometimes be as rapid as 40 to 50 breaths/min, gradually slowing to 25-32/min by 36 hours of age.
*You will measure BP in children 3yrs of age and older.
*BP is low in a newborn, it gradually rises, so that by the end of adolescence it is about 120/78mm Hg
*It is important to use the correct cuff size.
*Measure BP before performing any anxiety-producing procedures.
*Genetic factors influence assessment of skin color, as do physiologic factors.
*Edema decreases intensity of skin color, sometimes producing false pallor.
*Pallor is a sign of potential anemia, chronic disease, edema, shock.
*Erythema will usually be the result of increased temp., local inflammation, or infection.
*Normal skin texture in the young child is smooth, soft, and slightly dry to the touch.
*Scalp hair is usually lustrous, silky, and elastic.
*Normal nails are pink, convex, smooth, and hard, but flexible, not brittle.
*The palm normally shows three flexion creases.
*At birth, visual acuity is 20/400, which makes it important for the adult holding a baby to assume an en face position.
*By the 2nd wk of life tear glands begin to function. Newborns develop the ability to follow bright, colorful objects by the 2nd or 3rd week of life.
*Vision improves to 20/30 to 20/22 by age 2-3yrs.
*when a child starts school, accommodation and refraction also are present.
*Inspect the ears for general hygiene.
*Advise parents & children to clean the ears w/ a washcloth &, if they use a swab, to gently wipe only the outer portion of the external canal. Also advise that they will be able to soften any cerumen that is hard by instilling 2-3 drops of mineral oil..
Nose, Mouth, & Throat
*The nose normally lies from the center point between the eyes to the notch of the upper lip.
*Normally there is no discharge from the nose.
*It is important to inspect the lining of the mouth.
*During infancy, the chest is almost circular.
*As the child grows, the chest size is normally increases in transverse direction.
*Asymmetry in the chest indicates the possibility of serious underlying problems such as cardiac enlargement (Bulging on left side of ribcage) or pulmonary dysfunction.
*Make sure the child is relaxed & not crying, talking, laughing. Record if child is crying.
*Ask child to "blow out" the light on an otoscope or pocket flashlight; discreetly turn off the light on the last try so that the child feels successful.
*The back of a newborn is C-shaped.
*As growth occurs, the typical S-Shaped curve is seen in the older child and the adult.
*Marked curvature in posture is abnormal
*Examination of the abdomen involves: Inspection, auscultation.
*The most important sound to listen for is peristalsis.
*Examine the extremities at birth for symmetry, ROM, & signs of malformation.
*Count fingers & toes to be certain of normal numbers.
*As a toddler begins to walk, the legs are usually bowlegged until lower body and leg muscles develop.
*By school age, the walking posture is more graceful and balanced.
*During puberty, adolescents sometimes experience awkward posture resulting from rapid growth of extremities.
*In newborns there is a functional deficiency in the kidneys' abilities to concentrate urine & to cope w/conditions of fluid and electrolyte fluctuation, such as dehydration or fluid overload.
*Urine output varies and depends on the size of the infant or child.
*The urine is colorless and odorless.
*It is important to check a child's anal sphincter.
*Note Hx of BM's for diarrhea, constipation, or rectal bleeding.
*If the child complains of perianal itching, test for pinworms.
Factors influencing growth and development:
*The single most important influence on growth.
*A child's appetite fluctuates in response to growth spurts.
*Infants begin life outside the womb nursing at the breast or ingesting formula or breast milk by bottle or tube.
*Most infants are given solid foods at 4-6 months of age when they begin to need more iron in the diet and their teeth begin to erupt.
*It's important for each new food to be introduced, at weekly intervals so that it is possible to recognize any food allergies (An allergic response sometimes takes several days to appear.)
*By 9 months, several teeth have erupted, and it is possible to offer junior foods, which are of much coarser texture.
*By 12-15 months, toddlers are usually eating table food prepared for the famly.
*as children move through the toddler and preschool stages, they often develop fads w/strong preferences.
*Teach the school age child and parent the value of a diet balanced to promote growth.
*Metabolic needs vary among individuals. The rate of metabolism is highest in the newborn infant because of the ratio of total body surface area to body weight is much greater in the infant than in an adult.
*The body uses energy provided by foods.
*Because metabolism is so high in infants and children, their ability to recover from surgery or a fractured bone is swift compared w/that of an adult.
*Children spend less total time sleeping as they mature.
*Most babies are sleeping through the night in the later part of their 1st yr and take 1-2 naps/day.
*Most 12-18 month olds usually nap once a day.
*The 3 yr old child has usually given up all daytime naps.
*The best way to prevent sleep problems w/the infant and child is to establish bedtime rituals that do not foster problematic patterns.
*Crying at birth is the earliest evidence of speech. It is gradually followed by other sounds; cooing, laughing, or babbling.
*By 9 months, infants practice the noises they are able to make and painstakingly repeat them.
*a 1yr old has a 3-4 word vocab; Mama, Dada.
*Children usually know 25-50 words by 18 months but by 2yrs they often know more than 250 words.
*Make sure you know what typifies speech at certain stages of childhood.
*young children become very adapt at understanding nonverbal communication.
*They sense anxiety or fear, by the rise in pitch of the parent's voice.
*Nodding of the head, using direct eye contact, and using sign language are nonverbal symbols.
*Many hospitals have orientation programs for children who are to be admitted.
*The programs are based on the child's level of understanding and stage of development, w/the purpose of familiarizing the child w/hospital surroundings.
*Health care professionals, including nurses, tend to underestimate pain in children.
*We now know that anything will be painful to infants and children if it is painful to adults.
*Bathing the child provides you w/the opportunity to do a complete skin assessment. When giving a bath, protect the infant from drafts and chilling.
*Check water temp.
*If the umbilical cord is still attached, give a sponge bath.
*Bathe starting w/the face and moving on down the trunk.
*Infants enjoy being placed in basins or bathtub seats for baths. Allow the baby to play and splash.
*Provide toys for the child to use in splashing, water play, and bathing.
*For most younger children it is enough to allow them to enjoy themselves in a tub for 15-30 minutes.
*The school age child will sometimes be more reluctant to bathe, and many are not accustomed to a daily bath.
*Often a mother will wish to continue breastfeeding her baby who is ill or hospitalized. Assist the mother by providing a quiet environment and a comfortable chair for her to sit in when nursing her baby.
*Encourage the mother in this case to use a breast pump, and provide a private place for this activity.
*It is possible to freeze bottles of breast milk and give them later by bottle or tube feeding.
*The correct position for feeding an infant is one that is comfortable for both adult and infant.
*If a burp is not elicited by one position, try another.
*Have them feed the infant in an infant seat.
*Older infants (8-9 months old) will be able to eat in a high chair w/safety strap in place.
*Passing a feeding tube through the nose or mouth down the esophagus & into the stomach.
*To measure the tube before placing it, a qualified staff member will use one of the following 1)measure from the nose to the distal area of earlobe and then to the end of the xyphoid process or 2)Measure from the nose to the earlobe and then to a point midway between the xyphoid process and umbilicus.
*Some restraint of infant activity is likely to be necessary when passing the tube.
*often used in children when passing a gastric tube is contraindicated or in children who require tube feeding over an extended period.
*The practitioner inserts the tube through he abdominal wall into the stomach and secures it with a purse-string suture as well as anchoring the stomach to the peritoneum at the operative site.
*Feeding is carried out in the same manner and rate as in gavage feeding.
*A highly concentrated solution of protein, glucose, and other nutrients IV through conventional tubing with a special filter attached to remove particulate matter and microorganisms.
*Wide diameter vessels, such as the subclavian vein, are the usual sites of infusion.
*Nursing responsibilities include control of sepsis, monitoring of the unknown rate, and continuous observations.
*For safety reasons, children will often need to be restrained after surgery or during a procedure or exam.
*Safety reminder devices are used only as a last resort.
*Make absolutely sure to apply the SRD correctlyy, and closely monitor circulation and skin integrity.
*Move the SRD q2hr to permit exercise of that body area.
*Collecting a urine specimen when the child is not toilet trained is sometimes a major problem in ped's.
*Qualified personnel will sometimes perform suprapubic bladder aspiration on newborns and infants.
*the physician will sometimes use a jugular or femoral vein to obtain a blood specimen.
*it is your responsibility to prepare, and restrain the child.
*Holding the head or lower extremities absolutely immobile is critical
*explain procedure to parents.
*It's usually permitted to apply EMLA cream to the lumbar area. is not necessary to apply the cream at least 1hr before the procedure.
*Position the child at the edge of the exam table or bed, on the side, facing you. Often place the infant in a sitting position. Gently flex the neck and legs.
*Observe the child for any signs of difficulty.
*You may have to wrap a toddlers legs in a blanket to decrease activity.
*Supplemental oxygen helps improve the childs respiratory status by increasing the amt. of oxygen in the blood.
*It is also used in children who have cardiac or neurologic disorders.
*Use suctioning when secretions are audible in the airway or when signs of airway obstruction or oxygen deficit are present.
*It is possible to use various devices such as a bulb syringe, or a straight suction catheter of the proper size for the child.
*Depth: approx. 1/4-1/2in beyond the tip of the artificial airway.
*Timing: suctioning t not more than 5 seconds.
*Frequency:Allow 30secs between suctioning,
*Many health disorders necessitate accurate monitoring of the amount of solids and liquids taken in and the amount excreted.
*All fluids given to a child are documented on a record kept at bedside.
*Make sure you know how to compute the dose correctly and administer it properly.
*For safety, have a second nurse check all computed doses.
*Don't forget the 6 rights of med administration.
*Also remember to assess and document the child's response.
*Method's of calculatind doses for children consider age, body weight, and body surface area.
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