Lecture 4 Flashcards
Unique challenges of Pediatric nursing vs caring for adults
- Everything in pediatric nursing is fragile and sensitive. Tiny doses of meds run slowly on pumps, small chest tubes, and even the slightest nursing errors can have BIG consequences
- Peds: Variety of reasoning strategies are necessary for interventions
Unique challenges of Pediatric nursing vs caring for adults (8)
- Everything in pediatric nursing is fragile and sensitive. Tiny doses of meds run slowly on pumps, small chest tubes, and even the slightest nursing errors can have BIG consequences
- Peds: Variety of reasoning strategies are necessary for interventions
-> Possibly 3-5 patients from toddler to adolescent
-> Different coping skills
-> Different physical skills
-> Different cognitive abilities
-> Different lab values
-> Different vital sign normal ranges
Adults: The majority fall within the same categories - Two levels and direction of discussion are required:
-> For the parents, use logical explanation
-> For the child (the patient), simplify and use different language
-> For adult patients, you can address everyone in the room at once - Children often see nurses as a threat and cower from them when they
enter the room
-> Adults generally welcome the arrival of the nurse - Adults may have complicated and extensive medical hx and different
medical risks that must be sorted for dx
-> Pediatric nursing is more straightforward
-> Fewer allergies
-> Limited to no medical hx
-> Single medical problem with an associated etiology
-> But, pediatric patients crash quicker
-> Less reserves
-> Can compensate normal vitals for a period of time before sudden
decline
-> Codes almost always originate from respiratory cause
-> Can’t tell you where it hurts, how it hurts, when it started - Increased pressure to have things go right
-> Hovering family members create pressure to get IV in baby with just
one stick or risk an angry parental outburst
-> Or, parents can’t stay and child is needy, pulling you from other
patients. Nurse becomes disciplinarian, caregiver.
-> Adult patients are generally self-sufficient - ethical dilemmas
-> Parents may agree to tx, but adolescent patient disagrees. - Difficult to observe so much pain and sadness in innocent lives
-> Maternity patients generally have joy and excitement, and their pain
can disappear with epidurals
Benefits of Pediatric Nursing
- Poop is not as disgusting as with adults
- Throw-up is not as disgusting as with adults
- Diaper changes are not as difficult
Cephalocaudal
Improvement in structure and function come first in the head region, then in the trunk, and last in the leg region
Growth and Development
Travel from head to toe the first year of life in increments of 3 months
Second year of life double it and go in increments of 6 months
For the next two years, double it again and go in increments of 12 months
3 Month Growth
Maintain head upright
6 Months
Sitting upright
9 Months
Crawling
12 Months
Walking
18 Months
Running
2 Years
Jumping
3 Years
Tricycle
4 Years
Hop on one foot
Sigmund Freud’s Theory
Psychosexual development (he was a dirty, dirty old man)
Jean Piaget’s Theory
Cognitive development
Erik Erikson’s Theory
Psychosocial
Lawrence Kohlberg’s Theory
Moral development
Stage 1 of Separation Anxiety in Kids
Protest
-> Loud inconsolable cry
-> Clinging
-> Attempts to force parent to stay (don’t do mommy/daddy)
-> Lasts variable lengths of time
Stage 2 of Separation Anxiety in Kids
Despair
- Physical s/s: mimic “depression”
-> Weight loss
-> Prone to minor illnesses
-> Insomnia
- Other behaviors:
-> Inactivity
-> Disinterest
-> May appear sad
-> May wait not cry
-> Regression to earlier behavior
EVEN A “GOOD” PEDS PATIENT MIGHT SHOW THESE BEHAVIORS
Stage 3 of Separation Anxiety in Kids
Denial or Detachment
-> No protest (silent) when parent leaves
-> May seem happy with strangers or caregivers, but forms “surface”
relationships
-> Development delays are common
-> will probably have difficulty with future close relationships
-> Usually happens after prolonged hospitalization (longer than 6 months)
Stress Reactions In Infants
- Searching for parent with their eyes
- Clinging to parent
- Rejecting contact with strangers
- Crying
- Screaming
Stress Reactions in Toddlers
- Verbally attacks strangers (“go away”)
- Physical resistance
- May attempt to run away and find parent
- Continuous crying
- Verbally pleading for parent to stay
Stress Reactions in Pre-Schoolers
- Difficulty sleeping/nightmares
- Indirectly expressing anger (breaking toys, hitting other kids)
- Continually asking regarding parental return
- Crying quietly for parent
Stress Reactions in School Age Kids
- May be more stoic (act like a “big kid”)
- May withdraw/show emotional coldness
- Need to express anger may find alternative outlets (irritable, sad, silent)
Stress Reactions in Adolescents
- Self-assertion/aggression
- Anger/frustration
- Uncooperativeness
- Withdrawal: “no one understands me”
- Questioning adequacy of care
- Lack of concern for their privacy may cause more stress than physical
pain
Why Does Grief Hurt?
The “Missing Sink” explanation
- you get up in the middle of the night to get some water from the sink. You sleepily walk over to where it is and find that it is missing. You are suddenly wide awake and wondering where the actual heck the sink went.
- The brain cannot find loved one or friend in space and time and so
responds with cortisol, the fear hormones - Grief is fear that one is vulnerable/in a dangerous place (there is now
proof of this)
Infants and Toddlers Understanding of Death
- Even older infants and toddlers have limited understanding (except
separation anxiety at loss of a parent) - Nursing Care - Maintain routines, consistent care givers
Pre-School Age Child’s Understanding of Death
- Concepts of death are at the level of some understanding
- Believe they can cause death of someone who they dislike
- Also have some understanding that it is temporary. A departure and not
universal or inevitable
Preschool Reactions to Death
- May feel guilty if someone they dislike dies (“I caused it”)
- Greatest fear about death is separation from parents
- Behavior reactions may appear “strange” to parents (e.g. giggling)
Nursing Interventions: Preschoolers
- Age appropriate explanations (So-and-so got very sick/hurt)
- Provide continuity of caregivers
- Provide anticipatory education for parents regarding kids’ strange
reaction
School Age Concepts of Death
- May still think bad deeds/thoughts can cause death
- Understand death in “concrete” terms (know snake is dead on the road)
- By age 9-10, child’s understanding is capable of reaching “adult” level
School Age Reactions to Death
- May feel more responsible for death
- May be very inquisitive about it
- May be more fearful (r/t increased understanding)
Nursing Interventions: School Age
- Can give “cause of death” (aka germs cause cancer, etc) explanations
- Encourage honesty about death
- Kids do know something is wrong if family member dies
Adolescents’ Concepts Regarding Death
- May have leftover childhood notions
- Are capable of mature understanding
- Often feel it couldn’t happen to them or their friends
Adolescents’ Reactions To Death
- Concern is for the present vs the future
- Death rituals (funerals) may seem so unnecessary
- Least likely of the pediatric age groups to accept or cope well with death
Interventions for Adolescents
- Respect adolescent’s need for privacy. It’s their own style of grieving
- REMEMBER: They may need as much or MORE emotional support during
the grieving process than other kids
Young Infant Response to Pain
- Crying
- Facial appearance (lowered brows, eyes close, mouth open)
- Rigidity/Thrashing
Older Infant Response to Pain
- Crying
- Localized body response with withdrawal from what is causing pain
- Expression of pain or anger
- Physical struggle - pushing away from pain
Young Child Response to Pain
- Crying/screaming
- Verbal expressions (Ouch, ow)
- Thrashing or arms and legs
- Pushing away what is causing pain
- Lack of cooperation
- Clings to significant person
School-Age Child’s Response to Pain
- Same as young child, yet exhibits time wasting behavior - “Wait a minute,
I’m not ready” - Muscular rigidity - clenched fists, white knuckles, gritted teeth
Adolescent Response to Pain
- Less vocal and less physical resistance
- Expressions
- Displays increased muscle tension and body control
Elements of Pain Assessment
- Intensity
- Satisfaction with tx
- Symptoms and adverse events
- Physical recovery
- Emotional response
Self-Reporting Pain Rating Scales
If older than 4 years old
- Faces pain scale - revised
- FACES pain rating scale
- VAS (Visual Analog Scale)
Pain Assessment: Behavioral Pain Measures
- FLACC (Face, Legs, Activity, Cry, Consolability) - kids between 2 months
and 7 years old and for those unable to communicate pain - FACES (Wong-Baker) - for kids as young as 3 yrs old
- OUCHER - Ages 3-13 - Features non-white ethnic groups
- Standard Numerical rating scale (0-10) - Ages 5 and up
- Visual Analog Scale - Horizontal line scale with worst pain on left end to worst on right end of the line - Ages 4 1/2-5 years (VERY SPECIFIC?)
- APPT (Adolescent Pediatric Pain Tool) - Coloring areas of pain and intensity with dark or lighter red color on a body outline/graph
Nonpharmacologic Pain Management
- Distraction
- Relaxation
- Guided imagery
- Cutaneous stimulation
- Containment and swaddling
- Nonnutritive sucking
- Kangaroo care (in only diaper and skin-to-skin contact)
Complementary Pain Medicine
- Biologically based
- Manipulative treatments
- Energy based
- Mind-body techniques
Pharmacologic Pain Management
- Nonopioids (NSAIDS)
- Opioids
- Patient-controlled analgesia
- Epidural analgesia
- Transmuccosal and transdermal analgesia
