Peadiatrics Flashcards
What is family-centered care?
- Based on the tenets of Attachment Theory
- Recognizes family as constant in child’s life
- Systems must support, respect, encourage and enhance the family’s strength and competence
- Need so family must be addressed
What are some stressors of Hospitalization?
Separation anxiety
- Protest phase - crying and screaming, clinging to 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
What are some things infant needs when there is a loss of control?
- Trust
- Consistent loving caregivers
- Daily routines
What are preschooler needs when there is a loss of control?
- Egocentric and magical thinking is typical of this age
- May view illness or hospitalization as punishment for misdeeds
Preoperational thought
What are school-age children needs?
- Striving for independence and productivity
Fears of death, abandonment, permanent injury - Boredom
What are adolescent needs?
- Struggle for independence and liberation
- Separation from the peer group
- May respond with anger and frustration
- Need for information about their condition
How to normalise 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
What are the normal values after 1 week of birth?
RR: 30-60
PR: 100-160
Systolic BP: 50-70
What are the normal values of a 1-6 week infant?
RR: 30-60
PR: 100-160
Systolic BP: 70-95
What are the normal values of a 6 months infant?
RR: 25-40
PR: 90-120
Systolic BP: 80-100
What are the normal values of a 1-year-old?
RR: 20-30
PR: 90-120
Systolic BP: 80-100
What are the normal values of a 3-year-old?
RR: 20-30
PR: 80-120
Systolic BP: 80-110
What are the normal values of a 6-year-old
RR: 18-25
PR: 70-110
Systolic BP: 80-110
What are the normal values of a 10-year-old
RR: 15-20
PR: 60-90
Systolic BP: 90-120
What are some important factors for normal values?
- 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
How to prepare a child for procedures?
Main goal is to decrease anxiety, promote cooperation, and support coping skills
- Psychological preparation
- Establish trust and provide support
- Parental presence and support
- Explanation to the child
How to perform procedures for children?
- 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
- Encourage expression of feelings
- Provide support and encouragement through procedure; rewards help
- Prepare the family
What are the risks for developing illnesses throughout the ages?
- Younger than 3 months - maternal antibodies offer protection
- 3-6 months - the infection rate increases
- Toddlers and preschoolers - high rate of viral infections
- Older than 5 years- increase in GABHS and Mycoplasma pneumoniae infections
- Increased immunity develops with age
What is the difference between a child’s airways or an adults?
- Diameter of airways are smaller
- Distance between structures is shorter, allows organisms to rapidly move down
- Short and open eustachian tubes
What are some respiratory problems in children?
- Croup syndromes
- Bronchitis
- Bronchiolitis
- Asthma
- Epiglottis
What are the clinical manifestations of respiratory infections?
- Varies with age
- Generalised signs and symptoms and local manifestations differ in young children
- Fever
- Anorexia
- Cough, sore throat, nasal blockage or discharge
- Adventitious respiratory sounds
What are some 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
What are Croup Syndromes - URTI?
- Characterized by hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress
- Affects the larynx, trachea, and bronchi
- Problematic in infants and small children due to smaller diameter of airways
What is acute epiglottitis?
- Sore throat, pain, tripod positioning, retractions
- Inspiratory stridor, mild hypoxia, distress
- Potential for respiratory obstruction
How to prevent acute epiglottitis?
Haemophilus influenzae type b (Hib) vaccine
What is the therapeutic management for acute epiglottitis?
- Presumptive diagnosis of epiglottitis constitutes a medical emergency
- Should not be examined until anesthetist presents as immediate intubation or tracheostomy may be indicated for airway obstruction
- Keep patient calm, comfortable and minimise any distress
What is 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
- Spread by hand to eye, nose and other mucus membranes
What is febrile convulsion/ seizures?
- Most occurs 6 months to 3 years
- Boys are affected twice as often
- Most are generalised, last least than 5 minutes
- 30% of children have one occurrence
- Cause uncertain, rarely any long-term effects and are relatively harmless
- > 38.8 degree and occurs during temp rise
- Accompanying illness; otitis media, respiratory infections
What is the nursing management for febrile convulsions/seizures?
- Stay calm
- Think safety during and after seizure
- Call for help
- If lasting more than 5 minutes, doctor 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
What are signs of distress to look out for in a child?
Appearance:
- Abnormal tones
- Decreased interactiveness
- Decreased consolobility
- Abnormal look/gaze
- Abnormal speech/cry
Circulation to skin
- Pallor
- Motting
- Cyanosis
Work of breathing
- Abnormal sounds
- Abnormal position
- Retrations
- Flaring
- Apnea/gasping
What does CUPS stand for in paediatrics?
Measures the severity of the illness C - critical U - unstable P - potentially unstable S - stable
What are key assessments you need to consider when caring for a child?
- Health history - previous hospitilisation, immunisation status, medications
- Nutrition - Feeding appetite, allergies, food diary
- Family structure - family dynamics, culture (family norms), potential abuse
- Physical - weight, vital signs, level of consciousness, skin color, temperature
- Developmental - sensor & motor movements for age, interaction, physiological development
What is AVPU?
A - awake and alert
V - responsive to verbal stimuli
P - responsive to painful stimuli
U - completely unresponsive
