Pedatric Lecture - Exam 1 Flashcards
Infant Normal Heart Rate
80-150
Infant Normal Respiratory Rate
25-55
Toddler Normal Heart Rate
70-110
Preschooler Normal Heart Rate
65-110
Toddler Normal Respiratory Rate
20-30
Preschooler Normal Respiratory Rate
20-25
School-age Normal Heart Rate
60-95
School-age Normal Respiratory Rate
14-22
Adolescent Normal Respiratory Rate
12-18
Adolescent Normal Heart Rate
55-85
Infant Age
Birth-1 year
Toddler Age
1-3
Preschooler Age
3-5
School Age
5-12
Adolescent Age
13+
Erikson Stage 1
Birth - 1 year
Trust VS Mistrust
Establishment of trust dominates the first year of life. Consistent loving care by a mothering person is essential for development of trust. Mistrust develops when trust-promoting experiences are deficient or lacking or when basic needs are inconsistently or inadequately met. Although shreds of mistrust are sprinkled throughout the personality, from a basic trust in parents stems trust in the world, other people, and oneself. The result is faith and optimism.
Erikson Stage 2
1 - 3 years
Autonomy VS Shame & Doubt
The development of autonomy during the toddler period is centered on children’s increasing ability to control their bodies, themselves, and their environment. They want to do things for themselves, using their newly acquired motor skills of walking, climbing, and manipulating and their mental powers of selecting and decision making. Much of their learning is acquired by imitating the activities and behavior of others. Negative feelings of doubt and shame arise when children are made to feel small and self-conscious, when their choices are disastrous, when others shame them, or when they are forced to be dependent in areas in which they are capable of assuming control. The favorable outcomes are self-control and willpower.
Erikson Stage 3
3 - 6 years
Initiative VS Guilt
Children explore the physical world with all their senses and powers and develop a conscience. No longer guided only by outsiders, they have an inner voice that warns and threatens. Children sometimes undertake goals or activities that are in conflict with those of parents or others, and being made to feel that thier activities or imaginings are bad produces a sense of guilt. Children must learn to retain a sense of initiative without impinging on the rights and privileges of others. The lasting outcomes are direction and purpose.
Erikson Stage 4
6 - 12 years
Industry VS Inferiority
Having acheived the more crucial stages in personality development, children are ready to be workers and producers. They want to engage in tasks and activities that they can carry through to completion. They need and want real achievement. Children learn to compete and cooperate with others, and they learn the rules. It is a decisive period in their social relationships with others. Feelings of inadequacy and inferiority may develop if too much is expected of them or if they believe that they cannot measure up to the standards set for them by others. The ego quality developed from a sense of industry is competence.
Erikson Stage 5
12 - 18 years
Identity VS Role Confusion
Rapid and marked physical changes. Previous trust in their bodies is shaken, and children become overly preoccupied with the way they appear in the eyes of others as compared with their own self concept. Adolescents struggle to fit the roles they have played and those they hope to play with the current roles and fashions adopted by their peers, to intergrate their concepts and values with those of society, and to come to a decision regarding an occupation. Inability to solve the core conflict results in role confusion. The outcome of successful mastery is devotion and fidelity to others and to values and ideologies.
Expected Developmental Level VS Actual Developmental Level
Developmental Level on Admission VS Throughout Admission
What should you expect in a sick/hospitalized child in reference to developmental levels?
Regression to a prior developmental level
Expected stressors in the infant
Separation anxiety, stranger anxiety
Expected stressors in the toddler
separation anxiety, stranger anxiety, lack of familiarity environment and routines
Expected stressors in preschool aged children
separation anxiety, fear of mutilation and bodily injury, may view hospitalization as a punishment
Expected stressors in the school aged child
fear of mutilation and pain, fear of death, concerns of body image, loss of control
Expected stressors in the adolescent
loss of control and independence, threat of change in body image, restriction of physical activities, fear of rejection from peers, fear of death
TNI Infant *
Encourage parents to room in
Utilize primary nursing
Speak in gentle tone and maintain eye contact
Use gentle touch/swaddle for comfort and/or procedures
Gently rock in arms
TNI Toddler
Encourage parents to room in
Adapt hospital routines to home routines
Provide a “lovey” from home
Provide time for play
Perform procedures in sitting position
TNI Preschooler *
Encourage parents to room in
Bring favorite articles from home
Repeatedly explain reasons for procedures and evaluate child’s understanding
Provide distractions for child during procedures (bright objects, noises, games, blowing bubbles, etc.)
TNI School-age *
Provide special objects from home
Encourage school-work and visits from friends/relatives
Explain procedures clearly while eliciting child’s understanding
Involve child in planning their care (menu selection, keeping their room clean, playing with younger hospitalized children, assisting with their treatments)
TNI Adolescents *
Encourage teen to bring in favorites from home
Promote their independence (assist with planning their care, allowing street clothes, making their meal choices, continuing school work, room in with peers, encouraging visits from friends/family)
Thoroughly explain procedures and what they will see/smell and feel
Describe any scars they may incur on their body
Where should all painful procedures be done for children (especially younger children)?
Procedure room/treatment room
Post-Hospital Behaviors
General anxiety and regression
Separation Anxiety
Sleep Disorders
Eating Disturbances
Aggression toward authority
Apathy-withdrawal
PTSD
Factors influencing outcomes of hospitalization
Ability of child to maintain baseline functioning/ADLs
Degree of communication among all providers with parents/caregivers
Parent and child participation in care and decision making
Amount of past hospitalization experiences and the outcomes
Number of concurrent stressors
Pre-hospitalization coping
Length of hospital stay
Specific interventions during hospital stay to support child/family
Emotional state of child/family
How nursing can help families cope with a hospitalized child
Strongly encourage communication with child’s health care team
Review the parent/caregiver’s role during their child’s hospitalization
Review the parent/caregiver’s role to their non-hospitalized children
Encouraging the parent/caregivers’ to care for themselves during child’s hospitalization
Listen carefully
Parent/Caregiver response to hospitalization of a child
Loss of control
Range of emotions (fear, guilt, helplessness, anger, confusion, worry)
Emotional unavailability to others
Loss of work/sense of belonging
Loss of normal routine
Inability to maintain home/family life
Loss of martial relationship
Pain Management
Older children: numeric
Toddlers: FACES
Infants: body mechanics
Help children communicate and control pain
Take VS to look for elevations which indicate pain
Assess for sweaty palms, irritability, appetite and mobility
Routes: Tablet, liquid, IV
Assess and monitor respirations after administering narcotics
Consider safety after narcotic administration
Non-pharmaceutical: distraction, touch therapy, splinting (“bridging”)
Manage pain even if they cannot express it
Play
Helps children to process things that have happened, to learn, to grow, to gain a sense of mastery and to decrease fear
If staff is involved, that is positive
Focus on play based on their limitations
Try to make it normal through play
Play can be directed or free, unstructured play
Therapeutic and medical play to gain a sense of control, correct misconceptionss
Child life specialist or nurse can use medical play
Play can be used for teaching and to give child sense of control
Can help children adjust and learn
