Week Three Flashcards
What is family centred care?
- Recognises family as constant in child’s life
- Systems must support, respect, encourage and enhance the family’s strength and competence
- Needs of family must be addressed
What are stressors of hospitalisation?
Separation anxiety:
- Protest phase (Crying and screaming; clinging to the 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 infants needs when there is a loss of control?
- Trust
- Consistent living caregivers
- Daily routines
What are preschoolers needs when there is a loss of control?
- Egocentric and magical thinking is typical of this age
- May view illness or hospitalisation as punishment for misdeeds
- Preoperational thought
What are school-age children’s needs when there is a loss of control?
- Striving for independence and productivity
- Fears of death, abandonment, permanent injury
- Boredom
What are adolescents needs when there is a loss of control?
- 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
What are normal values of a child from birth to one week?
Respiratory rate - 30-60
Pulse rate - 100-160
Systolic BP - 50-70
What are normal values of a child from one week to six weeks?
Respiratory rate - 30-60
Pulse rate - 100-160
Systolic BP - 70-95
What are normal values of a child at six months?
Respiratory rate - 25-40
Pulse rate - 90-120
Systolic BP - 80-100
What are normal values of a child at one year?
Respiratory rate - 20-30
Pulse rate - 90-120
Systolic BP - 80-100
What are normal values of a child at three years?
Respiratory rate - 20-30
Pulse rate - 80-120
Systolic BP - 80-110
What are normal values of a child at six years?
Respiratory rate - 18-25
Pulse rate - 70-110
Systolic BP - 80-110
What are normal values of a child at ten years?
Respiratory rate - 15-20
Pulse rate - 60-90
Systolic BP - 90-120
What should you consider for vital sign values for children?
- Patients normal should always be considered
- HR, BP and 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 - act quickly
How to communicate with children and their families?
- Listening to the parent - are they concerned
- Parental involvement
- Developmental age of language development
How to prepare for procedures?
- Goal is to decrease anxiety, promote cooperation, and support coping skills
- Psychological preparation (Age-specific guidelines for preparation; Based on developmental characteristics)
- Establish trust and provide support
- Parental presence and support
- Explanation to the child
How to perform procedures?
- Use of the treatment room for procedures
- Expect success
- Involve the child
- Provide distraction
- Encourage expression of feelings
- Provide positive support
- Use of play in procedures
- Prepare the family
What immunity do infants younger than 3 months have?
Maternal antibodies offer protection
What infection rate do infants age 3 to 6 months have?
An increasing rate of infection
What is there a high rate of in toddlers and preschoolers?
High rate of viral infections
What is there an increase of in children older than 5 years?
An increase in GABHS and Mycoplasma pneumoniae infections
How does immunity change as children grow older?
- Immunity increases with age
How is size different in children?
- Diameter of airways is smaller
- Distance between structures is shorter, allowing organisms to rapidly move down
- Short and open eustachian tubes
What are types of respiratory dysfunction in children?
- Croup syndromes
- Bronchitis
- Bronchiolitis
- Asthma
- Epiglottitis
What are clinical manifestations of respiratory infections in children?
- Vary with age
- Generalised signs and symptoms and local manifestations differ in young children
What are clinical signs of respiratory infections?
- Fever
- Anorexia, vomiting, diarrhea, abdominal pain
- Cough, sore throat, nasal blockage or discharge
- Respiratory sounds
What are 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 is croup syndromes characterised by?
- Hoarseness
- Barking cough
- Inspiratory stridor
- Varying degrees of respiratory distress
What does croup syndromes affect?
- Larynx
- Trachea
- Bronchi
What is croup syndromes particularly problematic for infants and small children?
Due to smaller diameter of airways
What are principles of nursing care for a child with croup?
- Observe from a distance
- Reassure parents
- Minimal interaction
- Minimal intervention
- Adrenaline nebuliser if severe
- Stay calm
- Hydrate
What are clinical manifestations of acute epiglottitis?
- Sore throat
- Pain
- Tripod positioning
- Retractions
- Inspiratory stridor
- Mild hypoxia
- Distress
What is therapeutic management for acute epiglottitis?
- Potential for respiratory obstruction
- A presumptive diagnosis of epiglottitis constitutes an emergency
- Should not be examined until anaesthetist present as immediate intubation or tracheostomy may be indicated for airway obstruction
- Keep patient calm, comfortable and minimise any distress
How to prevent acute epiglottitis?
Haemophilus influenzae type b (Hib) vaccine
What are characteristics of bronchiolitis?
- Acute viral infection - bronchiolar level
- Rare in children over 2 years
- Respiratory syncytial virus (RSV)
- Spread by hand to eye, nose and other mucus membranes
- Causes childhood pneumonia as well
What are characteristics of a mild disease in children?
Behaviour - Normal
Respiratory rate - Normal-mild tachypnoea
Use of accessory muscles - Nil to mild chest retraction
Oxygen saturation/oxygen requirement - O2 saturations greater than 92% (room air)
Apnoeic episodes - None
Feeding - Normal
What do children need to have when having IV fluids administered?
Burette
What are characteristics of a moderate disease in children?
Behaviour - Some intermittent irritability
Respiratory rate - Increased
Use of accessory muscles - Moderate chest wall retractions, tracheal tug, nasal flaring
Oxygen saturation/oxygen requirement - O2 saturations 90-92% (room air)
Apnoeic episodes - May have brief apnoea
Feeding - May have difficulty or reduced feeding
What are characteristics of a severe disease in children?
Behaviour - Increased irritability and/or lethargy; fatigue
Respiratory rate - Marked increase or decrease
Use of accessory muscles - Marked chest wall retractions, marked tracheal tug, marked nasal flaring
Oxygen saturation/oxygen requirement - O2 saturations less than 90% (room air); hypoxemia may not be corrected by O2
Apnoeic episodes - May have increasingly frequent or prolong apnoea
Feeding - Reluctant or unable to feed
What are characteristics of febrile convulsions/seizures in children?
- Affects 4% of children
- Most occurs 6 months to 3 year
- Boys affected twice as often as girls
- Most febrile seizures generalised, last < 5 minutes
- 30% to 30% of children have one occurrence
- Cause uncertain
- > 38.8c and occurs during temperature rise
- Accompany illness: otitis media, respiratory infections
What is nursing management for children having febrile convulsions/seizures?
- Stay calm
- Think safety
- Call for help
- If lasting > 5 minutes - Dr consultation
- Observe and examine for origin of fever
- Parental support and education
How to ease respiratory effort?
- Positioning
- Oxygen
- Hydration
What age group is croup common in?
6 months to 3 years
What to inspect in children’s appearance ?
- Abnormal tone
- Decreased interactiveness
- Decreased consolability
- Abnormal look/gaze
- Abnormal speech/cry
What are key assessments when caring for children?
- Health history
- Nutrition
- Family structure
- Physical
- Developmental
What to inspect in children’s work of breathing ?
- Abnormal sounds
- Abnormal position
- Retractions
- Flaring
- Apnea/gasping
What to inspect in children’s circulation to skin?
- Pallor
- Mottling
- Cyanosis
What are ABCs of critical paediatric illnesses?
Absent airway, breathing or circulation
What are ABCs of unstable paediatric illnesses?
Compromised airway, breathing or circulation
What are ABCs of potentially unstable paediatric illnesses?
Normal airway, breathing, and circulation but significant mechanism of injury or illness
What are ABCs of stable paediatric illnesses?
Normal airway, breathing and circulation. No significant mechanism of injury or illness
What does CUPS stand for for paediatric illnesses?
Critical
Unstable
Potentially unstable
Stable
What to assess for the paediatric assessment triangle?
- Appearance
- Work of breathing
- Circulation
What does AVPU stand for?
Alert
Verbal
Pain
Unresponsive
What can increase HR and RR?
- Compensated shock
- Infection
- Stress
What can decrease RR?
- Medications (e.g. racemic)
- Exhaustion
What can cause decreased HR?
- Hypoxia
- End stage shock
What is angina?
- Symptom of coronary artery disease
- Chest pain due to lack of blood supply and oxygen to the heart
- Pain often spreads to shoulders, arm, neck and jaw
What does angina feel like?
- Squeezing
- Pressure
- Heaviness
- Tightness
- Pain in the chest
- Can be sudden or recur over time
How can angina be treated?
Depending on severity, can be treated by lifestyle changes, medication, angioplasty or surgery
What is atherosclerosis?
Build up of plaque
What is arteriosclerosis?
Thickening of walls of arteries