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Unit 2

Pediatric Nursing
Communicating With
Infants and Young Children

Infants respond to sounds and actions.

Distrust of strangers may last through the first 3 or 4

years of life.

Get down on their eye level.

The perceptions of young children are literal.

Communicating With
School-Age Children

Interested in knowing what and why

Simple explanations that help them understand how

equipment works are important.

These children will ask more questions if their curiosity

is not satisfied.
Communicating With Adolescents

Young teenagers frequently waver between thinking like

children and like adults.

Teens may need to relate information that they do not

wish others to know, and a discussion about
confidentiality may ease their concerns.

The nurse should listen attentively in an open-minded,

nonjudgmental way.
Communicating With Family Caregivers

Keep family caregivers well informed about what is

happening and being planned for their child.
Some caregivers are so anxious and apprehensive that
they communicate their concerns and negative reactions
to the child rather than provide support.
Health Maintenance

Routine well-baby or well-child visits are recommended

throughout childhood.
Dental caries (cavities) are a major health problem in
children and adolescents.
Protection against disease in the form of immunizations is
available against several serious or disabling diseases.
Pediatric Assessment

Collecting Subjective Data

Conducting the Client and Family Interview
Obtaining a Client History
Collecting Objective Data

General Status
Observing General Appearance
Noting Psychological Status and Behavior
Measuring Height and Weight
Measuring Head Circumference
Vital Signs
Providing a Physical Examination

Head and Neck

Chest and Lungs
Genitalia and Rectum
Back and Extremities
Hospitalized Child

Pediatric Unit
Infection Control
Caregiver Participation
Child Undergoing Surgery
Assisting with Basic Needs


Intake Measurement
Gavage Feeding
Gastrostomy Feeding
Pain Management
Assisting With Basic Needs

- Output Measurement
- Specimen Collection
- Restraints
- Transporting
- Holding
- Sleeping
Medication Administration

Evaluate each child from a developmental point of view

to administer medications successfully.

Always calculate the drug dosage to

ensure administration of the correct
Oral medications may be given to infants through a
nipple, with a medicine dropper, or with an oral syringe.

Medications should not be given in food.

Infants: 28 Days To 1 Year

Trust Versus Mistrust

Physical Characteristics
Social Characteristics
Nursing Implications
In the Health Care Facility
Toddler: 1 To 3 Years

Autonomy Versus Shame and Doubt

Physical Characteristics
Social Characteristics
Nursing Implications
In the Health Care Facility
Preschool Child: 3 To 6 Years

Initiative Versus Guilt

Physical Characteristics
Social Characteristics
Nursing Implications
In the Health Care Facility
School-age Child:
6 To 12 Years

Industry Versus Inferiority

Physical Characteristics
Social Characteristics
Nursing Implications
In the Health Care Facility
Preadolescent: Ages 10 to 12

Physical Characteristics
Preparation for Adolescence
Adolescent: Ages 12 to 18

Ego Identity Versus Role Confusion

Physical Characteristics
Social Characteristics
Nursing Implications
In the Health Care Facility
Developmental Disorders

Autism: pervasive developmental disorder

Down Syndrome: trisomy 21
Fetal Alcohol Syndrome
Lead Poisoning (Plumbism)
Mental Retardation

The most common classification of mental retardation is

based on IQ.
Medical Management: goal is to keep child in home
Nursing Process: The Child With Cognitive

Self-Care Deficit: Bathing/Hygiene,

Dressing/Grooming, Feeding, Toileting related to
cognitive or neuromuscular impairment (or both)
Impaired Verbal Communication related to impaired
receptive or expressive skills
Delayed Growth and Development related to physical
and mental disability
The Child With Cognitive Impairment

Compromised Family Coping related to emotional

stress or grief
Risk for Social Isolation (family or child) related to
fear of and embarrassment about the childs behavior or
Attention DeficitHyperactivity Disorder

Syndrome characterized by degrees of inattention,

impulsive behavior, and hyperactivity
Medical Management: treatment is multidisciplinary
Nursing Management
Build the childs self-esteem, confidence, and
academic success
Child Abuse and Neglect

Dysfunctional family
State laws require health care personnel to report
suspected child abuse
Physical Abuse
Emotional Abuse and Neglect
Sexual Abuse
Nursing Management for the Abused or Neglected Child
Nonorganic Failure to Thrive

Children who fail to gain weight and show signs of

delayed development
Organic failure to thrive: result of a disease condition
Nonorganic failure to thrive (NFTT): no apparent physical
Medical Management
Nursing Process: The Child With
Nonorganic Failure to Thrive

Imbalanced Nutrition: Less than Body

Requirements related to inadequate intake of calories
Risk for Delayed Growth and Development related
to physical or emotional neglect, lack of stimulation and
insufficient nurturing
Impaired Parenting related to lack of knowledge and
confidence in parenting skills
Respiratory Disorders

Acute Bronchiolitis/Respiratory Syncytial Virus

Croup Syndromes
Spasmodic Laryngitis
Acute Laryngotracheobronchitis
Nursing Process: The Child With a
Respiratory Disorder

Ineffective Airway Clearance related to obstruction

associated with edema, mucous secretions, nasal and
chest congestion
Impaired Gas Exchange related to inflammatory
Risk for Deficient Fluid Volume related to respiratory
fluid loss, fever, and difficulty swallowing
Compromised Family Coping related to childs
respiratory symptoms and illness
Cystic Fibrosis

Medical Management
Pulmonary treatment
Dietary treatment
Home care
Nursing Management
Sudden Infant Death Syndrome

Leading cause of infant mortality worldwide

No single cause has been identified; SIDS can neither be
prevented nor predicted.
American Academy of Pediatrics recommends that
infants must be placed in a supine position to sleep.
Referrals should be made to the local chapter of the
National SIDS Foundation.
Cardiovascular and Hematopoietic

Congenital Heart Disease

Congenital Heart Defects
Ventricular Septal Defect
Atrial Septal Defects
Patent Ductus Arteriosus
Coarctation of the Aorta
Tetralogy of Fallot
Transposition of the Great Arteries
Cardiovascular and Hematopoietic
Disorders (Continued)

Rheumatic Fever
Kawasaki Disease
Factor VIII Deficiency (Hemophilia A; Antihemophilic
Globulin Deficiency; Classic Hemophilia)
Factor IX Deficiency (Hemophilia B; Plasma
Thromboplastin Component Deficiency; Christmas
Neurologic Disorders

Cerebral Palsy
Ataxia type
Rigidity type
Mixed type
Ventriculoperitoneal shunting
Nursing Process: Postoperative Care of a Child
With a Shunt Placement

Risk for Ineffective Cerebral Tissue Perfusion

related to IICP
Risk for Impaired Skin Integrity related to pressure
from physical immobility
Risk for Infection related to the shunt
Risk for Delayed Growth and Development related
to impaired ability to achieve developmental tasks
Anxiety related to family caregivers fear of surgical
Haemophilus influenzae Meningitis

Medical Management: The child is initially isolated and
treatment is started using IV administration of
Nursing Management
Closely monitor the child for signs of IICP.
Side-lying position with the neck supported and head
Reye Syndrome

Assessment: symptoms appear within 3 to 5 days after

the initial illness
Medical Management:improving respiratory function,
reducing cerebral edema, and controlling hypoglycemia
Nursing Management
Accurate intake and output
Avoid giving aspirin to children
Spina Bifida

Failure of the posterior laminae of the vertebrae to close

as a result of a defect in the neural arch, generally in the
lumbosacral region
Surgery is required to close the open defect
Nursing Management
Until surgery is performed, the sac must be covered
with a sterile dressing moistened in a warm sterile
Sensory Disorders

Cleft Lip and Cleft Palate

Vision Impairment
Hearing Impairment
Gastrointestinal Disorders

Celiac Syndrome/Gluten-Induced Enteropathy

Diarrhea and Gastroenteritis
Gastrointestinal Disorders (Continued)

Congenital Aganglionic Megacolon

Pyloric Stenosis
Type 1 Diabetes Mellitus
Urinary and Renal Disorders

Exstrophy of the Bladder
Hypospadias and Epispadias
Nephrotic Syndrome
Nursing Process: The Child With Nephrotic

Excess Fluid Volume related to fluid accumulation in

tissues and third spaces
Risk for Imbalanced Nutrition: Less than Body
Requirements related to anorexia
Risk for Impaired Skin Integrity related to edema
Fatigue related to edema and disease process
Risk for Infection related to immunosuppression
Deficient Caregiver Knowledge related to disease
process, treatment, and home care
Urinary and Renal Disorders (Continued)

Urinary Tract Infections

Wilms Tumor (Nephroblastoma)
Musculoskeletal Disorders

Juvenile Rheumatoid Arthritis

Hip Dysplasia
Nursing Process: The Child in an
Orthopedic Device or Cast
Acute Pain related to discomfort of orthopedic device or
Risk for Impaired Skin Integrity related to pressure
of the cast on the skin surface
Risk for Delayed Growth and Development related
to restricted mobility secondary to orthopedic device or
Deficient Knowledge of family caregivers related to
home care of the child in the orthopedic device or cast
Musculoskeletal Disorders (Continued)

Legg-Calv-Perthes Disease (Coxa Plana)

Muscular Dystrophy
Talipes Equinovarus
Integumentary Disorders

Diaper Rash
Acute Infantile Eczema
Fungal Infections
Parasitic Infections
Immune Disorders

Communicable Diseases
Infectious Mononucleosis