Chapter 31: Basic Pediatric Care

● Family centered care

○ Recognizes the family as the constant in the child’s life and holds that systems
and personnel must support, respect, encourage, and enhance the strengths and
competence of the family
● Nursing Implications of Growth and Development
○ Identifying an infant or child who is demonstrating cognitive or physical
impairment
○ Use a developmental rather than a chronological approach to pediatric nursing
care- focus on what child CAN do rather than what they CAN’T do
○ Select age-appropriate toys for the infant or young toddler and devise activities
that appeal to the school-age child or adolescent
○ Basis for anticipatory guidance with parents- ex: your child will start crawling!
Start baby proofing.
■ Major injuries >6 months
● Children’s Concepts of Illness
○ The stage they are in reflect how they understand illness
■ They think they have done something wrong
○ Infants- perceive illness as pain/discomfort
○ Preschoolers- I must have done something bad, mom and dad can magically fix
it
○ School-age: sometimes they think they did something bad, sometimes that they
have an awareness of body parts.
○ Adolescents: focus on discrete symptoms, intellectually question, use
denial/overcompensation sometimes.
● Growth measurements
○ They stay within the same percentile over the years
■ Weight
■ Height/Length (Length until child is 2)
● Crown to heel recumbent length
■ Head Circumference- up to 36 months (biparietal)
○ Plot the child's measurements with percentiles on growth charts and compare
them with those of the general pediatric population to determine deviations from
the norm
● Vital signs
○ With an infant- respirations first before infant cries
○ Temperature- unstable regulatory period in neonates.
■ 104 is normal
■ Seizure
■ Brain damage
■ Take temp closer to infant head
○ Infants and toddlers prone to wide variations
○ Don’t take the pressure until they are 3 years old on wellness visit
 ○ Newborn heart rate is 120
■ Take radial pulse until they are 5 years old
■ Apical or brachial pulse preferred
○ Normal vital signs of a newborn since birth to 1 month
■ HR 100 - 180
■ RR 40 - 60
■ BP systolic - 65 - 86
■ BP diastolic - 45 - 55
○ Normal vital signs of 1 month old to 12 months
■ HR 100 - 180
■ RR 35- 40
■ BP systolic - 70 - 100
■ BP diastolic - 45 - 55
● Head to Toe
○ Skin- soft, smooth and slightly dry.
■ Assess for cyanosis and jaundice.
■ Pallor indicate anemia
■ Erythema indicate infection
○ Accessory structures
○ Eyes and Ears
■ 20/400. They can see from the breast to the face.
○ Teeth
■ Dental visit at 1 year
■ The first teeth to develop our first central incisors
○ Children sit up from 6 to 9 months
○ Crawl from 8 to 10 months
○ They start walking at 1 year
● Factors Influencing Growth and Development
○ Nutrition- the SINGLE most important influence on growth.
■ Do not give grapes or honey (botulism)
■ breast-feed up to 12 months of age
■ From 6 to 8 months, the child weigh doubles
■ By 1 year, the child weight triples
○ Metabolism- BMR highest in newborn infants.
■ Children have fast metabolism therefore they heal faster
○ Sleep and rest
○ Speech and communication- between 12 months and 2 years, children
learn 250 words
○ Speak to the child according to the child’s stage of development.
● Child Maltreatment
○ Most maltreated children are between under a year. However, many cases go
unreported.
■ Most reports of maltreatment are made by professionals
■ Notify nurse manager immediately
 ■ Healthcare providers are obligated to report it
■ A factor of child abuse is inconsistency in the story and injury
○ Child neglect
■ Physical
■ Emotional
○ Child abuse
■ Physical
■ Emotional
● Shaken baby syndrome
○ When an infant or toddler is shaken, the brain bounces back-and-forth against
the school
○ Infants have a large head surface
○ Symptoms
■ Unequal pupils - brain damage
■ Decor posture
■ Purple cry
■ Body tremors
● Hospitalization of a Child
○ Pre Admission programs
○ Admission
■ Parents are anxious
■ History
■ Bracelets
■ Vitals
■ High and weight for meds
○ Hospital policies
○ Developmental support for the child
○ Pain management
■ FACE scale
■ Relaxation - rocking, swaddling, pacifier, provide comfort
○ Surgery
○ Parent participation
○ 15 to 30 months they experience separation anxiety
■ Regression
○ Parents lose control in the hospital setting and feel powerless. To this point, they
alone have cared for their son or daughter. Now a nurse assumes control over
the child’s care.
○ “If an accident is the cause for hospitalization, parents sometimes blame
themselves and feel guilty “
■ Anticipatory guidance
● Common Pediatric Procedures
○ Bathing
■ Start on the head and move down
● Wash fontanelles
 ■ Football position
■ Skin assessment
■ Water temperature
○ Feeding and burping:
■ Lay on the R side
■ Burp frequently
■ Solids 4 to 6 months
■ Table food at 1 year
■ Change vegetables every week
■ To find out NG tube placement aspirate content
○ Safety reminder devices- mummy restraint
○ Oxygen therapy
○ Suctioning
■ 5 seconds or less
■ Give 30 seconds rest in between suctions
■ 2 or 3 attempts at most
○ I & O’s - weight the diaper
○ Specimen Collections
■ Urine collection (plastic bag), venipunctures to obtain blood specimens-
(jugular or femoral vein), and lumbar puncture (meningitis)
■ Suprapubic bladder aspiration
● Medication
○ Unit doses are NOT used in pediatrics because children are of various ages and
weights.
○ Methods of calculating dosages for children consider age, body weight and
body surface area (BSA)- the total area exposed to the outside environment.
● Medication Administration
○ The nurse must know how to compute the dose correctly and administer it
properly
○ All computed dosages must be checked by a second nurse for safety
○ The right amount of the right medication must be given to the right child at the
right time and via the right route
○ Observe and document a child’s response to the drug
○ Calculating dosages for children consider age, body weight, and body surface
area
● Injections
○ The primary site for IM injections are the vastus lateralis muscles and the
ventrogluteal muscle.
○ The deltoid muscle is possible to use in children who are 18 months or older.
○ Few children cooperate- have someone available to help gently restrain the
child.
● IV Administration
 ○ A superficial scalp vein is used in infants younger than 9 months, because
these veins have no valves, so it is possible to insert a needle in either
direction.
○ Their heads are large and get lots of blood flow. In addition, the child can
move the head without dislodgement.
● Safety
○ Protecting a child from harm is a major issue in pediatrics
○ Anticipatory guidance for parents of infants and toddlers and health teaching
for school-age children and adolescents are two methods of preventing accidents
○ Injuries cause more deaths and disabilities in children than do all causes of
disease combined
○ The adult who is a role model can influence a child immensely
■ Burns
■ Suffocation
■ Choking
■ Drowning
■ Electrical burn
■ MBA’s
■ Injuries from fall
■ Sports
■ Spinal cord injuries (teenagers)