Basic Concepts of Pediatric Nursing

Cephalocaudal

"Head-to-toe" Head develops first and is large and complex, whereas the lower end is small and simple and takes shape at a later period

Proximodistal

"In-to-Out" or "Near-to-far" Shoulder control precedes mastery of hands, whole hand is used as unit before fingers can be manipulated, CNS develops more rapidly than peripheral nervous system

Differentiation

development from simple operations to more complex activities and functions

Predictable sequence. Crawling before creeping, creeping before standing, standing before walking

Development does not progress at same rate or pace. When a spurt occurs in gross motor, minimal advances may take place in language. Rapid growth levels off throughout early childhood, is slow during middle childhood, and increases at beginning of adolescence, levels off at adulthood.

Periods termed critical, sensitive, vulnerable, and optimal are those times in the life of an organism when it is more susceptible to pos or neg influences

Physiologic maturation of CNS is influenced by adequacy and timing of contributions from environment such as stimulation and nutrition. First trimester is sensitive period for physical growth of fetus. First year r/t social attachments and trust in infants.

therapeutic relationship

nontherapeutic relationship

child and family

education; anticipatory guidance

patient's right to be self-governing

obligation to minimize or prevent harm

obligation to promote the patient's well-being

concept of fairness

talking to the nurse, making eye contact, accepting the offered equipment, allowing physical touching, choosing to sit on exam table rather than parent's lap.

Talk to parent while ignoring child; gradually focus on child or fav. object. Make complimentary remarks about the child. Tell funny story/play magic trick. Have a nonthreatening "friend" available (i.e. puppet)

Assess reason for behavior; involve child and parent in process; avoid prolonged explanations; use firm, direct approach regarding expected behavior; perform exam as quickly as possible; limit number of ppl in rm; use isolated rm; use quiet, calm, confident voice

Use activities that can be presented as games; "Simon Says", Paper-doll technique

Alter sequence to accommodate needs of different-age children; examine painful areas last; In emergency, ABC's and injured area first

Before able to sit alone- supine or prone, preferably in parent's lap; before 4-6 mo, can place on exam table.
After able to sit alone-Sitting in parent's lap when possible; if on table, place with parent in full view

If quiet, auscultate heart, lungs, abd.
Record heart and resp. rate.
Palpate and percuss same areas.
Proceed in usual head-to-toe direction
Perform traumatic procedures last (eyes, ears, mouth [while crying])
Elicit reflexes as body part is examined.
Elicit Moro reflex last.

completely undress if warm room; leave diaper on male infant; gain cooperation with distraction; smile-use soft, gentle voice; pacify with bottle of sugar water or feeding; have parent help restrain; avoid abrupt, jerky movements

Sitting or standing on or by parent.
Prone or supide in parent's lap.

Inspect body are through play: "count fingers", "tickle toes."
Use min. phys. contact initially.
Introduce equipment slowly.
Auscultate, percuss, palpate whenever quiet.
Perform traumatic procedures last.

Have parent remove out clothing; remove underwear as body part is examined; allow to inspect equipment; if uncooperative, perform procedure quickly; use restraint when appropriate; talk about exam if cooperative (use short phrases); praise for cooperative behavior

Prefer standing or sitting
Usually cooperative prone or supine
Prefer parent's closeness

Cooperative: head-to-toe
Uncooperative: process as with toddler

Request self-undressing; allow underpants if shy; offer equipment for inspection (briefly demonstrate use); make up story about procedure; paper-doll technique; give choices when possible; expect cooperation and use pos. statements.

Prefer sitting
Cooperative in most positions
Younger child prefers parent's presence
Older child may prefer privacy

Proceed in head-to-toe direction.
May examine genitalia last in older child.

Respect need for privacy; request self-undressing; allow to wear underpants; give gown to wear; explain purpose of equipment and significance of procedure; teach about body function and care

Same as for school-age child
Offer option of parent's presence

Same as older school-age child
May examine genitalia last

Allow to undress in private; give gown; expose only area to be examine; respect need for privacy; explain findings during exam; matter-of-factly comment about sexual development; emphasize normalcy of development; examine genitalia as any other body part-may leave to end.

school adjustment and any unusual habits
family and home environment

-how children handle themselves (confidence in dealing w/ others, answering q's, coping w/ new situations)
-parent-child relationship (respect, focus on strengths, constant reprimands, emphasis on weakness/faults, messages about body image)
-Older children write down 5 things they like/dislike about themselves

* Predominant form of play in infants
* Essential for muscle development
* Release of surplus energy
* Gain impressions through tactile, auditory, visual, and kinesthetic stimulation

*Through exploration/manipulation child learns colors, shapes, textures, significance of obj.
*Number significance
*Associate words with objects
*Abstract concepts and Spatial Relationships
*Puzzles, Books, Game

*Children feel the satisfaction of creating something new and different

*Creativity is stifled by pressure towards conformity.

* Primarily solitary but enhanced in group setting

*Children learn who they are and their place in the world

*Learn the sex role society wants them to fulfill

*Test their abilities and compare them to others

*Children can express emotions and release unacceptable impulses in a socially acceptable fashion

*Experiment and test fearful situations and assume vicarious roles

*Need presence of adult to help them control aggression and destructive behavior

* Enforcement of moral standards rigid during play

* Learn peers are less tolerant of behavior so they can maintain a position in the group.

* Sensorimotor Development
*Intellectual Development
* Creativity
* Self Awareness
* Therapeutic Value
* Moral Value

Infant

Toddler

4-6 months

Parent
Child

Interactions / non-verbal clues

Separate

24 hr Recall

Allergies

*Ocassionally used for reflux

* Latch-on
*Position
*Alignment
*Suckling
*Swallowing

24 hrs

*at least 1 wet diaper and 1 stool

*Football
*Cradle
*Cross Cradle
*Side lying position

*Suck-swallow pattern has slowed
*Breast is softened
*Newborn appears content
*Fall asleep or release

*Low birth weight
*Hypoglycemia
*Error of metabolism

Nipple confusion

*Swaddling
*Skin-to-skin contact
*Holding
*Talking soothingly
*Suck on a clean finger

the C hold

2-3 cm

nose, cheeks, and chin sould all be touching breast

insert finger in the side of mouth between gums and keeping it there until nipple is completely out of mouth

*8-12 feedings Q 24hr
*Awaken infant at least q3hr during day and q4hr at night to feed

*suck-swallow pattern is slow
*breast is softened
*newborn appears content and may fall asleep or release nipple

low birth weight, hypoglycemia, inborn error of metabolism

engorgement occurs, mother/baby seperated, mother employed outside of home, nipples are sore/cracked

the 24 hour recall

child/parent recalls every item eaten in past 24 hrs with approximate amounts

qualitative info about child's diet

Record of every food and liquid consumed for a certain number of days. Family should record immediately after eating.

4-7 days; food allergies

1 liter

usually refers to relinquishing the breast or bottle for a cup

Replacing one bottle or breast-feeding at a time

*express needs through crying
*older infants experience stranger anxiety
*more at ease upright than horizontal
*hold infants so they can see parent

*egocentric
*see things in relation to themselves
*allow to play with equipment
*direct, concrete thinking and very literal interpretation

*Rely less on what they see and more on what they know
*Want to know why's and how's

communicate on whatever level they are on

sleep up to 12 hr a day

3 years old

12 months

oral

plastic disposable syringe (esp. TB syringe for volumes less than 1 ml)

Vastus lateralis
After 18 months, move to arm
Usually no more than 1 ml max volume should be administered in a single site

distraction, relaxation, guided imagery, and cutaneous stimulation

male and female partners and their children live as an independent unit, sharing roles, responsibilities, and economic resources

consist of unrelated family members who join together to create a new household. (divorce, remarriage, "steps")

Other relatives living in the same household

comprise an unmarried biological or adoptive parent who may or may not be living with other adults

*family members assume appropriate roles
*social roles are learned in pairs (mother-father, parent-child, brother-sister)