Peds

• Health Promotion- Healthy People 2030 goals


  • Sets goals a decade at a time
  • 1st goals set 1980-1990
  • Long term goals: Research
  • Decreasing death
  • Improving quality of life
• Disease Prevention - Anticipatory Guidance


  • Oral Health
  • Healthy Weight
  • Healthy Activity
  • Personal Hygiene
  • Sun exposure
• Disease Prevention - Other areas


  • Environmental hazards
  • Abuse
  • Self-harm
• Include the child for age-appropriate guidance (privacy may be appropriate)
• Screenings - Risk Assessment


  • Includes objective and subjective data to determine the likelihood that the child will develop a condition
• Selective Screening has high sensitivity (lots of false positives) and low specificity (few false negatives)
• Screening Tests require follow-up exam or diagnostic testing
• Hearing Screening - Early (preverbal)


  • Reacts to sounds
  • Developmentally appropriate vocalization
  • Parental concerns
• Vision Screening - Tests


  • Snellen- The eye chart with the big and small letter and numbers
  • Allen figures- similar to Snellen but uses familiar pictures- planes, birthday cakes, and birds
  • CVTME- Color and vison test- color blind
• Iron-deficiency anemia


  #1 nutritional deficiency
• Iron-deficiency anemia screening


  1. Assess risk at 4, 15,18, 24, and 30 months, then annually

  2. H/Hct at 12 months
• Lead Screening Assessment


  • Anorexia
  • Fatigue
  • Abdominal pain
  • Behavioral problems
  • Learning difficulties
  • Irritability
  • Hyperactivity
  • Encephalopathy
  • Seizures
  • Brain damage
  • Anemia/Pallor
  • Jaundice
• Lead Screening - Who should be tested


  • Live or spend time in a house or building built before 1978
  • Are from low-income households
  • Are immigrants, refugees, or recently adopted from less developed countries
  • Live or spend time with someone who works with lead or has hobbies that expose them to lead
• Sources of lead


  • Paint/ paint chips (1978)
  • Paint on toys/furniture (imported)
  • Soli contaminated with leaded gas (1996)
  • Folk remedies (greta, azarcon)
• Family Centered Care is a partnership between child, family, and the health care team
• Principles of Family Centered Care

  • Age-appropriate participation (independence with family support)
  • Respect for child and family
  • Recognition of diversity (cultural, racial, ethnic, socioeconomic, historical interactions with healthcare)
  • Identify and support family's strengths
  • Provide honest and helpful information
  • Support the families choices
  • Be flexible, supportive, collaborate, and empower
• FAMILY IS THE CONSTANT IN THE CHILD'S LIFE
• CLSs


  Child Life specialists. They focus on the psychosocial needs of the child. They can teach and support the cild and family. They provide activities to support normal growth and development. They advocate. They provide Grief and bereavement support.
• Nursing Interventions - Immobility


  1. Have the child point toes inward and wiggle them

  2. Ask the child to squeeze your hand

  3. Encourage the child to count aloud

  4. Sing a song and have the child sing along

  5. Point out the pictures on the ceiling

  6. Have the child blow bubbles

  7. Play music appealing to the child
• Family-centered Care


  • Provide accomodations for the parent
  • Support parent in decision to remain or leave during procedures
  • Maintain the child's accustomed routine
  • Provide continuity of care
  • Encourage use of security item
  • Therapeutic play: provides emotional outlet or coping devices
  • Include child and family in POC (right at the start!)
  • Child education: developmentally appropriate
  • Parental education: engages parents as active participants in health care team
  • Therapeutic Communication: goal directed, focused and purposeful
• Serial growth


  Part of growth and development assessment
• How to calculate BMI


  Divide weight in kilograms by height in meters squared (weight [kg]/height [m2])
• BMI categories


  • Underweight: BMI <20
  • Normal weight: BMI 20-25
  • Overweight: BMI > 85th and < 95th percentile
  • Obesity: BMI > than 95th percentile
• How to determine body surface area (BSA)


  1. Measure the child's height

  2. Determine the child's weight

  3. Using the nomogram, draw a line to connect the height measurement in the left column and the weight measurement in the right column

  4. Determine the point where this line intersects the line in the surface area column. This is the BSA, expressed in meters squared (m2)
• Punnett Square


  • A- Dominant
  • a- Recessive
  • AA- 2 dominant- dominant will express
  • Aa- 1 dominant/1 recessive= dominant will express
  • aa- 2 recessive=recessive will express
• 1. Linked Traits


  • Recessive is more common than dominant
  • Males are usually the only ones who show effects of abnormal X-linked recessive trait
  • Females can show full disorder if trait is carried on both genes
  • Can be mild (color blindness) or severe (hemophilia)
• Structural Chromosomal Abnormalities


  • May be clinically normal because total genetic material is normal or may present with varying levels of anomaly
  • Part of chromosome may be missing or added
  • DNA may be rearranged
  • Part of a chromosome is attached to another (translocation)
  • Too much or too little chromosomal material

  
• Clean Catch Urine


  • Indications: Screen for drugs, r/o UTI, Kidney function (24 hour)
  • Procedure: Traditional clean catch (have parents help), For children/infants in diapers - Clean perineal area, Apply collection bag, Replace diaper, Change bag is stool contaminates
• Stool specimen collection


  • Indications: To identify specific illness, R/o occult blood
  • Procedure: Diapers - Use a tongue blade to scrape a specimen into the collection container, Runny stool - A piece of plastic wrap in the diaper may catch the specimen, Older ambulatory child - Same as adult (avoid urine contamination), Bedridden child - Collect the specimen from a clean bedpan
• Blood specimen collection


  • Indications: Blood tests including state screening
  • Procedure: Consider use of warming device, Consider use of transilluminator, SAFETY - position with help of parents or additional staff as needed, Select and cleanse site, Use lancet for capillary sample or venipuncture
• Indicators of pain in infants


  • Behavioral: Facial expressions, Body movements, Crying (unable to console), Increased irritability, Refusal to move injured body part, Interrupted sleep, Poor feeds
  • Physiologic: Changes in heart rate, respiratory rate, oxygen saturation levels, Low vagal tone, Plantar or palmar sweating
  • Parents report the infant has pain
• Indicators of pain in children


  • Guarding
  • Lethargy
  • Restlessness
  • Social Withdrawal
  • Refusal to participate in regular activities
  • Parents report the child has pain
• Pain management


  • Individualize interventions based on amount of pain experienced, developmental level, Temperament, previous pain experience, coping strategies
  • Use nonpharmacologic and pharmacologic approaches
  • Teach about pain-relief interventions and techniques
  • Discuss expectations of pain management
• Nurse's Role in Pharmacologic Pain management


  • Adhering to the rights of medication administration: Right medication, Right patient, Right time, Right route of administration, Right dose, Right approach, Right documentation, Right to be educated, Right to refuse, Right form
  • Knowledge about the drug's pharmacokinetics and pharmacodynamics
  • Assessment is crucial and ongoing
  • Monitor physiologic parameters: level of consciousness, vital signs, oxygen saturation levels, urinary output, monitor for signs of adverse effects (respiratory depression)
  • Assess the child's and parents' emotional status
  • Teach the child and parents about the drug
• Moderate (conscious) Sedation


  • Moderate sedation is a medically controlled state of depressed consciousness
  • Ensuring that emergency equipment is readily available
  • Maintaining a patent airway
  • Monitoring the child's level of consciousness and responsiveness
  • Assessing the child's vital signs (especially pulse rate, heart rate, blood pressure, and respiratory rate)
  • Monitoring oxygen saturation levels
• Nurse's role in managing chronic pain


  • Similar to that for the child experiencing acute pain or procedure-related pain
  • Assessment of the child's pain is key: Onset, duration, intensity, and location of pain, Alleviating or exacerbating factors, Impact on child's daily life, Effect on child and family's stress level, Methods used to alleviate pain (including home remedies or alternative therapies), Physical examination
  • Multiple nonpharmacologic and pharmacologic strategies combined to provide pain relief
• Pain assessment tools


  • Premature Infant Pain Profile
  • Neonatal Infant Pain Scale
  • Riley Infant Pain Scale
  • CRIES Scale for Neonatal Postoperative Pain Assessment
  • FLACC Behavioral Scale for Postoperative pain in Young Children
  • FACES pain rating scale (ages 3+)
  • Oucher pain rating scale (ages 3+)
  • Poker chip tool (ages 3+)
  • Visual analog and numeric scales (ages 5+)
  • Adolescent pediatric pain tool (ages 8 to 15)
• Factors affecting absorption of medications in children vs. adults


  • Oral medications: may increase or decrease
  • Intramuscular absorption: decreased
  • Subcutaneous absorption: decreased
  • Topical absorption of medications: increased
  • First-pass elimination: decreased
  • Half-life: increased
  • Immature blood–brain barrier, especially neonates, allowing movement of certain medications into the CSF
• Determining Pediatric Doses by body weight


  1. Weigh the child

  2. Check a drug reference for the safe dose range (e.g., 10 to 20 mg/kg of body weight)

  3. Calculate the low safe dose

  4. Calculate the high safe dose

  5. Determine if the dose ordered is within this range
• The safe dose of a medication is 10 to 20 mg/kg. What would the nurse calculate as the low safe dose for a child who weighs 40 kg?