Pediatric Nursing.
Pediatric Nursing
Growth &
Development
❖ Theories of Development
➢ Erikson
▪ Psychosocial development
• Trust v. mistrust (birth – – learns needs are met by the caregivers
• 1yr) Autonomy v. shame (1 – child becomes more independent “im a big kid
now”
• Initiative v. guilt (3 – 6yr) – develops conscience, right v. wrong
• Industry v. inferiority (6 – 12yr) – rule following behavior, social relationships are
important
• Identity v. role confusion (12 – 19yr) – changes in body are great, preoccupied w/
appearance, peers very important
• Generativity v. stagnation
• Integrity v. despair
❖ Birth – 1yr
➢ HR/RR
▪ Newborn
• HR: 100-160
• RR: 30-60
• BP: 39/16
▪ 1-11month
• HR: 100-160
• RR:25-35
• BP: 72/37
➢ Developmental milestones
▪ Weight doubles by 6 months, triples by 1 year
▪ Length increased by 50% by 1 year
▪ Explores by motor and oral means
▪ Social smile @ 2 months
▪ Starts speaking around 1yr
➢ Developmental stage
▪ 1. Trust v. mistrust: needs met by caregivers
➢ Nursing implications
▪ During hospitalization infants emerging skills may disappear
▪ Infant may be inconsolable if parents cannot be with it (6 months – 30 months)
▪ Plan to include parents in care
▪ Keep infant’s routine as much as possible
▪ Teaching directed to parents
❖ Toddler (1 – 3 yr)
,Pediatric Nursing.
➢ HR/RR
▪ HR: 100-150
▪ RR:20-30
▪ BP: 86/42
➢ Developmental milestones
▪ Birth weight quadruples by 30 months (2.5yrs)
▪ 50% of adult height by 2 years
▪ Growth slows
▪ 2-3-word sentences by 2yrs
▪ First & last name by 2.5yrs-3yrs
▪ 3-4-word sentences by 3yrs
➢ Developmental stage
▪ 2. Autonomy v. shame: becomes more independent
➢ Nursing implications
▪ give simple brief explanations before procedures
▪ security object from home should be provided
▪ have parents explain plan to toddler (“I will be back after your nap”)
▪ use child routine as often as possible
▪ toddlers are concerned about their bodies, autonomy when appropriate
❖ Preschool (3-6yrs)
➢ HR/RR
▪ HR: 80-130
▪ RR: 20-25
▪ BP: 89/46
➢ Developmental milestones
▪ Gains 5lbs and 2.5-3” each year
▪ Standing upright
▪ Learns to run, jump, skip, hop
▪ Writing hand established
▪ Able to ride tricycle
▪ Uses scissors @4yrs
▪ Ties shoelaces @5yrs
▪ Colors/shapes learned
▪ Eyesight approaches 22/20
▪ Learns sexual identity
▪ Imaginary playmates/fears common
▪ Aggressiveness @4yrs turns into independence @5yrs
➢ Developmental stage
▪ 3. Initiative v. guilt: learning right from wrong
➢ Nursing implications
▪ Explain to child they did not cause the illness and painful procedures are not a
punishment
▪ Questions should be answered at the child’s developmental and learning level
▪ Encourage therapeutic play
,Pediatric Nursing.
▪ Use small bandages when possible
▪ Give simple explanations to what is going to happen and what is going to be fixed
❖ School age (6-12yrs)
➢ VS
▪ HR: 80-120
▪ RR: 18-20
▪ BP: 97/57
➢ Developmental milestones
▪ May lose first tooth
▪ Drawing, painting, riding bikes, jumping rope
➢ Developmental stage
▪ 4. Industry v. inferiority: social relationships are important and rule following
➢ Nursing implications
▪ Maintaining contact with peers are important during hospitalization
▪ Privacy and modesty are important
▪ Provide explanations for all procedures
▪ Allow participation in plan of care
❖ Adolescent (12-19yrs)
➢ VS
▪ HR: 60-90
▪ RR: 16-20
▪ BP: 110/64
➢ Developmental milestones
▪ Girls growth spurts are around 10, boys start around 14
▪ Girls finish growing around 15, boys finish around 17
▪ Secondary sex characteristics develop
▪ Adult-like thinking starts around 15
▪ Family conflicts start
➢ Developmental stage
▪ 5. Identity v. role confusion
➢ Nursing implications
▪ Important for teens to maintain contact with peers and school activities
▪ Education should be given with and without parents present so the teen can ask
questions they are not comfortable discussing in front of parents
Pain assessment & management
❖ Nursing assessment
➢ Obtain verbal report of pain
▪ Children as young as 3 can say where pain is and how intense
➢ Observe for nonverbal signs
▪ Grimacing, irritability, restlessness, difficulty sleeping/feeding
▪ 𝖳 HR, RR, diaphoresis, O2
, Pediatric Nursing.
➢ Include parents in assessment
❖ Interventions
➢ Use pain scale appropriate for developmental level
▪ CRIES for 32-60wks old
• Crying
• Requires 𝖳O2
• Increased VS
• Expression
• Sleeplessness
▪ Pain rating scale used will children of any age
• FACES pain scale can be used by 3y/o
• Number pain scale can be used at 9y/o
• Oucher pain scale (similar to FACES, using culturally specific photos)
• FLACC for nonverbal children
◆ Facial expression
◆ Leg movement
◆ Activity
◆ Cry
◆ Consolability
▪ Documenting child report is essential to effectively treat pain
➢ Nonpharmacologic interventions
▪ Used according to developmental level/age
• infants: pacifiers, holding, rocking
• toddler/preschool: distraction (books, music TV, bubble blowing)
• school age/adolescents: guided imagery
▪ massage, application of heat/cold, deep breathing
➢ Pharmacologic interventions
▪ VERIFY DOSAGE IS SAFE FOR CHILD
• Use body weight or BSA
▪ Monitor VS after administering opioids
▪ Can be taught to use PCA @5y/o
▪ May deny pain if there is fear of a shot
Communicable Diseases
❖ Rubeola (measles)
➢ HIGHLY CONTAGIOUS: can lead to neurologic problems/death
➢ Transmission: droplet, direct contact
➢ Contagious mainly through prodromal period
▪ Fever, upper respiratory symptoms
➢ Classic S/S
▪ Photophobia
▪ Koplik spots on buccal mucosa
Pediatric Nursing
Growth &
Development
❖ Theories of Development
➢ Erikson
▪ Psychosocial development
• Trust v. mistrust (birth – – learns needs are met by the caregivers
• 1yr) Autonomy v. shame (1 – child becomes more independent “im a big kid
now”
• Initiative v. guilt (3 – 6yr) – develops conscience, right v. wrong
• Industry v. inferiority (6 – 12yr) – rule following behavior, social relationships are
important
• Identity v. role confusion (12 – 19yr) – changes in body are great, preoccupied w/
appearance, peers very important
• Generativity v. stagnation
• Integrity v. despair
❖ Birth – 1yr
➢ HR/RR
▪ Newborn
• HR: 100-160
• RR: 30-60
• BP: 39/16
▪ 1-11month
• HR: 100-160
• RR:25-35
• BP: 72/37
➢ Developmental milestones
▪ Weight doubles by 6 months, triples by 1 year
▪ Length increased by 50% by 1 year
▪ Explores by motor and oral means
▪ Social smile @ 2 months
▪ Starts speaking around 1yr
➢ Developmental stage
▪ 1. Trust v. mistrust: needs met by caregivers
➢ Nursing implications
▪ During hospitalization infants emerging skills may disappear
▪ Infant may be inconsolable if parents cannot be with it (6 months – 30 months)
▪ Plan to include parents in care
▪ Keep infant’s routine as much as possible
▪ Teaching directed to parents
❖ Toddler (1 – 3 yr)
,Pediatric Nursing.
➢ HR/RR
▪ HR: 100-150
▪ RR:20-30
▪ BP: 86/42
➢ Developmental milestones
▪ Birth weight quadruples by 30 months (2.5yrs)
▪ 50% of adult height by 2 years
▪ Growth slows
▪ 2-3-word sentences by 2yrs
▪ First & last name by 2.5yrs-3yrs
▪ 3-4-word sentences by 3yrs
➢ Developmental stage
▪ 2. Autonomy v. shame: becomes more independent
➢ Nursing implications
▪ give simple brief explanations before procedures
▪ security object from home should be provided
▪ have parents explain plan to toddler (“I will be back after your nap”)
▪ use child routine as often as possible
▪ toddlers are concerned about their bodies, autonomy when appropriate
❖ Preschool (3-6yrs)
➢ HR/RR
▪ HR: 80-130
▪ RR: 20-25
▪ BP: 89/46
➢ Developmental milestones
▪ Gains 5lbs and 2.5-3” each year
▪ Standing upright
▪ Learns to run, jump, skip, hop
▪ Writing hand established
▪ Able to ride tricycle
▪ Uses scissors @4yrs
▪ Ties shoelaces @5yrs
▪ Colors/shapes learned
▪ Eyesight approaches 22/20
▪ Learns sexual identity
▪ Imaginary playmates/fears common
▪ Aggressiveness @4yrs turns into independence @5yrs
➢ Developmental stage
▪ 3. Initiative v. guilt: learning right from wrong
➢ Nursing implications
▪ Explain to child they did not cause the illness and painful procedures are not a
punishment
▪ Questions should be answered at the child’s developmental and learning level
▪ Encourage therapeutic play
,Pediatric Nursing.
▪ Use small bandages when possible
▪ Give simple explanations to what is going to happen and what is going to be fixed
❖ School age (6-12yrs)
➢ VS
▪ HR: 80-120
▪ RR: 18-20
▪ BP: 97/57
➢ Developmental milestones
▪ May lose first tooth
▪ Drawing, painting, riding bikes, jumping rope
➢ Developmental stage
▪ 4. Industry v. inferiority: social relationships are important and rule following
➢ Nursing implications
▪ Maintaining contact with peers are important during hospitalization
▪ Privacy and modesty are important
▪ Provide explanations for all procedures
▪ Allow participation in plan of care
❖ Adolescent (12-19yrs)
➢ VS
▪ HR: 60-90
▪ RR: 16-20
▪ BP: 110/64
➢ Developmental milestones
▪ Girls growth spurts are around 10, boys start around 14
▪ Girls finish growing around 15, boys finish around 17
▪ Secondary sex characteristics develop
▪ Adult-like thinking starts around 15
▪ Family conflicts start
➢ Developmental stage
▪ 5. Identity v. role confusion
➢ Nursing implications
▪ Important for teens to maintain contact with peers and school activities
▪ Education should be given with and without parents present so the teen can ask
questions they are not comfortable discussing in front of parents
Pain assessment & management
❖ Nursing assessment
➢ Obtain verbal report of pain
▪ Children as young as 3 can say where pain is and how intense
➢ Observe for nonverbal signs
▪ Grimacing, irritability, restlessness, difficulty sleeping/feeding
▪ 𝖳 HR, RR, diaphoresis, O2
, Pediatric Nursing.
➢ Include parents in assessment
❖ Interventions
➢ Use pain scale appropriate for developmental level
▪ CRIES for 32-60wks old
• Crying
• Requires 𝖳O2
• Increased VS
• Expression
• Sleeplessness
▪ Pain rating scale used will children of any age
• FACES pain scale can be used by 3y/o
• Number pain scale can be used at 9y/o
• Oucher pain scale (similar to FACES, using culturally specific photos)
• FLACC for nonverbal children
◆ Facial expression
◆ Leg movement
◆ Activity
◆ Cry
◆ Consolability
▪ Documenting child report is essential to effectively treat pain
➢ Nonpharmacologic interventions
▪ Used according to developmental level/age
• infants: pacifiers, holding, rocking
• toddler/preschool: distraction (books, music TV, bubble blowing)
• school age/adolescents: guided imagery
▪ massage, application of heat/cold, deep breathing
➢ Pharmacologic interventions
▪ VERIFY DOSAGE IS SAFE FOR CHILD
• Use body weight or BSA
▪ Monitor VS after administering opioids
▪ Can be taught to use PCA @5y/o
▪ May deny pain if there is fear of a shot
Communicable Diseases
❖ Rubeola (measles)
➢ HIGHLY CONTAGIOUS: can lead to neurologic problems/death
➢ Transmission: droplet, direct contact
➢ Contagious mainly through prodromal period
▪ Fever, upper respiratory symptoms
➢ Classic S/S
▪ Photophobia
▪ Koplik spots on buccal mucosa
