Kayla Weber
Maternity/Pediatric First Exam
Week 1& 3 Growth and development
1. Pediatric Nursing
a. Assessment quick review!
a. Check for moist membranes, turgor and presence of tears
b. Physical Assessment-Pediatric Variations approach slowly, gain trust
c. Focused Interview – take developmental stage into consideration
d. Also ask if they family eats dinner together for at least one meal for
bonding and social skills
e. Kids that grow at a slower rate look at genetic factors
f. Nose breathers up to 6 months
b. VS… assess RR, HR, TEMP, BP
a. HYPOTENSION is a late sign of illness/decompensation in children
i. Check CPR for perfusion
b. Listen apically to heart for full minute to count heart rate
c. Newborn:
i. RR: 30-50
ii. HR: 120-160
iii. Systolic BP: 50-70
iv. Weight kg: 2-3
v. Weight lbs.: 4.5-7
d. Infant
i. Infants when they cry increases HR and BP
ii. Urine output: infant and toddlers: 1-2mL/kg/hr
iii. RR: 20-30
iv. HR: 80-140
v. Systolic BP: 70-100
vi. Weight kg: 4-10
vii. Weight lbs: 9-22
e. Toddler
i. Urine output: infant and toddlers: 1-2mL/kg/hr
ii. RR: 20-30
iii. HR: 80-130
iv. Systolic BP: 80-110
v. Weight kg: 10-14
vi. Weight lbs: 22-31
f. Preschool
i. RR: 20-30
ii. HR: 80-120
iii. Systolic BP: 80-110
iv. Weight kg: 14-18
v. Weight lbs: 31-40
g. School age
i. RR: 20-30
ii. HR: 70-110
, iii. Systolic BP: 80-120
iv. Weight kg: 20-42
v. Weight lbs: 41-92
h. Adolescent
i. Urine output: adolescents: 0.5mL/kg/hr
ii. RR: 12-20
iii. HR: 55-105
iv. Systolic BP: 110-120
v. Weight kg: >50
vi. Weight lbs: >110
c. Pain
a. Flacc Scale
i. Used in infants
b. Wong-Baker Faces
i. Used older children
c. Trust parents assessment of child’s pain as they know their child best
d. Always re assess pain
e. Indication to look for by age
i. 0-6months: cry, bodily movement
ii. 6.5-12months: resistance, uncooperative
iii. 1-3years: aggressive behavior
iv. 3-5years: fear of punishment, mutilation, death; verbal
abuse
v. 5-12years: fear of disability, concern for privacy, words to
describe pain
vi. >12years: effect on body image, questioning, privacy
d. Pews
a. Done with every set of VS
b. The higher the score, the more intervention is needed
c. IF HAVE 3 IN ANY CATEGORY MUST NOTIFY DR!
,e. Regression
a. Children may revert to younger behaviors when sick
i. Let parents know this is normal
ii. EX: a 6yr/o may be incontinent when hospitalized
b. This can occur at all age group
f. Separation
a. ALWAYS foster bonding… never wants to separate family! That’s NEVER the answer
b. Have parents bring favorite toys and things to make them feel comfortable
c. Separation anxiety
i. Stage of protest
1. May last hrs to days
2. Crying, kicking
ii. Stage of despair
1. Withdrawn
2. May not be happy to see parent and still look sad
iii. Stage of detachment
1. Superficial adjustment to loss (not usually seen in hospi.)
d. Early childhood:
i. Separation is a great stress
ii. Presence of caregiver helps with them cope w. stress of illness
iii. Preschooler is apt to not eat, withdraw, or play roughly w/ toys
e. Late childhood/ adolescence
i. Even if they don’t like school they miss friends and routine
ii. The older child may feel stress of losing peer group status
1. Have friends come in and visit
2. Skype w/ friends
, g. Family inclusion
a. Parents are allowed to give certain meds but RN need to be a witness
b. Coordination and collaborate:
i. Work together!
1. EX: mom does bath, RN does assessment
ii. Respect the differences in the roles
iii. Teaching and guidance vs imposing your preference
iv. As long as the child is safe it might not matter the order
v. Education/ Teaching
1. Always reinforce why they are taking the meds and what it is
2. You can’t discipline infants/early toddlers...you distract them.
vi. Provide support and guidance for parents:
1. Preparing toward confident discharge
2. Encouraging participation
3. Cultural and religious views
3. Growth and Development
a. Motor skills:
a. Lifts head, 1 month
i. Obligatory nose breathers till 6 months old
b. Head up 90 degrees, 4 months
c. Chest up-arm support 4-5 months
d. Rolls over, 4-6 months
e. Pulls to a sit, no head lag 6 months
i. First dentist appointments at 6 months
ii. Weight doubles by 6 months
f. Sits, no support 8 months
g. Stands, 8-9 months
h. Crawls at 7 months and creeps at 9 months
i. Cruises and walks well by 12-15 months
i. Birth 3x length 2x
b. Neonate and Infant
a. Neonate: first 28-30 days of life
b. Infant: one month to end of first year
i. Assess when the infant is quiet, soothed
c. Sensorimotor (Birth to 2 Years)
i. Talking to infants, singing lullabies, moving them gently, rocking
and cuddling promote sensory development.
ii. External stimuli such as pictures, mirrors, music and mobiles
provide visual stimulation
iii. They develop a sense of cause and effect as they direct behavior
toward objects.
iv. Infant learns to initiate, recognize and repeat pleasurable
experiences from the environment
d. Trust vs. Mistrust (Birth to 1 Year)
i. Most important attribute to develop for a healthy personality is
basic trust.
Maternity/Pediatric First Exam
Week 1& 3 Growth and development
1. Pediatric Nursing
a. Assessment quick review!
a. Check for moist membranes, turgor and presence of tears
b. Physical Assessment-Pediatric Variations approach slowly, gain trust
c. Focused Interview – take developmental stage into consideration
d. Also ask if they family eats dinner together for at least one meal for
bonding and social skills
e. Kids that grow at a slower rate look at genetic factors
f. Nose breathers up to 6 months
b. VS… assess RR, HR, TEMP, BP
a. HYPOTENSION is a late sign of illness/decompensation in children
i. Check CPR for perfusion
b. Listen apically to heart for full minute to count heart rate
c. Newborn:
i. RR: 30-50
ii. HR: 120-160
iii. Systolic BP: 50-70
iv. Weight kg: 2-3
v. Weight lbs.: 4.5-7
d. Infant
i. Infants when they cry increases HR and BP
ii. Urine output: infant and toddlers: 1-2mL/kg/hr
iii. RR: 20-30
iv. HR: 80-140
v. Systolic BP: 70-100
vi. Weight kg: 4-10
vii. Weight lbs: 9-22
e. Toddler
i. Urine output: infant and toddlers: 1-2mL/kg/hr
ii. RR: 20-30
iii. HR: 80-130
iv. Systolic BP: 80-110
v. Weight kg: 10-14
vi. Weight lbs: 22-31
f. Preschool
i. RR: 20-30
ii. HR: 80-120
iii. Systolic BP: 80-110
iv. Weight kg: 14-18
v. Weight lbs: 31-40
g. School age
i. RR: 20-30
ii. HR: 70-110
, iii. Systolic BP: 80-120
iv. Weight kg: 20-42
v. Weight lbs: 41-92
h. Adolescent
i. Urine output: adolescents: 0.5mL/kg/hr
ii. RR: 12-20
iii. HR: 55-105
iv. Systolic BP: 110-120
v. Weight kg: >50
vi. Weight lbs: >110
c. Pain
a. Flacc Scale
i. Used in infants
b. Wong-Baker Faces
i. Used older children
c. Trust parents assessment of child’s pain as they know their child best
d. Always re assess pain
e. Indication to look for by age
i. 0-6months: cry, bodily movement
ii. 6.5-12months: resistance, uncooperative
iii. 1-3years: aggressive behavior
iv. 3-5years: fear of punishment, mutilation, death; verbal
abuse
v. 5-12years: fear of disability, concern for privacy, words to
describe pain
vi. >12years: effect on body image, questioning, privacy
d. Pews
a. Done with every set of VS
b. The higher the score, the more intervention is needed
c. IF HAVE 3 IN ANY CATEGORY MUST NOTIFY DR!
,e. Regression
a. Children may revert to younger behaviors when sick
i. Let parents know this is normal
ii. EX: a 6yr/o may be incontinent when hospitalized
b. This can occur at all age group
f. Separation
a. ALWAYS foster bonding… never wants to separate family! That’s NEVER the answer
b. Have parents bring favorite toys and things to make them feel comfortable
c. Separation anxiety
i. Stage of protest
1. May last hrs to days
2. Crying, kicking
ii. Stage of despair
1. Withdrawn
2. May not be happy to see parent and still look sad
iii. Stage of detachment
1. Superficial adjustment to loss (not usually seen in hospi.)
d. Early childhood:
i. Separation is a great stress
ii. Presence of caregiver helps with them cope w. stress of illness
iii. Preschooler is apt to not eat, withdraw, or play roughly w/ toys
e. Late childhood/ adolescence
i. Even if they don’t like school they miss friends and routine
ii. The older child may feel stress of losing peer group status
1. Have friends come in and visit
2. Skype w/ friends
, g. Family inclusion
a. Parents are allowed to give certain meds but RN need to be a witness
b. Coordination and collaborate:
i. Work together!
1. EX: mom does bath, RN does assessment
ii. Respect the differences in the roles
iii. Teaching and guidance vs imposing your preference
iv. As long as the child is safe it might not matter the order
v. Education/ Teaching
1. Always reinforce why they are taking the meds and what it is
2. You can’t discipline infants/early toddlers...you distract them.
vi. Provide support and guidance for parents:
1. Preparing toward confident discharge
2. Encouraging participation
3. Cultural and religious views
3. Growth and Development
a. Motor skills:
a. Lifts head, 1 month
i. Obligatory nose breathers till 6 months old
b. Head up 90 degrees, 4 months
c. Chest up-arm support 4-5 months
d. Rolls over, 4-6 months
e. Pulls to a sit, no head lag 6 months
i. First dentist appointments at 6 months
ii. Weight doubles by 6 months
f. Sits, no support 8 months
g. Stands, 8-9 months
h. Crawls at 7 months and creeps at 9 months
i. Cruises and walks well by 12-15 months
i. Birth 3x length 2x
b. Neonate and Infant
a. Neonate: first 28-30 days of life
b. Infant: one month to end of first year
i. Assess when the infant is quiet, soothed
c. Sensorimotor (Birth to 2 Years)
i. Talking to infants, singing lullabies, moving them gently, rocking
and cuddling promote sensory development.
ii. External stimuli such as pictures, mirrors, music and mobiles
provide visual stimulation
iii. They develop a sense of cause and effect as they direct behavior
toward objects.
iv. Infant learns to initiate, recognize and repeat pleasurable
experiences from the environment
d. Trust vs. Mistrust (Birth to 1 Year)
i. Most important attribute to develop for a healthy personality is
basic trust.
