Intro To Pediatric Nursing

  1. Main ped problems
    • overweight/obesity
    • tobacco/substance use
    • safe sex
    • mental health
    • injury/violence
  2. leading cause of childhood mortality
    • accidents
    • violent deaths have increased too
  3. most common type of disease affecting children
    • respiratory (50% of all acute illness)
    • followed by GI
  4. what is the most related to a childs risk of injury
    directly related to the developmental level of the child
  5. What accidental injuries are most likely to occur at each developmental stage
    • infants: exposure through taste and touch (ie led, poisoning)
    • toddlers: becoming increasingly mobile with heavy heads (falls)
    • younch children: engrossed in play and can be easily distracted
    • adolescents: risk taking behaviors
  6. factors affecting family dynamics
    • parenting styles
    • temperment of the child
    • parent-child fit (do they mesh)
    • sibling and extended family relationships
    • home environment
    • stressors
    • family roles
  7. pediatric nursing requires an understanding and appreciation of
    • the uniqueness of the family
    • family dynamics and family centered care
    • diversity of influences on the health and well-being of families
  8. types of children
    • easy child
    • slow to warm up child
    • difficult child
  9. characteristics of the easy child
    • even-tempered
    • predictable
    • positive reaction to new things
    • open/adaptable to change
    • overall positive- go with the flow
    • they will be excited to see you and warm up right away
  10. characteristics of the difficult child
    • highly active- may be irritable
    • less predicatble
    • irregular in habits
    • negative withdrawal responses to new stimuli- may withdraw when you approach them. 
    • require a strucutured environment- dont do well in the hospital
    • adapt slowly to new routines, ppl and situations, need mroe time
    • moods typically intense and often negative
    • prone to temper tantrum if frustrated
  11. characteristics of the slow to warm up child
    • less active and moody
    • need time to adapt, require a repeated approach
    • only moderate irregularity in habits
    • negative withdrawal responses to new stimuli with mild intensity
    • adapt slowly with repetition
    • respond with mild but passive resistance to change in routine
  12. how to promote acceptable behavior in children
    • validate their feelings
    • treat them as unique
    • set limits and expectations depenidng on development level- they feel out of control without boundaries
    • provide role model and positive reinforcement
  13. types of parenting styles
    • authoritarian
    • permissive
    • authoritative
    • neglectful
  14. authoritarian parenting
    • parent is strict and demanding but not responsive
    • my way or the highway
    • little dialogue between parent and child
    • use punishment- dont teach a lesson just say thats the way it is
    • gives few choices/no compromising
    • little emotional support
  15. what can authoritarian parenting lead to
    • poor self-esteem
    • fearfulness
    • shyness
    • acting out when child older
  16. Permissive parenting
    • parents nurturing and responsive but no clear boundaries/expectation
    • parent/child roles blurred- they try to be kids friend
    • rules are inconsistant and parent doesnt follow through- lack of structure
    • often passive to avoid conflict- theyd rather let the child run the show than argue
  17. results of permissive parenting
    • child may grow up with little/no self discipline and self-control
    • inadequate social skills
  18. authoritative parenting
    • ideal parent
    • high expectations for children, but temper them with understanding and support
    • have rules and consequences
    • healthy open communications
    • not friends with children, but find the balance to know whats going on in their lives
  19. Neglectful parenting
    • can be intentional or unintentional
    • failing to inconsistantly meet childs physical/emotional needs
    • lack of communication in childs life
    • intervention is warrented and often parental education is effective
  20. risk factors for neglectful parenting
    parental immaturity and inexperience
  21. consequences of neglectful parenting
    child can have difficulties with relationships as they get older
  22. difference between growth and development
    • growth: the physical anatomical processes, a quantitative change. 
    • development: a qualitative change. focuses ont he process of progressive continuous and predictable changes. but each child goes through things at a different place. includes cognition, language, motor skills
  23. what do the processes of growth and development depend on
    endocrine, genetic, environmental and nutritional influences.
  24. when should developmental milestones be hit
    • its a RANGE, not a set time. 
    • ie early talkers late walkers
  25. Patterns of growth and development
    • directional trends: cephalocaudal (head to toe. ie a child cant sit up alone until they have control over their head), proximodistal, differentiation
    • sequential trends
    • developmental pace (milestones)
    • sensitive periods
  26. what are sensitive periods
    • Critical points in development
    • ie: prenatally (avoiding exposure to teratogens)
    • ie: trust vs mistrust in infancy
  27. how much does the infant grow (weight and height) in the first 6 months
    • 1.25-1.5 lbs per month
    • 1 inch per month

    birth weight doubles by 6months and triples by 1 year
  28. growth of preschool/school age children
    4-6 pounds per year

    there are also marked growth spurts in puberty
  29. when do you see the most dramatic developmental changes
    infancy: 1-12 months
  30. hardest group to assess
    toddler: 1-3 years
  31. name the developmental age periods
    • infant: 1-12 mo
    • toddler: 1-3 years
    • preschooler: 3-6 years
    • school aged: 6-13 years
    • adolescent: 12-18 years
  32. growth in adolescence
    accelerated physical growth, but slower development than younger ages
  33. types of development
    • physical development
    • fine and gross motor skills
    • cognitive development (Piaget)
    • language development
    • psychosocial development (Erikson)
  34. Piaget's stages of cognitive development
    • sensorimotor: birth- 2years
    • preoperational: 2-7 years
    • concrete operations: 7-11 years
    • formal operations: 11-15 years
  35. erickson's stages of psychosocial development
    • trust vs mistrust: birth- 1year
    • autonomy vs shame and doubt: 1-3 years
    • initiative vs guilt: 3-6 years
    • industry vs inferiority: 6-12 years
    • identity vs role confusion 12-18 years
  36. content of play
    • social-affective play
    • sense-pleasure play
    • skill play
    • unoccupied behavior
    • dramatic or pretend play (big in preschoolers)
  37. social types of play
    • onlooker play: child intently watches play thats going on but does nto try to join in
    • solitary play: plays alone (infants)
    • parallel play: doing similar play next to eachother but not interacting with eachother (toddlers)
    • associative play: playing together but not toward a common goal
    • cooperative play: more structured. rules, rewards, leaders, followers etc (school aged)
  38. functions of play
    • sensorimotor development
    • intellectual development
    • creativity and self expression
    • self-awareness
    • therapy
    • morality development (expectations of peers, society, acceptable behavior, fairness etc)
  39. atraumatic care
    • should be given to all kids
    • serves to reduce psychological and physical distress to the child
  40. how to provide atraumatic care
    • foster the parent-child relationship during their time in hospital
    • preparing the child before an unfamiliar treatment or procedure
    • control pain (esp non pharmacologically)
    • give privacy
    • provide play activities to express feelings
    • offer choices
    • respect culture
  41. risk factors for hospitalization stress
    • impaired child-parent bonding
    • temperment (ie the difficult child may not be able to stay in a room/bed all day)
    • age (esp 6mo-5yrs)
    • multiple and continuing stresses (ie frequent hospitlizations, unstable home)
  42. child reactions to hospitalization
    • seperation anxiety to caregiver (greatest stressor, esp in those under 5)
    • fear of bodily harm
    • fear of loss of control
  43. phases of seperation anxiety
    • protest phase
    • despair phase
    • detatchment phase (occurs with prolonged separation)
  44. protest phase of separation anxiety
    • dramatic in toddlers
    • they may sense that the caregiver is going to leabe and will claw at the parent and not let them go
    • in infants: crying, desperately clinging to parent
    • in toddlers: do that and may even attack the stranger and attempt to plead with and physically force the parent to stay
  45. despair phase in separation anxiety
    • ceases crying
    • withdrawn and depressed
    • regressive behaviors
    • refusal to eat/drink/sleep
  46. Detachment phase of separation anxiety
    • usually only occurs in prolonged separation
    • child resigns self to new situation, superficially interacts with new caregiver and appears adjusted but not content
    • may even ignore/reject parent upon their return
  47. what can the nurse do to help the child
    • avoid/minimize separation
    • create a familiar environment for the child
    • maintain presence if parent/caregiver needs to leave
    • minimize unfamiliar/frightening stimuli
    • family centered care
  48. parent reactions to child hospitalization
    • helplesseness, powerlessness, fear
    • questioning skills of staff
    • dealing with fear
    • coping with uncertainty
    • seeking reassurance
  49. managing the stress of hospitalization
    • prepare child ahead of time
    • prevent/minimize parental seperation
    • minimize loss of control- encourage freedom/independence. keep routine
    • Atraumatic care
    • child life specialist
    • provide developmentally appropriate activities
  50. post-hospital behaviors in young children
    • initial aloofness towards parents (few hours to a few days)
    • dependency behaviors
    • clingyness
    • may act out when they get home
    • nightmares, resistance to going to bed, attachement to blanket/toy, tantrums, regressive behavior
  51. post-hospitalization behavior in older children
    rejection and outward anger towards parent or siblings
Card Set
Intro To Pediatric Nursing
Exam of 1/27/2020