Nicole Tinny, MSN, CNS Pediatrics LSCC - Fall 2011

1. Nicole Tinny, MSN, CNSPediatricsLSCC - Fall 2011

2. What is a family? Every discipline has a definition • Biological – perpetuation of the species •  Psychology – Responsibility for personality development • Economics – Productive unit providing for material needs • Sociology – Social unit that reacts with larger society

3. A family is a group of people living together or in close contact, who take care of one another and provide guidance for the dependent members. • Family is whatever/whoever the client considers it to be.

4. Family function: The interactions of family members (caregiving, nurturing & training children) • Family Structure – organization/arrangement/composition

5. Types of families • Nuclear: Husband, wife, children (natural or adopted) living in common household • Extended: Nuclear family plus relatives

6. Single parent family: Usually headed by mother • Binuclear: Joint custody in separate households • Reconstituted: Stepparents, stepchildren

7. Alternative family structures: • Polygamous – spouse has multiple mates • Communal – share common ownership of property, goods, children • Same sex/homosexual parents

8. Family Centered Care • The Family Plan of Care • Remember you are caring for more than 1 person (the entire family)

9. Professional Nursing Roles • Provider of Care • Critical Thinker • Effective Communicator • Teacher • Collaborator • Advocate

10. Family Culture Characteristics • Acculturation & Assimilation • Identity • Connectedness • Communication Pattern • Socioeconomic Class

11. Subjective • Health History • Patterns of daily living • ROS (review of systems)

12. ROS: Children

13. Objective • Developmental Milestones • Denver Development II Test • Anthropometric Measurements • Growth Charts • Vital Signs

14. Objective • Psychosocial development • Erickson’s Theory • Temperament • Age related variations in PA

15. Stages of Growth and Development • Newborn/Infant (birth to 12 months) • Toddlerhood (1 to 3 years) • Early Childhood (Preschool) • (3 to 6 years) • School-Age Child (6-12 years) • Adolescence (12 to 19 years)

16. Developmental Assessment • DDST –II identifies developmental age • Evaluates 4 areas: • 1. Personal-Social • 2. Fine motor • 3. Language • 4. Gross motor

17. Anthropometric Measurements • Length • Weight • BMI • HC • Skinfold thickness Measurements

18. Vital Signs • Temperature • Pulse • Respirations • Blood Pressure

19. Psychosocial Development (Erikson’s) • Trust vs Mistrust • Autonomy vs Shame and Doubt • Initiative vs Guilt • Industry vs Inferiority • Identity vs Role Confusion

20. Temperament • Birth: response to surroundings • Baby: caretaker and environment

21. Age Related Variations (PA) • Sensory • Physical • Cognitive • Language • Moral

22. Overall Assessment • Establish a relationship with the family • Ask Questions • Comprehensive Health History • Family Medical and Social History • PMH • Immunizations • Developmental milestones • ADL • ROS

23. Physical Assessment • Use all of your senses • Observation skills • Smell • Touch

24. Physical Assessment

25. General Principles • Never lie to a child • Engage their help • Let them touch and feel • Treat assessments like games • If it’s going to hurt tell them

26. Health Promotion • Infant and Child • Nutrition • Dental • Sleep & Rest • Immunizations • Health Screenings • Lead Poisoning

27. Health Promotion – Infant/ChildNutrition • Breast or bottle • Whole milk at 1 yr • Solids at least 4 months • Finger foods 8 to 12 months • Begin to use spoon – 1 yr to 18 months • Age 3 – Food Pyramid for Kids

28. Teething • Drooling • Irritability • Chewing on objects • Crying episodes • Disrupted sleep and eating patterns

29. Sleep & Rest • Newborns • Infants • Toddlers/Preschool • School-age

30. Health Promotion – Infant/ChildSocial Aspects of Play • Solitary Play • Onlooker Play • Parallel Play • Associative play • Cooperative play

31. Health Promotion • Adolescent • Nutrition • Obesity • Dental Care • Sleep & Rest • Eating disorders • Anorexia Nervosa • Bulimia Nervosa

32. Parenting Styles • Dictatorial • Permissive or laissez faire • Democratic

33. Misbehavior • Stretches the limits • Minor consequences • Major consequences

34. Types of Discipline • Redirection • Reasoning • Time Out • Consequences • Behavior Modification • Corporal Punishment

35. Discipline – Newborn/Infant • Discipline = teaching • Helps with overall function as an individual • Limit setting • Personal childrearing practice • Expectations for each developmental stage

36. Discipline - Toddler • Teaches socialization & safety • Firm structure with safe limits • Be flexible with limits • Concrete vs realistic • Can do ≠ wants to do • PRAISE!!

37. Discipline – Early Childhood (Preschool) • Actions have consequences • Explain rules beforehand • Consequences = behavior being punished • Time-out • Charts, stickers, stars = encourage good behavior (rewards) • Helps regulate own behavior

38. Discipline – School-Age • Internalize rules • More independent = natural consequence for behaviors • Not “rescuing” from consequences • Not all understand responsibility or ignore consequences • Timeout or grounding

39. Discipline - Adolescence • Internalize responsibility • Needs parental support for rules • Monitor own actions through critical thinking • Positive behaviors should be the focus • Remove privileges

40. VerbalCommunication • Language and vocalizations • May be used to distort reality • Avoidance language • Distancing language

41. Non-verbalCommunication • Pitch, pause, rate, volume of speech • Children understand tone and pitch before meaning • Children are sensitive to non-verbal cues

42. Family-CenteredCommunication • Establishing rapport • Availability and openness to questions • Family education and empowerment • Feedback from children and families • Management of Conflict • Spirituality

43. Communication Development and the Infant (0-1 yr) • Cry, babble, coo • Single words, name an object • Dependent on others • Respond to environmental stimuli • Distinguish between sounds • Beginning of separation anxiety • Interactions very reflexive • 1-2 min attention span

44. Communication Development and the Toddler (1-3yr) • Two words • “I do” “I want” • Turn taking in communication • “No”; uses gestures • Strong need for security • Separation anxiety peaks • Parallel play • Needs routine • Independence, but dependent • Explores • Cause and Effect • 3-5 min attention span

45. Communication Development and the Preschooler (3-6yr) • Egocentric • Concrete thinkers still • Speak in full sentences • “WHY” • Stutters • Attention seeking behavior • Cooperation developing • Set limits and boundaries • Developing concept of time • 5-10 attention span

46. CommunicationDevelopment and School age (6-12 yr) • “WHY” changes to “HOW” • Recognizes consequences for actions • Memory development • Increase langauge Still somewhat concrete thinkers • Logical thinking = solve problems • Metacognition • Aware of own thinking leads to critical thinking

47. Communication Development for Adolescents (12-19 yr) • Adult concepts • Make plans/sets goals • Competitive • Group identity • Close friends • Questions authority • Needs for privacy • Logic to solve problems • Speak/write correctly • Communication skills

48. Communicating with Children with Special Needs In working with children with special needs, the nurse must carefully assess each child’s physical, mental, and developmental abilities and determine the most effective methods of communication.

49. Common Stressors During Hospitalization • Separation anxiety • Loss of control • Bodily injury & pain

50. Separation anxiety • Toddlers – cling to parents, beg them to stay, may be angry at mom if she leaves and father stays • Intervention – encourage parents to stay, cot in room, bring objects from home (cup, bottle, toy, blanket); if parent cannot stay the nurse becomes caregiver…build trust