Pediatric Assessment Elisa A. Mancuso RNC, MS, FNS Professor of Nursing. Course Requirements. Course Objectives Schedule-Lecture & Clinical Assignments-Page 7. Lecture - 2 exams = 95% + 1 ATI Exam (5%) = 100% Clinical Assignments 1 Pediatric NCP 2 Journals
Schedule-Lecture & Clinical
Lecture- 2 exams = 95% + 1 ATI Exam (5%) = 100%
1 Pediatric NCP
Daily Nursing Process Plan (1 per patient)
1 Clinical Case Study Presentation
Assignments not submitted on time will result in a failed clinical day.
Maximum 2 failed clinical days for NUR 246.
Academic Integrity = Professionalism
BLS CPR certification must be current to 12/22/10
Dosage Calculation Assessment
90% or higher to pass
IV rates (gtts/min)
Conversions: mg ↔ grains , grams ↔ micrograms
Pediatric Calculations: mg per kg = dose
2.2 pounds = 1 kg
Two opportunities within one week.
ATI: Nursing care of children: RN edition - 7.0
Elllis and Hartley (2009) Managing and coordinating nursing care (5th ed.) ISBN-13: 9780781774109
London, M. et al (2011) Maternal & child nursing care. (3rd ed) ISBN-13: 978-0-135-07846-4.
London, M., et al (2011)MyNursingLab with Pearson eText Student Access Code Card for Maternal and Child Nursing Care (3rd ed.) ISBN-13: 978-0-132-11511-7). URL: http://www.mynursinglab.com
Suffolk County Community College NUR 246/248 Case Studies Maternal & Child Health Nursing (2010) ISBN-13: 978-0-558-72350-7
Children are not small adults!
Identify their developmental level and needs:
Infants - Trust vs. Mistrust
Toddlers - Autonomy vs. Shame & Doubt
Preschool – Initiative vs. Guilt
School-Age – Industry vs. Inferiority
Adolescent – Identity vs. Role Confusion
Approach adult first, then acknowledge child.
Get down to child’s eye level.
Identify self and nature of visit.
Reinforce what will be done and how it will feel.
Maintain a sense of humor and have fun!
Recognize developmental needs.
Use age appropriate language.
Assess child’s prior health care experiences.
Encourage child to answer questions independently.
Encourage child to ask questions.
Provide privacy from family/parents
Let child handle equipment.
“Examine” toys or doll first.
Allow patient to examine doll or RN.
Provide information during exam.
Encourage child to participate.
Be honest and prepare for all sensations child may experience.
Select a coping technique; hold bear,
Major life crisis.
Change from usual state of health & routine.
Loss of control.
Unfamiliar environment and people.
At child for becoming ill & causing stress
Revise routine to accommodate work and child
Regarding potential diagnosis & painful procedures
Financial and family obligations.
Did they cause their child’s illness?
Loss of Objectivity
Apply different rules to ill child
Allow manipulation by ill child.
Healthy children are “forgotten”
Feelings of Inadequacy
Feel helpless in parenting role
Allow staff to assume decision making and caretaking responsibilities.
0 to 1 year
Trust vs. Mistrust
Separation Anxiety @ 6 months
Altered Feeding, Sleeping and Stool patterns
Primary RN for consistency
Encourage parents to participate in care
Simulate home routine
Bath time, Meal time & Nap time
Bring familiar objects from home
Pacifier, Blanky or lovey
1 to 3 years
Autonomy vs. Shame and Doubt
Mobility = Control
Separation anxiety @ 18 – 24 mos.
3 Distinct Stages of Separation Anxiety
Cry constantly = terrified
Clings to Parent
Searches for parent
Avoids and Rejects stranger contact
Less Activity & Crying
Disinterested in play
- Appears happy
- Eats & plays
- Accepts other adults
- Self-centered behaviors
Accept child’s hostility
Acknowledge feelings to gain trust
Simulate home environment/schedule
Allow maximum mobility
Provide comfort measures
Allow child to make choices
Encourage parents to stay with
3 to 5 years
Initiative vs. Guilt
Fear of :
Fantasy and unrealistic reasoning
Hostility & Aggression
Physical & Verbal
Protest, Despair & Detachment
Allow child to verbalize
Accept regressive behavior
Provide play activities
Provide honest and simple preparation
Immediately before procedure
6 to 12 years
Industry vs. Inferiority
Loneliness & Boredom
Isolated from Peers
Passively accept pain
Explore feelings RT Illness
Encourage child’s participation in care
I & O
Provide projects & activities
Encourage peer visits, phone calls, email
- Arrange tutors for school work
13 to 18 years
Identity vs. Role Diffusion
Fear of change in body image
Loss of identity
Encourage verbalization of feelings
Help develop + coping skills
Explain information honestly
Provide demonstrations & encourage accountability
Allow peer visitations PRN
Support pt’s identity
Decorate room, wear own clothes
Age of child and development
Previous health care experiences
Nature of health needs
Severity of illness and symptoms
Acute vs. chronic
Degree of discomfort
Perception of illness
Loss of appetite
Disinterest in environment
Loss of previously acquired tasks
Thumb sucking, bed wetting
Clinging & Irritability
Demanding & Possessive
Assess psychological preparation
Ask, “What are you in the hospital for?”
Orient to room, staff and unit.
Review process and procedures.
What, where, when, & how
Use dolls, toys and videos.
ID Band and alarm tag
Review orders and procedure consent
√ completion of Pre-Op Check list
Comfort and support
“Special Sleep” = Anesthesia
Age, Ht, Wt (kg), HR, RR, T & BP
√ for loose teeth & document!
NPO status – Varies according to age
Infants: 2-4 h,Toddlers: 4-6 h, School-Age: 6-8 h
Review all ordered tests;
CBC, UA, X-Rays, Type & X, completed
Results attached & MD notified PRN
Remove any prosthetic devices;
Retainers or Body piercing
Encourage use of bathroom prior to transport
Administer pre-op meds & review SEs
Keep side rails up!
Update all documentation & verbally review with transport personnel.
Review with parents how and where information will be communicated.
First 24 hours are most crucial.
Assessments must be frequent and complete to identify any changes in status.
Ventilation & Perfusion
Fluid & Electrolyte Balance
Reinforce necessity of assessment to parents.
Maintain Airway Patency
Rate & Rhythm
Anterior & Posterior
Depth & Symmetry
Color lips & mucous membranes
Amount, type, color
Apical Rate & Rhythm
Listen for a full minute!
(Compare with baseline data.)
Check cuff size!
Extremities - Compare bilaterally
Color & Temp
S = subjective
L = location
I = intensity
D = duration
A = associated factors
Check all dressings, wounds, drains/tubes.
Note patency & drainage.
Color & amount
Document q h or PRN
Check dependent areas for breakdown.
Elevate any edematous areas.
Check IV Solution and rate. (Confirm MD orders)
All Pediatric patients must be on IV Pumps.
Hydration therapy = ml/kg/day (Ex. 25 kg child)
100 ml (for 1st 10 kg) x 10 kg = 1000 ml/d
50 ml (for 2nd 10 kg) x 10 kg = 500 ml/d
20 ml (Per add’l kg) x 5 kg = 100 ml/d
25 kg = 1600 ml/d or 65 ml/h
Fluid Deficit (FD)
FD = Pre-illness weight (kg) – Current weight (kg)
Pre-illness weight (kg)
Strict I & O.
All fluids: PO, IV, urine, feces, emesis, diaphoresis & wound drainage.
Positive Gag reflex & Bowel sounds x 4
Nausea & Vomiting (N & V)
Amount & type of emesis
Medicate as ordered:
Tigan 100-200mg PR
Zofran 0.1 mg/kg/dose x 1 IV
Abdominal Distention; + measure Abd. Girth (cm)
Color, viscosity and amount
Rectal most accurate
Oral when compliant
Increases BMR & Temp
Color & Temp
Assess pain accurately with appropriate scale;
Faces, numbers, colors or FLACC
Review prior effective RX
Tylenol vs. Motrin vs. Opiods
Interventions, least to most invasive:
Medications IV or PO never IM!
No Demerol!(Metabolite = ↑ seizures)
Morphine (MSO4) 0.1 – 0.2 mg/kg/dose q 2-4h PRN
Max Dose = 15mg
Review child’s status
Procedures, explain equipment used, etc.
Anticipated LOS and treatments ordered.
Review family role:
Comforting not monitoring
Collaborative partners in care
Encourage verbalization of concerns
Reinforce need for frequent assessment
Based on child’s condition!
You have more than one patient!
Optimal outcome for all:
Physical and emotional
+ Healthcare experience