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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

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course requirements
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

Daily Nursing Process Plan (1 per patient)

1 Clinical Case Study Presentation

Leadership Assignment

Assignments not submitted on time will result in a failed clinical day.

Maximum 2 failed clinical days for NUR 246.

course requirements1
Course Requirements

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:

Suffolk County Community College NUR 246/248 Case Studies Maternal & Child Health Nursing (2010) ISBN-13: 978-0-558-72350-7

pediatric assessment
Pediatric Assessment

Children are not small adults!

Family Involvement

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

establish trust
Establish Trust

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!

communication is key
Communication is Key

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

if desired.

physical exam
Physical Exam

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,

wiggle toes.

illness and hospitalization
Illness and Hospitalization

Major life crisis.

Change from usual state of health & routine.

Loss of control.

Unfamiliar environment and people.

parental response
Parental Response


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?

parental response1
Parental Response

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.

children s response infants
Children’s ResponseInfants

0 to 1 year

Trust vs. Mistrust

Separation Anxiety @ 6 months


Body Rigidity


Altered Feeding, Sleeping and Stool patterns


Nursing Interventions

Primary RN for consistency

Encourage parents to participate in care

Simulate home routine

Bath time, Meal time & Nap time

Bring familiar objects from home

Allow self-comforting

Pacifier, Blanky or lovey


1 to 3 years

Autonomy vs. Shame and Doubt


Seeks independence

“Me Do”

Mobility = Control

Temper Tantrums

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



- Hopelessness


Less Activity & Crying



Disinterested in play




Superficial Adjustment

- Appears happy

- Eats & plays

- Accepts other adults

- Self-centered behaviors

- Resignation

nursing interventions
Nursing Interventions

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


pre school

3 to 5 years

Initiative vs. Guilt


Fear of :




Fantasy and unrealistic reasoning

Hostility & Aggression

Physical & Verbal

pre school1

Protest, Despair & Detachment

Nursing Interventions

Allow child to verbalize

Accept regressive behavior

Provide play activities

Provide honest and simple preparation

Immediately before procedure

school age

6 to 12 years

Industry vs. Inferiority


Loneliness & Boredom

Isolated from Peers

Displaced anger

Postpone procedures

Passively accept pain

school age1

Nursing Interventions

Explore feelings RT Illness

Encourage child’s participation in care

I & O

Dressing Changes

Provide projects & activities

Encourage peer visits, phone calls, email

- Arrange tutors for school work


13 to 18 years

Identity vs. Role Diffusion


Rejection, Withdrawal

Non compliant


Fear of change in body image

Loss of identity


Nursing Interventions

Encourage verbalization of feelings

Help develop + coping skills

Explain information honestly

Maintain privacy

Provide demonstrations & encourage accountability

Allow peer visitations PRN

Support pt’s identity

Decorate room, wear own clothes

children s adjustment
Children’s Adjustment

Impacting Factors:

Age of child and development

Previous health care experiences

Coping skills/preparation

Nature of health needs

Severity of illness and symptoms

Acute vs. chronic

Degree of discomfort

Required procedures

Perception of illness

children s stress responses
Children’s Stress Responses

Loss of appetite

Disinterest in environment

Loss of previously acquired tasks

Regressive behavior

Thumb sucking, bed wetting

Temper tantrums

Clinging & Irritability

Demanding & Possessive

pre op care
Pre-Op Care

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

Encourage questions

Parents role

Comfort and support

Pre-op Meds

Valium Robinol

“Special Sleep” = Anesthesia


physical prep
Physical Prep

Vital Signs:

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

Dress in gown & ID any toy/blanket

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.

post op

First 24 hours are most crucial.

Assessments must be frequent and complete to identify any changes in status.

Ventilation & Perfusion

Fluid & Electrolyte Balance

Temperature Regulation

Energy Needs

Pain Management

Reinforce necessity of assessment to parents.


Maintain Airway Patency

Rate & Rhythm

Pulse Oximeter

Breath sounds

Anterior & Posterior

Depth & Symmetry

Color lips & mucous membranes


Amount, type, color


Apical Rate & Rhythm

Listen for a full minute!

(Compare with baseline data.)

Blood Pressure

Check cuff size!

Extremities - Compare bilaterally

Peripheral Pulses

Color & Temp

Capillary Refill

neurological status
Neurological Status





S = subjective

L = location

I = intensity

D = duration

A = associated factors

skin integrity
Skin Integrity

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.

fluid balance
Fluid Balance

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.


NPO until

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)

NG tube



Color, viscosity and amount



Rectal most accurate

Oral when compliant

Tympanic unreliable


Increases BMR & Temp


Color & Temp

pain management
Pain Management

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:


Distraction/Guided Imagery


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

parents needs
Parents’ Needs

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!

patient advocacy
Patient Advocacy

You have more than one patient!

Optimal outcome for all:


Physical and emotional



+ Healthcare experience

Rev 6/09