What is a Pediatric

Nurse?

Philosophy of Pediatric
Nursing
Family-Centered Care
Atraumatic Care
Evidenced-based practice

Nursing Process: Growth

and Development

Assessment
Nursing diagnosis
Outcome identification and planning
Implementation
Outcome evaluation

Growth and Development

Growth increase in size and weight
Development gradual change to a
more advanced stage of complexity
Maturation increase in competence
and adaptability, makes it possible
for functioning at a higher level

Principles of Growth and

Development
Head to Toe (cephalocaudal)
Near to Far (proximodistal)
Simple to complex functions (differentiation)
Predictable sequence
Does not progress at constant rate
Body system differences in patterns and rates
Critical periods when particular influences
must be present

THE FOUR STAGES OF LIFE:

1)
2)
3)
4)

You
You
You
You

believe in Santa Claus.

don't believe in Santa Claus.
are Santa Claus.
look like Santa Claus.

Developmental Age Periods

Prenatal Conception to birth
Infancy Birth to 12 mo.
Neonatal - Birth to 27 or 28 days
Early Childhood - 1-6 yr
Toddler 1-3 yr
Preschool 3-6 yr
Middle Childhood 6- 11 or 12yr
Later Childhood 11-19 yr
Prepubertal 10-13 yr
Adolescence 13-18 yr

Influences on Growth
and Development
Family
Structure
Parenting Styles
Birth Order (ordinal position)
Culture
Race
Ethnicity
Subculture
Nationality
Religion

 Socioeconomic Status
School / Education / Teachers
Peers / Socialization
Heredity
Nutrition
Prenatal Health Care
Gender

Nursing Care Implications of

Diet and Nutrition(cont.)
MyPlate guidelines
Variety of foods
Balance; portion size; physical activity
Grain products, fruits, and vegetables
Diet low in fat, saturated fat, and
cholesterol
Moderate: sugars, salt/sodium, alcohol

 Health Care
Disease
Environment
Media
Temperament

Developmental Theorists
Eriksons Theory of Psychosocial
Development
Piagets Theory of Cognitive
Development

Theorists:
Freud

Kohlberg

Erikson

Piaget

What does your theorist study?

Look at toddler development according
to your theorist. Develop a nursing plan
for a toddler based on the principles of
the theorist. (How would the theory
influence your care of the toddler
patient?)
Pick someone in your group to share
your information.

 A world without children is a world

without newness, regeneration, color,
and vigor Gods Little Instruction
Book for Parents

 Please pick up a crossword puzzle

and see how much you can complete.

Unit 1: Infant

Physical Growth

Weight doubles by 4-6 mo.

triples by 12 mo. Length increases by 50% by 12 mo
doubles by 2 yr
n

Click icon to add picture

Organ System
Maturity

Neuro
Fontanels
Reflexes
Cardiovascul
ar
Blood
Respiratory
GI
GU
Immunity

Psychosocial Development
Erikson Stage:

Narcissism
Little tolerance for delayed
gratification

Stranger
Anxiety
&
Separation
Anxiety

Click icon to add picture

Progress from primitive reflex
behaviors to voluntary acts
Body image development
(separates self from
environment)
Object permanance

Cognitive Development
Piaget Stage: Sensorimotor

Nurses Role

Group 1

Gross Motor / Fine Motor

Group 2

Language

Group 3

Personal / Social : Sensory & Solitary Play

Skill & Imitative Play

Group 4

Safety: Car / Water

Group 5

Safety: Home

Group 6

Safety: Sleep

Nutrition
Birth to 6 Mo.
Schedule
Burping

Spitting Up
Monitor

Nutrition (cont)
6mo to 12 mo.
Nutrition needs breast milk or formula still
main source , if breast feeding stopped,
substitute iron fortified formula, not more
than a quart per day

Solid Foods
Infants not developmentally ready for
solids till after 4 months
Signs of Readiness for Solids:

Head control
Able to sit with help
Tooth eruption is starting
extrusion reflex is disappearing

Solid Foods

First food usually iron fortified cereal

Juice good source of Vit. C, after 6 mo.
New Foods add new foods, one at a time
Baby Foods

pureed, strained, or mashed

avoid combination products
dont add fat, salt or sugar
not in bottle

Solid Foods (Cont)

Finger Foods
crackers at 6 mo.
cheerios at 9 mo.
junior and chopped table food after 9 mo.
Weaning from bottle to cup by 12 mo tooth decay
Self-feeding

Common Developmental Concerns

Promoting Healthy Teeth and Gums

Thumb Sucking vs. Pacifiers
Teething
Diaper Rash
Spitting up

Case Study- hospitalized infant

Bobby baby, age 8 months has been hospitalized
with croup. What kinds of stressors would he
face?
What interventions could the nurse take to
minimize the effects?

Case Study The mother of six week old Ernie infant tells the nurse that her
son has been very fussy and cries a lot, especially in the
evening. She is concerned he might be sick, and says the
constant crying is driving she and her husband crazy.
What other information would the nurse want to know about
this situation?
What is probably wrong with this baby?

Group 1

Increasing the number of mothers who exclusively breastfeed

until 6 months of age

Group 2

Reducing the rate of infant deaths

Group 3

Increasing immunization levels for universally recommended

vaccines among young children

Group 4

Increasing age-appropriate vehicle restraint systems in

children aged 0 to 12 months

Group 5

Decreasing the number of children who die from sudden infant

death syndrome (SIDS)

Nursing Care of a Family

when a Child has a
Gastrointestinal Disorder
Chapter 45

The Beginning and the End

Differences between the

adult and pediatric client
Swallowing
Stomach capacity
For infants or nonverbal children
must monitor behavioral changes

Differences between the

adult and pediatric client

Water balance
extracellular fluid(ECF)
body surface area
basal metabolic rate
kidney function
fluid requirements

Nursing Diagnosis
Impaired Parenting related to
interference with establishing the
infant-parent bond
Interrupted family processes related
to a chronic illness in child
Risk for deficient fluid volume
related to chronic diarrhea
Imbalanced nutrition, less than body
requirements, related to

Assessment
Failure to thrive
Spitting up/regurgitation
Nausea, vomiting, diarrhea,
constipation
Abdominal pain, distention, GI
bleeding

Assessment
Jaundice
Dysphagia
Hypoactive, hyperactive, or absent
bowel sounds

Observation & Physical

Exam
Growth and Development
General Appearance
Always assess for dehydration

Diagnosis and Therapeutic

Techniques

Labs
Bowel Studies
Abdominal radiographs
Abdominal &pelvic ultrasounds

Familiy/Child need preparation for

procedures

answer the following

questions
Stephen is a 5 month old infant visiting
the well-child clinic for his second series
of immunizations.
1. Stephen weighed 7lb and was 20in long
at birth. On the basis of normal growth
and development parameters, what
should his weight be at this visit?
2.List a normal set of vital signs that may
be assessed from Stephen.
3.On what physiologic principle might the

Health Promotion and

Risk Management
Teach proper hand washing and food
prep
Teach nutritional guidelines
Promote family bonding by eating at
least one meal as a family
Teach S&S of GI dysfunction
(diarrhea and vomiting)

Fluid, Electrolyte, and Acid

Base Imbalances
Daily Maintenance Fluid
Requirements Table 45.1 pg 1313
Up to 10 kg> 100ml/kg/24 hr
11-20kg> 1000ml + (50ml/kg for wt>10
kg)24hr
>20kg> 1500ml + (20ml/kg for wt >
20kg)/24hr
Divide total amount by 24hr to obtain
hourly rate