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Pediatrics Acute Care
Kim Martin, RN,MSN
Nursing Instructor
Harrisburg Area Community College
Pediatric Lab Day
2012
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Communication with Children
• Infants– -Respond quickly, soothing,
mothering tone– Gentle handling, no sudden
movements – Hold infant firmly and close to
body for security– Stranger anxiety 4-6months
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Communication with Children
• Toddlers– Give toddlers their space– Talk with parents first so they
can see that parents accept you
– Routine– Simple words and directions– Play!
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Communication with Children
• Preschooler– Strives for independence– Give choices– Use doll or puppet to help
explain procedures– Let them touch and explore the
equipment– Be honest
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Communication with Children
• School Age– Use concrete explanation– Formal presentations– Answer questions honestly– Concerned about mutilation
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Communication with Children
• Adolescents– Concrete, logical, abstract– Do not demean them– Observe language, actions and
body language– Social connections are most
important
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Assessment
• Obtain history first• Head to toe• Save ears and perineal area
for last • Observe parent’s interactions• Growth and Development• Nutritional status• Hygiene• Behavior
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Assessment
• Temperature– Temporal– Axillary– Rectal for infants
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Assessment
• Pulse– Take apical– Count for one full minute
AGE RANGE
Infant 100-140
Toddler 90-120
Preschooler 80-120
School Age 70-110
Adolescent 60-100
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Assessment
• Respirations
AGE RANGE
Infant 26-40
Toddler 20-30
Preschooler 20-25
School-Age 17-22
Adolescent 15-20
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Assessment
• Blood Pressure
AGE RANGE
Infant 74/50 – 100/70
Toddler 80/50 - 112/70
Preschooler 82/50 – 110/78
School Age 84/54 -120/80
Adolescent 94/62- 140/88
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Assessment
• Weight and Height– Infant- naked and no diaper– Children
• Head Circumference– Chest and abdominal
circumference as per institutional policy
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Assessment
• Pain- 5th vital sign– Must assess with vital signs– Use faces scale for toddlers
and preschooler– Numeric scale for older
children
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Assessment
• Face pain scale
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Assessment
• University of Wisconsin Children’s Hospital Pain Scale
Vocal/cry No cry Occasional Whimpers
Moaning, gentle cry
Consistent cry that increases in volume and duration
Facial Smiling, calm, relaxed
Neutral expression, frowning, occasional grimace
Occasional tense expression; slightly negative expressions; brow bulge
Marked distress; Brow bulge; eyes squeezed shut; open mouth; taut tongue
Behavior Neutral, moves easily; interacts with people or environment; strong suck
Easy to console with holding, position change; or sucking; winces when touched/moved
Consoles with moderate difficulty; sucks for very short time; followed by crying; cries when moved or touched
Inconsolable; absent or disorganized sucking; high pitched cry or scream when touched or moved
Body Movement/Posture
Normal motor activity; baseline muscle tone
Fidgeting; mild hyper tonicity above baseline
Moderate agitation or moderate immobility; intermittent flexion; moderate hyper tonicity above base line
Thrashing; flailing; incessant agitation or strong voluntary immobility; pronounced flexion; strong hyper tonicity above baseline
Sleep Sleeping quietly with easy respirations; normal sleep/rest periods
Restless while asleep
Sleep periods shorter than normal, awakes easily, sleeps intermittently
Unable to sleep or sleeping for prolonged periods of time interrupted by jerky movements
Overall Rating 0 1 2 3 4 5
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Assessment
• Pain– Pain management
• Non-pharmacological• Pharmacological
– Invasive procedure• EMLA- Eutectic Mixture Local
Anesthetic or LMX• Apply 30 minutes before
procedure• Cover with occlusive dressing
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Developmental Approach
• Infant– Trust– Stranger Anxiety– Memory of past experience
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Developmental Approach
• Toddler– Autonomy– Preoperational thought– Negativism– Ritualism– Limited language– No concept of time
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Developmental Approach
• Preschooler– Initiative– Concrete– Egocentrism– Fear of bodily harm– Illness is punishment
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Developmental Approach
• School Age– Industry– Concrete– Increased language skills– Understanding of time– Self control– Relationships with peers
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Developmental Approach
• Adolescent– Identity- self concept– Formal operations– No concern for the future– Peers
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Milestones
• ..\child-development-milestone-chart.pdf
• http://www.child-development-guide.com/child-development-milestone.html