Wednesday, February 3, 2010

pediatrics notes

  • Define pediatrics, pediatrics nursing, and pediatrician.
Pediatrics- is the area of care that deals with children and adolescents.
Pediatrics nursing- nursing care of children.
Pediatrician- a physician who specializes in pediatrics or children.
  • Explain physical assessment of a child. The equipment for the physical examination of a child is the same as that for an adult, except that some pieces are smaller. The child’s cooperation is of utmost importance. If the child is too young, ill, or frightened to understand how to cooperate, you may need to restrain him or her for parts of the examination. Use restraint only as a last resort because it makes children feel more threatened and frightened. A little extra time helping children become comfortable often works wonders. Show the child the equipment and let him or her handle it to promote a sense of control
  • Write an immunization schedule for children.
1. Hepatitis B vaccine (HepB)-
· 1st dose given at birth
· 2nd dose administered between one to two months
· final dose given between 6-18 months but no later than age 24 months
2. Rotavirus vaccine (RV)-
· 1st dose given at age 6-14 weeks
· final dose at 6-8 months
3. Diptheria, Tetanus toxoid and acellular Pertussis vaccine (DtaP)- minimum age 6 weeks
· Series of doses every two months
· 4th dose as early as 12 months (provided 6 months has elapsed since the 3rd dose
· final dose in the series at age 4-6 years.
4. Haemophilus influenza type b conjugate vaccine (Hib)- minimum age 6
· Administered at ages 2 months then followed at 4 months of age
5. Pneumococcal vaccine (PCV)- recommended for all children younger than age 5.
6. Influenza Vaccine- administer annually to children age 6 months to 18 years.
7. Measles, mumps, and rubella vaccine (MMR)- minimum age 12 months
· 2nd dose at age 4-6 years. May be given before age 4 provided at least 28 days has elapsed at least 28 days after 1st dose
8. Varicella vaccine- minimum age 12 months
· 2nd dose administered at age 4-6 years. May be given before age 4 provided at 3 months has elapsed after the 1st dose.
9. Hepatitis A vaccine (HepA)- minimum age 12 months
· Administer 2 doses at least 6 months apart
10. Meningococcal vaccine (MCV)- minimum age 2 years.
· Administer to children aged 2-10 years old.

  • Discuss specific care for hospitalized infants, toddlers, preschoolers, school age children and adolescents.
Infant- infant health supervision includes documentation of milestones of development and growth, as well as documentation of immunizations and family teaching. Examination center around discussion with family caregivers and anticipatory teaching. General observations include the following; how the family caregivers hold the infant, general cleanliness of the infant skin, color ,warmth, and texture, fontanels, reflexes, achievement of developmental milestones, etc.
Toddlers- as a toddler’s growth progresses, independence and autonomy become important. Documentation for a well-child check-up will include: age of weaning from breast or bottle to cup (usually achieved by age 12 months), ages at which toilet training was started and completed, language development, sleep patterns. Discuss with family caregivers their child’s behavior patterns and the type of discipline they use at home. Encourage caregivers to begin dental checkups for toddlers as early as 12 months of age. Teaching requires a strong focus on safety.
Preschoolers- the physical examination for preschool children focuses on readiness for school. Use a systems checklist to evaluate each child’s physical condition. Focus attention also on sleep patterns, safety, and relationships with peers, siblings, and family caregivers. Evaluation of speech, hearing, and vision is critical in the preschool years. Each must be within normal limits to facilitate learning. Determine if a child’s developmental age is commensurate with his or her chronological age.
School-age child- continue to plot the school-age child’s heights and weight on the growth grid to establish a comparison with other children of the same age. Emphasize successful completion of school work and relationships with peers, siblings, and family caregivers. Evaluate nutrition, elimination, and sleep patterns.
Adolescents- health supervision issues for adolescents focus on puberty and smooth transition to young adulthood. Adolescents require an update of the diptheria-tetanus immunization. Adolescents are capable of expressing individual concerns; therefore, you will benefit from talking separately with caregivers and with adolescents. A tactful approach to care includes detailed explanations of procedures you are to perform.
  • Write teaching plan relating to healthcare for child, client and family.
Although the process of admitting children to healthcare facility is similar to that for admitting adults, a special effort should be made to be alert to the needs of both the family caregivers and the child. Make family members as comfortable and secure as possible; it is important to earn their confidence and cooperation. Often if children see that their family caregivers accept and trust you, they become more willing to accept you as well. Ask family caregivers about their child’s special needs, likes and dislikes, allergies, and special vocabulary, especially for items such as “potty”. You can include children in gathering this information by directing the questions to them. You should also introduce them to roommates. The playroom is anon-threatening environment in which the family and nursing staff can get to know each other, thereby helping to put children at ease.
  • Discuss preoperative and postoperative care of a child.
Preoperative Care- prior to elective surgery, children should have an opportunity to tour the facility and touch equipment, as well as to meet the nurses before surgery. If the child is to go directly to the operating room on the morning of surgery, try to alleviate fear of the unknown by giving calm explanations.
Postoperative Care- prepare the room to receive the child. The room should have available an IV stand, emesis basin, tissues, blood pressure apparatus, drainage equipment, and any other necessary supplies. If the child is being cared fro in a same-day surgery unit, he or she will return to the unit in the same bed on which he or she left. However, if the child is returning to pediatric unit, arrange the room so that the gurney from the recovery room can be easily moved in.

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