NURSING MISC HISTORY OF CHILD CARE

1. Identify events that were significant to the health care of children in the United States in the 20thcentury For centuries children were considered miniature adult. In colonial America children were expected to assume adult responsibilities as soon as they could. Infant and childhood mortality rate were high. Epidemic diseases were common, with no control or treatment for smallpox, diphtheria, measles, dysentery, mumps, chickenpox, yellow fever, cholera, or whooping cough. Industrializion in America Population shifted from rural to urban settings. People lived in overcrowded and unsanitary conditions. Children were looked at as little adults and worked in factories 12 to 14 hours a day. They had no legal rights and there were no work laws. 2. Discuss the works of Abraham Jacobi and Lilian Wald 1860: Dr. Abraham Jacobi, a New York physician referred to as the “father of pediatrics,” first lectured to medical students on the special diseases and health problems of children. At “milk stations,” infants were weighed and mothers were taught how to prepare milk before giving it to their babies. Late 1800s: Increasing concern developed for the social welfare of children, especially those who were homeless or employed as factory laborers. Lillian Wald: founder of public health or community nursing Early 1900s: Children with contagious diseases were isolated from adult patients; parents were prohibited from visiting.1940s: Famous works of Spite and Robertson on institutionalized children; the effects of isolation and maternal deprivation were recognized.1909: White House Conference on Children focused on issues of child labor, dependent children, and infant care.1912: U.S Children’s Bureau was established. 3. Describe the purposes and outcomes of the White House Conferences on Children between 1909 and the 1980s 1909: White House Conference on Children focused on issues of child labor, dependent children, and infant care.1912: U.S Children’s Bureau was established. 1919: First funded program for mothers and children1929: Depression caused conditions for children to decline, once again1987: National Commission on Children formed; served as a forum on behalf of the children of the nation Children are the focus of many reform initiatives in the twenty-first century, and solutions will emphasize collaboration among various disciplines. 4. Discuss the personal characteristics and professional skills of a successful pediatric nurse Pediatric nursing is different from other clinical specialties in nursing. Pediatric nursing is family-centered nursing in its truest sense. The pediatric nurse must have keen observation skills, especially when caring for infants and toddlers or children who are critically or cannot communicate in the traditional sense. Supporting a children a through difficult procedures or illnesses is an activity in which a pediatric nurse commonly becomes involved. 5. Identify key elements of family-centered care • Identity and mobilize internal and external strengths. • Access appropriate resources in the extended family and community • Recognize and enhance positive communication patterns. • Decide on a consistent discipline approach and access parenting programs if needed • Maintain comforting cultural and religious traditions and sources of healing. • Engage in joint problem solving • Acquire new knowledge by providing information about a specific health problem or issue. • Become empowered • Allocate sufficient privacy, space, and time for leisure activities • Promote health for all family members during times of crisis. 6. Describe areas in which the pediatric nurse uses principles of growth and development Growth Measurements: Child whose growth may be questioned include the following:-children whose height and weight percentiles are widely disparate. Length Measurements are taken when children are supine; recumbent length is usually measured until 2 years of age. Height Measurement is of a child standing upright. Weight: Fluid loss and inadequate calories are reflected in a child’s weight, especially that of infants and toddlers. Same scale should be used, and the child should be weighed at the same time every day. Skinfold Thickness Skin fold thickness should be determined at one site with at least two measurements. Arm circumference measures muscle mass. Vital Signs: Key elements in evaluating physical status are vital signs-temperature, pulse, respiration, and blood pressure. Temperature Reflects metabolism, is fairly stable from infancy through adulthood. Despite the ability to regulate their temperatures, infants and toddlers are prone to wide variations, especially after crying for extended periods or after active play. Female maintain a temperature slightly above that of males throughout life. 7. Describe how to use head-to-toe method for the physical assessment of a child Skin Genetic and physiologic factors affect assessment of color. Pallor may be a sign of anemia, chronic disease, edema, or shock. Erythema may be the result of increased temperature, local inflammation, or infection. Skin texture should be smooth, soft, and slightly dry to the touch. Accessory Structures: Hair should be lustrous, silky, and elastic Nails should be pink, convex, smooth, and hard but flexible, not brittle Handprints and footprints Palm normally shows three flexion creases Eyes: At birth, visual acuity is 20/400; when holding a baby, assume an en face position. Clear vision by the baby only at very close range. By the second week of life, tear glands begin to function. Newborns can follow bright, colorful objects by the second or third week of life. Vision improves to 20/30 by age 2 to 3 years. Accommodation and refraction are present by school age. Ears: Inspect for general hygiene. If the ear canal appears free of cerumen, ask how ears are cleaned. Advise parents and children to clean the ears with a washcloth; wipe only the outer portion of the canal with a swab. Mineral oil may be used to soften cerumen. Nose, Mouth, and Throat: Nose should lie from the center point between the eyes to the notch of the upper lip. Normally there is no discharge from the nose. Infants and toddlers, however, usually resist and will not open their mouth. It is also important to check the number of teeth. Good dental hygiene begins as soon as the primary teeth erupt. Permanent teeth begin to appear at about 6 years, and most are present by 12 years. Lungs: Make sure the child is not crying. Have them “blow out.” Listen systematically. Chest: Chest is almost circular. As the child grows, the chest normally increases in a transverse direction. Asymmetry may indicate serious underlying problems. Back: Newborn is C-shaped. Older child typically has S-shaped curve. Marked curvature in posture is abnormal. Abdomen Inspection: done while the child is erect and supine. Abdomen is cylindrical and position is flat Auscultation: unlike listening to heart or lung sounds. The most important sound to listen for is peristalsis, which may be heard every 10 to 30 seconds, depending on when the child last ate. Extremities: Examine for symmetry, range of motion, and signs of malformation. Fingers and toes should be counted. Toddler begins to walk, the legs are usually bowlegged until lower body and leg muscles develop. Observe for arch development and correct gait. School-aged walking posture is more graceful and balanced. During puberty, adolescents may experience awkward posture from rapid growth of extremities. Renal Function: There is a functional deficiency in the kidney’s ability to concentrate urine and to cope with conditions of fluid and electrolyte fluctuation, such as dehydration or fluid overload. Urine output varies and depends on the size of the infant or child. Many tests done in adults are not done in young children because of immature kidney function. Anus: Check the anal sphincter. History of bowel movements should be noted. Assess for perianal itching; test for pinworms. Genitalia: This is an excellent time to elicit questions concerning body functions or sexual activity. The examination is an excellent time for eliciting question concerning body function or sexual activity. 8. Describe metabolism in the child and its relationship with nutrition Metabolism: Metabolic needs vary among individuals. Rate of metabolism is highest in the newborn infant because of ratio of total body surface to body weight is much greater than it is in the adult. The body uses energy provided by foods. Because metabolism is so high in infants and children, their ability to recover from surgery or a fractured bone is swift compared with that of an adult. Nutrition: Nutrition is probably the single most important influence on growth. A child’s appetite fluctuates in response to growth spurts. Infants begin life outside the womb, nursing at the breast or ingesting formula or breast milk via bottle or tube. Most infants are given solid foods at 4 to 6 months of age, when they begin to need more iron in the diet and their teeth begin to erupt. 9. List general strategies to consider when talking with children • Use a calm, unhurried, and confident voice. • Speak clearly, be specific, and use as few words as possible • Sate directions and suggestions in a positive way; for example say, “you need to stay very still,” rather than “Don’t move” • Because children see things only in relation to themselves and from their viewpoint, focus communication on them. • After greeting the child, continue to talk to both the child and the parent while pursuing activities that do not involve the child directly. • Use play as a strategy for getting to know he child. • Listen to and observe the child at play. • Look for opportunities to offer the child choice, but offer them only when they really exist. • Be honest with children. • Use direct and concrete communication with young children because they are unable to work with abstractions or to separate fact from fantasy. • Avoid use of a phrase that is open to a young child’s misinterpretation. • Children between 5 and 8 years want concrete explanations and reasons for everything because they rely more on what they know than what they see when faced with new problems. • One of the most important points to remember is to speak with a child according to the child’s stage of development. 10. Describe the three categories of child abuse. Physical abuse is the intentional infliction of physical injury on a child, usually by the child’s caregiver. Emotional abuse is the intentional attempt by a parent or caretaker to impair or destroy the mental or emotional state of a child. Sexual abuse is defined as commission of a sexual offense by a person responsible for the child’s care such as a parent, relative of the family or babysitter, against a child who is dependent or developmentally immature, for the purpose of the perpetrator’s own sexual stimulation or gratification. 11. Outline several approaches for making the hospitalization of children a positive experience for them and their families. A child’s ability to play while being in the hospital constitutes a sign of health in a particularly difficult environment, which shows that the child may continue his/her usual activities, or that there is some progress in the course of the disease. Play is a form of communication and self-expression, which gives them the possibility of communicating with both the family and the medical and nursing staff, while helping them process a series of emotions 12. Discuss pain management in infants and children. Pain Management: Health care professionals tend to underestimate pain in children. Anything that is painful to adults should be assumed to be painful to infants and children. Pain is now considered the fifth V/S and must be recorded during each shift assessment. Knowing when a child is in pain and how intense the pain is can sometimes be difficult; the nurse must rely on physiologic variables and behavioral variable. Wong-Baker Faces Scale may be helpful in assessing pain level. 13. Explain the needs of parents during their child’s hospitalization Later, diagnostic test, medications, or procedures that are planned by the physician should be explained to the parents. As the parents’ comfort increases, they become more involved in meeting their child’s physical needs. Parents must be confident in their ability to perform given tasks in their child’s care and should be encouraged to participate only in as many activities as they feel comfortable performing. The pediatric nurse must gain the trust of the parents by reviewing and interpreting information, asking the parents whether have any question, conveying concern of the parents’ well-being, listening and being available, respecting them as experts on their child and soliciting their input. 14. Discuss common pediatric procedures Bathing: Infants enjoy being placed in basins for baths. Use dry hands to pick up the infant. Allow this child to play and splash. Most toddlers love to be placed in a tub for their bath. Toys should be provided. The child should never be left in a tub without supervision. School-aged children may be reluctant to bathe; encourage them to participate in their care. Adolescents bathe or shower daily; privacy is important. Feedings: Breast feeding mother may wish to continue breastfeeding her baby who is ill or hospitalized. Provide a quiet environment and a comfortable chair for nursing. If the mother is unable to be present for every feeding, encourage her to use a breast pump; bottles of breast milk can be frozen and given later by bottle or tube feeding. Formula: Positioning should be comfortable for the adult and the infant; infant should be held securely. If a burp is not elicited in one position, try another. Formula or juice should fill the nipple entirely to decrease the amount of air swallowed in the course of the feeding. After feeding, the infant is positioned on the right side. Solids: Infant should be fed in an infant seat. Older infants can be placed in a high chair with a safety strap. Toddlers may resist high chairs; nurse may need to try an alternative to prevent injury. Parents should provide three regular meals and planned snacks each day so that the child eats about every 2 to 3 hours. Children should sit down to eat; choking is more likely if children eat on the run. Gavage: Some infants and children require the passing of a feeding tube through the nose or mouth, down the esophagus, and into the stomach. To measure for placement: measure from the nose to the bottom of the earlobe and then to the end of the xiphoid process or go by height. Restraint may be needed to pass the tube. Because infants are nose breathers, the mouth is preferred. Gavage: Older children can be asked to swallow as the tube is placed. Once the tube is in place, secure with tape. Before feeding, check placement. Infants are given a pacifier to associate sucking with satisfying hunger. Allow to flow into the stomach via gravity. At the completion of feeding, flush the tube with sterile water. Gastrostomy: This is often used in children when passing a gastric tube is contraindicated or in children who require tube feeding over an extended period. A tube is inserted into the abdominal wall and into the stomach and secured with a purse-string suture. Feedings are carried out in the same manner and rate as in gavage feeding .After feedings, the child is placed on the right side or in Fowler’s position. Total Parenteral Nutrition: A highly concentrated solution of protein, glucose, and other nutrients is infused intravenously through conventional tubing with a special filter attached to remove particulate matter and microorganisms. Wide-diameter vessels, such as the subclavian vein, are the usual sites of infusion. Nursing responsibilities include control of sepsis, monitoring infusion rate, and continuous observation. Safety Reminder Devices: At times, for safety, children should be restrained after surgery or during a procedure or examination. This is used only as a last resort. The device should be applied correctly, and circulation and skin integrity must be monitored closely. The device should be removed every 2 hours so that the body area can be exercised. Release extremities one at a time so that the child cannot pull out an IV or NG tube. Urine Collection: Collecting a urine specimen can be a major problem in pediatrics when the child is not toilet trained. Methods of Collection Suprapubic bladder, tapPlastic urine collection and bags Catheterizations Venipunctures to Obtain Blood Specimens: In infants and young children, a jugular or femoral vein may be used to obtain a blood specimen. The nurse’s responsibility is to prepare, position, and restrain the child. Holding the head or lower extremities absolutely immobile is critical. Pressure should be applied to the site to prevent the formation of a hematoma. Sometimes the veins of the extremities, especially the arm and the hand, are used. Lumbar Puncture: Explain the procedure and answer any questions. EMLA, a local anesthetic cream, may be applied to the lumbar area; it should be applied at least 1 hour before procedure. Position the child at the edge of the exam bed, on the side, facing nurse with neck and legs gently flexed. Observe for any signs of difficulty .A toddler may need to have the legs wrapped in a blanket. The child should be held securely until the spinal tap is completed. Oxygen Therapy: This is used to improve the child’s respiratory status by increasing the amount of oxygen in the blood; it is also used in children who have cardiac or neurologic disorders. Infants and young children receiving oxygen are monitored on an oximeter. Methods Hood and incubator Mist tents Nasal cannula Suctioning: Suctioning should be used when secretions are audible in the airway or when signs of airway obstruction or oxygen deficit are present. Various devices are used to suction children such as a bulb syringe or a straight suction catheter. Depth: approximately 1/4 to 1/2 inch Timing: not more than 5 seconds Frequency: allow 30 seconds between attempts Intake and Output: Many health disorders require accurate monitoring of the amount of solids and liquids taken in and the amount excreted. All fluids given to a child are documented on a record kept at the bedside. All urine voided is measured before it is discarded; weigh diapers if appropriate. Medication Administration: The nurse must know how to compute the dose correctly and administer it properly. All computed dosages must be checked by a second nurse for safety. The right amount of the right medication must be given to the right child at the right time and via the right route. Nurses must also observe and document a child’s response to the drug. Methods of calculating dosages for children consider age, body weight, and body surface area. 15. Discuss administration of pediatric medications Oral medications-when administration liquid, care must be observed to prevent aspiration.-to encourage the child’s acceptance of oral medication:-give the child an ice pop or small ice cube to suck to numb the tongue before giving the drug.-mix the drug with small amount such as sweet thing.-many pediatric medications are given by drops pr dropper. Intradermal, subcutaneous, and intramuscular medications-injection are a source of pain and fear for children, so drugs are usually given by injection only when other routes cannot be used.-injection administered with care seldom produce trauma to the child. Factors that are considered when selecting a site for IM injection on an infant or child include: 1. The amount and character of the medication to be injected. 2. The amount and general condition of the muscle mass. 3. The type of medication being given. The IV route of administering a medication is often selected for the following reasons:-medication is almost immediately distributed to tissues and prompt physiologic action occurs.-with consecutive doses, predictable drug levels can be achieved to maintain therapeutic effects. Optic, otic, and nasal administration There are few differences in administering eye, ear, and nose medication to children or adult.-instilling eye drops in infants can be difficult because they often clench their lids together.-eardrops are instilled with the child restrained.-for nasal administration, position the child with the head hyperextended to prevent strangling sensations cause by medication tricking into the pharynx rather than up into the nasal passages. Rectal administration: The rectal route is less reliable but sometimes is used when the oral route is difficult or contraindicated. Enema-the procedure for an enema does not differ essentially from that of an adult.-proper insertion of the catheter tip, especially in infant, is essential to prevent rectal damage and perforation. 16. Discuss hazards and accident prevention in the pediatric population Safety Protecting a child from harm is a major issue in pediatrics. Anticipatory guidance for parents of infants and toddlers and health teaching for school-age children and adolescents are two methods of preventing accidents .Injuries cause more deaths and disabilities in children than do all causes of disease combined. Parents and children should talk and listen to each other to prevent many accidents. The adult who is a role model can influence a child immensely.   Birth defects: Congenital anomalies. Any abnormality present at birth, particularly a structural one, that is possible to inherit genetically, acquire during gestation, or acquire during parturition. Children with special needs: Infants and children with congenital abnormalities, malignancies, GI diseases, and CNS abnormalities. Family-centered care: The philosophy of care that recognizes the family as the constant in the child's life and holds that systems and personnel are called on to support, respect, encourage, and enhance the strengths and competence of the family. Anticipatory Guidance: Psychological preparation of a patient for an event expected to be stressful. En face position: Position in which the adult's face and the infant's face are approximately 8 inches apart and on the same plane, as when the mother holds the infant up in front of her face or when she nurses the infant Weaning: Gradually eliminating breastfeeding or bottle feeding and instituting cup and table feedings Anterior fontanelle: A space, roughly diamond shaped covered by tough membranes between the bones of an infant's cranium; the posterior fontanelle is triangular