Presentation is loading. Please wait.

Presentation is loading. Please wait.

Nicole Tinny, MSN, CNS Pediatrics LSCC - Fall 2011.

Similar presentations

Presentation on theme: "Nicole Tinny, MSN, CNS Pediatrics LSCC - Fall 2011."— Presentation transcript:

1 Nicole Tinny, MSN, CNS Pediatrics LSCC - Fall 2011

2 What is a family? Every discipline has a definition Biological – perpetuation of the species Psychology – Responsibility for personality development Economics – Productive unit providing for material needs Sociology – Social unit that reacts with larger society

3 A family is a group of people living together or in close contact, who take care of one another and provide guidance for the dependent members. Family is whatever/whoever the client considers it to be.

4 Family function: The interactions of family members (caregiving, nurturing & training children) Family Structure – organization/arrangement/composition

5 Types of families Nuclear: Husband, wife, children (natural or adopted) living in common household Extended: Nuclear family plus relatives

6 Single parent family: Usually headed by mother Binuclear: Joint custody in separate households Reconstituted: Stepparents, stepchildren

7 Alternative family structures: Polygamous – spouse has multiple mates Communal – share common ownership of property, goods, children Same sex/homosexual parents

8 Family Centered Care The Family Plan of Care – Remember you are caring for more than 1 person (the entire family)

9 Professional Nursing Roles Provider of Care Critical Thinker Effective Communicator Teacher Collaborator Advocate

10 Family Culture Characteristics Acculturation & Assimilation Identity Connectedness Communication Pattern Socioeconomic Class

11 Subjective Health History Patterns of daily living ROS (review of systems)

12 ROS: Children GeneralGI SkinGU HEENTMusculoskeletal NeckNeurological ChestEndocrine CV

13 Objective Developmental Milestones – Denver Development II Test Anthropometric Measurements – Growth Charts Vital Signs

14 Objective Psychosocial development Erickson’s Theory Temperament Age related variations in PA

15 Stages of Growth and Development Newborn/Infant (birth to 12 months) Toddlerhood (1 to 3 years) Early Childhood (Preschool) – (3 to 6 years) School-Age Child (6-12 years) Adolescence (12 to 19 years)

16 Developmental Assessment DDST –II identifies developmental age – Evaluates 4 areas: – 1. Personal-Social – 2. Fine motor – 3. Language – 4. Gross motor

17 Anthropometric Measurements – Length – Weight – BMI – HC – Skinfold thickness Measurements

18 Vital Signs Temperature Pulse Respirations Blood Pressure

19 Psychosocial Development (Erikson’s) Trust vs Mistrust Autonomy vs Shame and Doubt Initiative vs Guilt Industry vs Inferiority Identity vs Role Confusion

20 Temperament Birth: response to surroundings Baby: caretaker and environment

21 Age Related Variations (PA) Sensory Physical Cognitive Language Moral

22 Overall Assessment Establish a relationship with the family Ask Questions Comprehensive Health History – Family Medical and Social History – PMH – Immunizations – Developmental milestones – ADL – ROS

23 Physical Assessment Use all of your senses Observation skills Smell Touch

24 Physical Assessment General ImpressionEar AssessmentCardiac Assessment Skin AssessmentNose/Sinus AssessmentAbdominal Assessment Head AssessmentThroat/Mouth AssessmentGU/GI Assessment Neck AssessmentChest AssessmentMusculoskeletal Assessment Eye AssessmentLung AssessmentNeuro Assessment

25 General Principles Never lie to a child Engage their help Let them touch and feel Treat assessments like games If it’s going to hurt tell them

26 Health Promotion Infant and Child – Nutrition – Dental – Sleep & Rest – Immunizations – Health Screenings Lead Poisoning

27 Health Promotion – Infant/Child Nutrition Breast or bottle Whole milk at 1 yr Solids at least 4 months Finger foods 8 to 12 months Begin to use spoon – 1 yr to 18 months Age 3 – Food Pyramid for Kids

28 Teething Drooling Irritability Chewing on objects Crying episodes Disrupted sleep and eating patterns

29 Sleep & Rest Newborns Infants Toddlers/Preschool School-age

30 Health Promotion – Infant/Child Social Aspects of Play Solitary Play Onlooker Play Parallel Play Associative play Cooperative play

31 Health Promotion Adolescent – Nutrition Obesity Dental Care Sleep & Rest Eating disorders – Anorexia Nervosa – Bulimia Nervosa

32 Parenting Styles 1.Dictatorial 2.Permissive or laissez faire 3.Democratic

33 Misbehavior Stretches the limits Minor consequences Major consequences

34 Types of Discipline Redirection Reasoning Time Out Consequences Behavior Modification Corporal Punishment

35 Discipline – Newborn/Infant Discipline = teaching Helps with overall function as an individual Limit setting Personal childrearing practice Expectations for each developmental stage

36 Discipline - Toddler Teaches socialization & safety Firm structure with safe limits Be flexible with limits Concrete vs realistic Can do ≠ wants to do PRAISE!!

37 Discipline – Early Childhood (Preschool) Actions have consequences Explain rules beforehand Consequences = behavior being punished Time-out Charts, stickers, stars = encourage good behavior (rewards) Helps regulate own behavior

38 Discipline – School-Age Internalize rules More independent = natural consequence for behaviors Not “rescuing” from consequences Not all understand responsibility or ignore consequences Timeout or grounding

39 Discipline - Adolescence Internalize responsibility Needs parental support for rules Monitor own actions through critical thinking Positive behaviors should be the focus Remove privileges

40 Verbal Communication Language and vocalizations May be used to distort reality –Avoidance language –Distancing language

41 Non-verbal Communication Pitch, pause, rate, volume of speech Children understand tone and pitch before meaning Children are sensitive to non-verbal cues

42 Family-Centered Communication Establishing rapport Availability and openness to questions Family education and empowerment Feedback from children and families Management of Conflict Spirituality

43 Communication Development and the Infant (0-1 yr) Cry, babble, coo Single words, name an object Dependent on others Respond to environmental stimuli Distinguish between sounds Beginning of separation anxiety Interactions very reflexive 1-2 min attention span

44 Communication Development and the Toddler (1-3yr) Two words –“I do” “I want” Turn taking in communication “No”; uses gestures Strong need for security Separation anxiety peaks Parallel play Needs routine Independence, but dependent Explores Cause and Effect 3-5 min attention span

45 Communication Development and the Preschooler (3-6yr) Egocentric Concrete thinkers still Speak in full sentences “WHY” Stutters Attention seeking behavior Cooperation developing Set limits and boundaries Developing concept of time 5-10 attention span

46 Communication Development and School age (6-12 yr) “WHY” changes to “HOW” Recognizes consequences for actions Memory development Increase langauge Still somewhat concrete thinkers Logical thinking = solve problems Metacognition Aware of own thinking leads to critical thinking

47 Communication Development for Adolescents (12-19 yr) Adult concepts Make plans/sets goals Competitive Group identity Close friends Questions authority Needs for privacy Logic to solve problems Speak/write correctly Communication skills

48 Communicating with Children with Special Needs In working with children with special needs, the nurse must carefully assess each child’s physical, mental, and developmental abilities and determine the most effective methods of communication.

49 Common Stressors During Hospitalization Separation anxiety Loss of control Bodily injury & pain

50 Separation anxiety Toddlers – cling to parents, beg them to stay, may be angry at mom if she leaves and father stays Intervention – encourage parents to stay, cot in room, bring objects from home (cup, bottle, toy, blanket); if parent cannot stay the nurse becomes caregiver…build trust

51 Separation anxiety Preschool- usually not quite as intense in reactions; do not label a child as “spoiled or a brat” – these are normal stress responses Intervention – same as toddler

52 Separation anxiety Schoolage- usually handle separation well, sometimes you have those who don’t cope well –they may not ask for help, may not express feelings Intervention - familiar objects from home (pictures, radio, game-boy, pjs; look at child as an individual; provide continuity of care

53 Separation anxiety Adolescent: geared more towards separation form peers and usual activities; loneliness, boredom, depression, can act against the nurse (sometimes a challenge to care for) Intervention – provide association with peers, use of phone, be a little more relaxed with rules

54 Loss of control Toddlers – autonomy vs shame and doubt; can temper tantrums – ask them to lie down –IV lines are always a challenge they don’t like them “in” –Do not like change in routine –Interventions- good admission assessment will help find rituals & routine; bring favorite items from home including food if diet allows –Forced dependency b/c of hospital routine – let child make decisions when possible (games, drinks)

55 Loss of control Preschooler – magical thinking! Fantasy, superheroes, exaggerates what is to happen or what is really happening -initiative vs guilt – view the hospital as punishment “take me home, I’ll be good” Interventions- allow them to make decisions; explain EVERYTHING do not use threatening words

56 Loss of control School age- industry vs inferiority; very vulnerable to loss of control they feel they need to be productive Intervention – participate in care as much as possible, allow them to make decisions, explain things in advance, allow for questions

57 Loss of control Adolescents – anything that threatens their identity – identity vs role confusion Intervention – explain procedures, tiem to prepare themselves, know what their present needs are

58 The role of the Peds Nurse Care Provider Teacher Collaborator Researcher Advocate Manager

59 Care Provider Empowers the family

60 Teacher To promote health of child; principles of teaching and learning to change family behavior when caring for child

61 Collaborator Coordinating and managing care (interdisciplinary rounds)

62 Researcher Evidenced Based

63 Advocate Intercede on the child’s behalf because they are a vulnerable group

64 Manager of Care Delegate tasks in order to work with other personnel, plan, coordinate, and collaborate

65 In General: The Peds Nurse Bathing Feeding Rest Safety Measures Infection Control Fever-Reducing Measures Emotional/Spiritual Support

66 Atraumatic Care FIRST DO NO HARM Minimize separation Promote sense of control Prevent or minimize bodily injury or pain

67 Hospitalized child and family Nursing assessment –Parental needs –Seek parental advice –Open communication –Concerns –Trust –Positive reinforcement –Ongoing evaluation of POC

68 Preparing the child for Procedures Know your patient and his needs Provide information in terms that can understand Provide support Let the child know it’s ok to express his feelings Praise the child Allow the child to “perform” the procedure

69 Pain Assessment and Management Assessment of pain in infants –Parent of care-giver participation is key based on child’s “normal” behavior patterns –Requires frequent assessment –Pain “clueing” – squirming, jerking,

70 Pain Assessment and Management Toddlers – – may react to non painful procedures as violently as they do painful ones –Explanations do not help –Intense emotional upset & physical resistance, overly active –Can point to pain

71 Pain Assessment and Management Preschooler – –very vulnerable to threats of bodily injury –Respond well to explanations –More verbal “ I hate you” –Can use face scale

72 Pain Assessment and Management School age –Less concerned with pain than disability or death –Ask questions –Listen and attentive –May try to postpone it –Tolerate procedure well but it’s stressful –Privacy

73 Pain Assessment and Management Adolescent –Body imagine is # 1 concern –Do not want to be different from peers –Privacy –Need reassurance that everything is normal –Self control about pain, more adult-like

74 Pain management in the verbal child: –Question the child –Use a pain rating scale - >3 yo (faces) older child 1-10 scale –Look for behavioral and physical signs of pain – preverbal behavior changes & VS changes –Secure parent’s involvement –Look at cause of pain – could anything else be going on –Take action and evaluate – both pharm and non pharm

75 Pain Management Techniques Non-pharmacologic: relaxation, distraction, cutaneous stimulation Pharmacologic measures: –Use pain medications preventively –Avoid im injections if possible –Prepare your patient –Evaluate your interventions promptly and reassess frequently

76 The chronically ill child Last longer than 3 months –Physical –Psychological –Cognitive Adaptive devices

77 The chronically ill child Threat of unknown Loss of control Long-term effects not known Frequent hospitalizations/clinic visits Coping with unfamiliar people

78 The chronically ill child Therapeutic relationship General growth failure –Patho of condition Severe hypoxia Chemo –Developmental delay Parental, teacher, (positive or negative)

79 Caring for the Dying child Boundaries Communication Beliefs and Practices Pain control Hospice Care Dying process and time of death Nurses Response

80 Failure to Thrive Organic – physical ailments Nonorganic – maternal/child attahcment Idiopathic – unknown

81 SIDS Sudden death of infant younger than 1 year Peak age 2-4 month of life Pulmonary edema and intrathoracic hemorrhage No sounds made at time of death

82 Autism Males vs females Abn EEG, cerebella hypoplasia, permanent intellectual and behavioral deficits Bizarre with interactions, communication, and behavior “Rain Man” – idiot savant

83 Infant and Child Safety Medication storage Crib safety Smoke detectors Car seats Drowning Falls Poisoning Choking Falls Poisoning Burns Safety helmets Environmental Factors

84 Adolescent Safety Accidents and injuries Risk taking behaviors Driving Bicycle Firearms Water Reproductive Substance abuse Violence Tattooing/Body piercing

85 Accident Prevention Infant Motor vehicle safety - Rear facing car seat until 20 lbs or 1 year Burns Falls Aspiration (leading cause of choking…latex balloons) Child Proofing House

86 Accident Prevention Toddler Injuries (MVA, drownings, poisoning, and burns) Proper use of Car seats –Forward facing after 1 year or 20 pounds

87 Accident Prevention PreSchooler Child Abuse Sexual Abuse Fire/burn safety Firearm safety Personal safety – no to strangers

88 Issues Related to the School-Age Child Adjustment to school Self-care children (latchkey) Obesity –meals on the run Stress/Depression Accident Prevention –Safety education (car, fire/burn) –Supervised sports (safety gear)

89 Issues Related to the School-Age Child Behavioral problems –ADHD – Attention Deficit/Hyperactivity Disorder Symptoms present before age 7 and present in at least 2 settings Inappropriate inattention, impulsivity, and hyperactivity Numerous, mild, severe Intelligence Quotient (IQ) - wide gap seen between verbal and performance scores Ritalin & Dexedrine – most common drugs - watch for nervousness, insomnia, increased BP, decreased appetite, weight loss, growth

90 Issues Related to the School-Age Child –Enuresis – bedwetting 2 x week for 3 months Organic & psychogenic factors; cease b/tw 6-8 yrs; boys Organic – structural problems (kidney), neurologic deficits, diabetes Psychogenic – emotional factors, family hx Childhood depression

91 Issues Related to the School-Age Child School phobia – severe anxiety or fear of school related experiences Anorexia, n/v, diarrhea, dizziness, HA, tired, stomach aches s/s subside when child can stay home, holidays, weekends Parents must be firm but gently that immediate return to school is crucial Speak with teachers and counselors

92 Issues Related to the School-Age Child Head Lice Bullying Food Allergies

93 Issues Related to the Adolescent Body Image is biggest concern Eating disorders –Obesity –Anorexia Nervosa (AN) – etiology is unclear, but a psychologic component is present –Bulemia

94 Issues Related to the Adolescent Smoking Substance abuse –Changes in personality, behavior, physical appearance –Defense mechanism for anxiety, fear, anger Pregnancy –Use of contraception –Prenatal Care importance –Reduction of Risky behaviors

95 Issues Related to the Adolescent STD Suicide –Warning signs –Education to parents Car safety – seat belts Violence toward others – control issues Firearm safety Lawn Mower accidents

96 Huffing Inhalant abuse –Intervention clip

97 Maltreatment of children Child physical abuse Child sexual abuse Child emotional abuse Child neglect Munchausen-by-proxy syndrome –Deliberately making child sick

98 Depression: children and adolescent ( these are abbrev.) Period of 2 weeks with 5 key elements present and persistent –Sad or irritable mood –Loss of interest –Change in appetite or body weight –Difficulty sleeping or oversleeping –“being slowed down” –Fatigue loss of energy –Feelings of worthlessness or excessive guilt –Decreased ability to think –Recurrent thoughts of death

99 Depression - infant Listlessness without physical cause Failure to respond to caregiver

100 Adolescent dating violence Learned behavior Telling partner what to wear Permission to go Who he/she can be friends with Making partner do something or not unwillingly Destroy property Threatening after break up Repeated contact after breakup

101 Homicide 1/3 of all homicides occur in adolescents Stem from history of abuse in home –Distant, passive, or absent fathers –Dominant, overprotective, sexually inappro. Mothers –Violence b/tw family members –Turmoil in home –Feeling of distrust in home

102 Suicide 3 rd leading cause of death in adolescents Overwhelmed/anxious Peer pressure Females engage (15%) – males carry out (85%)

103 Lead Poisoning Lead based paint Contaminated soil Certain Vinyl mini-blinds Folk remedies Living near major highway Contact with imported pottery, jewelry, cosmetics

Download ppt "Nicole Tinny, MSN, CNS Pediatrics LSCC - Fall 2011."

Similar presentations

Ads by Google