1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 11 Care of the Pediatric Patient

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pediatric Unit Usually decorated in child-friendly colors and designs Most have central activity areas Most have accommodations for rooming-in Often meals (“parent trays”) can be ordered so the family caregiver and the child can eat together

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pediatric Unit

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of Hospitalization on the Child and Family Children often become stressed when separated from family caregivers and go through three stages: Protest Despair Denial

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Fears of the Hospitalized Child Pain Punishment Mutilation Death

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Importance of Play for Hospitalized Child

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Play

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins FACES Pain Rating Scale

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Minimizing a Child’s Pain Repositioning and the use of supportive devices Massage or gentle touch Smaller children may be comforted by being held or rocked Activities: talking, playing, listening to music, or watching television

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Role of the Nursing Assistant in Caring for Pediatric Patients Consider developmental stage Assist with nutrition Assist with elimination Assist with procedures Assist with restraints Assist with transport

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of a Restrained Pediatric Patient Restraints, especially when used on small children, are extremely dangerous Make sure to check on a child who is restrained frequently (at least every 10 minutes) Remove the restraint and stay with the patient for a short period of time every 2 hours

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

13. Common Disorders Affecting Children Congenital disorders Trauma Infectious disease Chronic illness and developmental disabilities Cancer

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Respiratory Disorders Respiratory syncytial virus (RSV) –Most common in 6months to 2 years –Antibiotics are not effective –Produces thick mucous that plugs bronchioles Croup –Viral or bacterial infection of URT –Causes a harsh, bark-like cough –Usually children under 3 years

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Respiratory Disorders Epiglottitis –Form of croup caused by a bacteria –Causes swelling of the glottis Asthma –Affects the bronchi and bonchioles –May be triggered by allergies, smoke or weather Cystic fibrosis –Genetic disorder –Mucous is extremely thick

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of a Child With Respiratory Disorders Observations that should immediately be reported to the nurse: The child is having difficulty breathing The child’s lips appear blue (cyanosis) There is a change in the child’s vital signs The child is becoming restless

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Cardiovascular Disorders Septal anomalies –Affects the wall of the heart, occurs during development Patent foramen ovale Small opening allows blood that enters rt atrium to pass to the left atrium Blood bypasses the lungs Ventricular septal defect Small opening in ventricle allows blood to pass from left ventricle to rt ventricle

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Patent Foramen Ovale

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Cardiovascular Disorders (cont) Disorders of the great vessels –Patent ductus arteriosus Oxygenqated blood flows from aorta into pulomonary artery May require surgery if signs and symptoms –Coarctation of the aorta Aorta becomes narrow before leaving the lt ventricle Cause extra work on ventricle to pump blood Can lead to congestive heart failure

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Patent Ductus Arteriosus

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Cardiovascular Disorders –Tetrology of Fallot Four heart anomalies Requires open heart surgery before the age of 1 –Transposition of the great arteries Pulmonary artery and aorta are switched Causes less o2 to be pumped to the body

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Neurologic Disorders Congenital anomalies –Cerebral palsy-damage to the cerebrum –Hydrocephalus-build up of cerebralspinal fluid –Spina bifida-vertebrae don’t close and leave spinal cord exposed

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Neurologic Disorders Meningitis –Inflammation of the meninges (surrounds brain and spinal cord –Bacterial (infants and children) and viral (older than 16) Diagnosed by spinal puncture Traumatic brain injury and spinal cord injury

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Gastrointestinal Disorders Diarrhea and vomiting –Most common is rotavirus Congenital anomalies –Esophageal atresia-esophagus doesn’t develop –Imperforate anus-opeing to the anus is blocked –Hernias-many types umbilical is common –Omphalocele-intestines protrude through umbilicus Appendicitis

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Esophageal Atresia -

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Omphalocele

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Appendicitis

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Most Common Endocrine Disorder Type 1 diabetes mellitus –First signs are usually weight loss, slowed growth, and a lack of energy

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Diabetic Child Observations that should immediately be reported to the nurse: Odd, unusual, or antisocial behavior Weakness, fatigue, or lethargy (lack of energy) Nervousness Headache Blurred vision Dizziness Hunger Pallor Sweating

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Genitourinary Disorders Cryptorchidism Hypospadias

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Musculoskeletal Disorders Fractures Hip dysplasia Juvenile rheumatoid arthritis Muscular dystrophy

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for a Child With a Cast Immediately report the following to the nurse: The fingers or toes are pale, blue, or cold The child complains of increased pain, numbness, or tingling There is increased drainage on the cast There is a foul odor

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cancer Leukemia Lymphomas Brain tumors Wilms’ tumor Nephroblastoma

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Care Needs of Pediatric Cancer Patients The same methods to treat cancer in adults are used to treat children: –Surgery –Chemotherapy –Radiation –Bone marrow transplant Reverse (protective) isolation

35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs of Cancer in Children Unusual mass or swelling Unexplained pallor and loss of energy Sudden tendency to bruise Persistent, localized pain or limping Prolonged, unexplained fever or illness Frequent headaches, often with vomiting Sudden eye or vision changes Excessive, rapid weight loss

36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs of Child Abuse

37. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Most hospitalized children separated from their family caregivers go through which of the following three stages? A.Denial, anger, bargaining B.Fear, betrayal, protest C.Despair, depression, acceptance D.Protest, despair, denial

38. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Protest, despair, denial A child’s illness or injury, especially if it results in the need for hospitalization, is very stressful for the child and family.

39. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Therapeutic play is a play technique that is often used for which of the following? A.A child who is unable to go to the central activity area (for example, because he has a contagious disease B.Choosing age-appropriate toys C.Helping a child have a better understanding of treatment or surgery D.Adolescents and teenagers

40. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Helping a child have a better understanding of treatment or surgery Any type of play that increases the child’s understanding of what is going to happen will help to decrease the child’s anxiety.

41. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. If you are suspicious about something a child has told you, question the child further yourself before reporting your suspicions to the nurse. A.True B.False

42. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. False It is better to allow a person who has experience and training in detecting child abuse to continue the questioning.