Week 1

pediatric nursing

-promotion of health
-prevention, diagnosis, and tx of disease
-independent/collaborative management of the child/family response to illness
-birth through adolescence

US history of child health

1870 first professorship in pediatrics
1900 infant mortality of 200/1000
Early 1900s improved sanitation
1902 first school nurse position
1935 Title V of social security act provided aid for MCH, child welfare
1940s studies on psychosocial effects of hosp

positive effects on child health

Improved sanitation
Antibiotics (penicillin in 1940s)
Improved nutrition
Attention to psychological needs
Child labor laws
Attention to safety needs

present focus of child health

Access to health care
Prevention of disease
New Morbidity
Atraumatic care
Clinical pathways
Clinical practice guidelines


rate of deaths

infant mortality

# of deaths/1000 live births, from 28 days of life to 1 year

neonatal mortality

first 28 days


rate of occurence

US infant mortality

5.8 deaths per 1000

Japan infant mortality

2.1 deaths per 1000

uses for mortality/morbidity

Target specific diseases & populations in need
Guide research
Direct teaching of disease prevention
Demonstrate/evaluate progress

infant causes of death

congenital malformations, low birth weight, SIDS, maternal complications, unintentional injuries

childhood causes of death (1-4yrs)

accidents/injuries, congenital anomalies, homicide

childhood causes of death (5-14yrs)

unintentional injuries, cancer, intentional injuries

adolescence causes of death

unintentional injuries, suicide, homicide

major causes of illness

Respiratory infections
Chronic disorders- asthma, sensory deficits, behavioral disorders
Diarrhea & urinary tract infections

developmental age periods

Infancy - birth to 1 year
Toddler - 1 to 2
Preschooler - 3 to 5
School age - 6 to 12
Adolescence - 13- 18

differences between care of adults/children

Influence of growth & development- constant change
Necessity for adult advocacy
Emphasis on Family- Parent plus child equals the client- Family centered care


directional trend
head to toe


directional trend
midline to peripheral


directional trend
from simple to more complex

sequential trends

definite predictable sequence (e.g., crawl, stand, walk)

developmental pace

periods of acceleration and deceleration- not at the same rate

sensitive periods

times when vulnerable and times are optimal

Sigmund Freud Psychosexual

Oral stage- birth to 1 year
Anal stage- 1 to 3 years
Phallic stage- 3 to 6 years
Latency period- 6 to 12 years
Genital stage- 12 and over

Freud oral stage

pleasure is centered on mouth- sucking, biting, chewing, vocalizing. Provide opportunities for pleasure.

Freud anal stage

interest centers on sphincter control. Toilet trained child may feel bad if she/he regresses. I & O and other nursing procedures important

Freud phallic stage

genitals become interesting and are curious about the differences between the sexes. Oedipus and Electra complexes? Any GU surgery or foley catheters may be upsetting

Freud latency stage

energy channeled into play and gaining knowledge. Many nursing opportunities to foster development

Freud genital stage

12 on
begins with puberty. Genital organs become source of sexual tension and pleasure. Energy invested in forming friendships and preparation for relationships

Erickson Psychosocial

Trust vs Mistrust- birth to 1 year
Autonomy vs Shame & Doubt- 1 to 3 years
Initiative vs guilt- 3 to 6 years
Industry vs Inferiority- 6 to 12 years
Identity vs Role Confusion- 12 to 18
[Other adult stages]

Erikson Trust v Mistrust

needs consistent loving care. Nurses foster trust by responding to basic needs.

Erikson autonomy v shame/doubt

want to control their bodies & environment and they want to do things for themselves. Nurses foster by giving real choices and control

Erikson initiative v guilt

explore their world, vigorous play, develop a conscience. Nurses foster initiative by setting them up for success

Erikson industry v inferiority

want to engage in activities with real sense of achievement, learn to compete and cooperate with others. Nurses foster with projects and having goals that they can attain. Avoid inferiority by not expecting something beyond their level.

Erikson identity v role confusion

marked by rapid physical changes, preoccupied with how other see them, struggle to fit into the roles they see as important, peers' opinion is critical. Nurses foster identity by enhancing self-concept, encouraging peer involvement, may need help in

Piaget Cognitive Development

Sensorimotor- birth to 2 years
Preoperational- 2 to 7 years
Concrete Operations- 7 to 11 years
Formal Operations- 11 on

Piaget sensorimotor stage

progress from simple reflexes to imitative behaviors. Nurses provide appropriate stimulation

Piaget preoperational stage

egocentric (inability to put oneself in place of another), cannot see another's point of view, reasoning is transductive (events occurring at same time are cause and effect).
Nurses- don't try to reason, give simple, concrete, explanations.

Piaget concrete operations stage

increasing logic and problem solving, conservation. Nurses give concrete examples linking concept to the child's world of experience. Medical world is foreign so link it to what they do know.

Piaget formal operations stage

thought is more adaptable, flexible, can think in abstract terms and use abstract symbols, draw logical conclusions, make and test hypotheses. Nurses can explain in more depth with real discussion of consequences.