pediatric nursing
-science/art
-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)
Immunizations
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
Homecare
New Morbidity
Atraumatic care
Clinical pathways
Clinical practice guidelines
mortality
rate of deaths
infant mortality
# of deaths/1000 live births, from 28 days of life to 1 year
neonatal mortality
first 28 days
morbidity
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
Injuries
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
cephalocaudal
directional trend
head to toe
proximodistal
directional trend
midline to peripheral
differentiation
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
0-1
pleasure is centered on mouth- sucking, biting, chewing, vocalizing. Provide opportunities for pleasure.
Freud anal stage
1-3
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
3-6
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
6-12
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
0-1
needs consistent loving care. Nurses foster trust by responding to basic needs.
Erikson autonomy v shame/doubt
1-3
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
3-6
explore their world, vigorous play, develop a conscience. Nurses foster initiative by setting them up for success
Erikson industry v inferiority
6-12
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
12-18
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
0-2
progress from simple reflexes to imitative behaviors. Nurses provide appropriate stimulation
Piaget preoperational stage
2-7
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
7-11
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
11-on
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.