Nursing Tips: Pediatrics

Authoritarian parents are those who are strict and require high control but offer little warmth. Authoritative parents have moderate-high control, but offer high amounts of warmth. 

When performing a Snellen exam for visual acuity, an adult should stand 20 feet away from the chart, but a child should stand 10 feet from the chart.

When caring for a child with appendicitis, report to the provider any sudden relief of pain. This may indicate that the appendix has perforated and requires emergency surgery!

When caring for a child with pheochromocytoma, be sure not to palpate the abdomen. Palpation can cause a sudden release of catecholamines, triggering severe hypertension!

At approximately 1 year of age, a child should begin using "holophrases," which are one-word sentences. By age 2 the child should use more than 50 words and 2 - 3 word phrases.

A child with scabies is likely to exhibit white lines in between fingers, toes, or skin folds. The whole family should be examined and treated!

A child with Osteogenesis Imperfecta may exhibit a blue color of the sclera. Be sure to report this finding to the provider for further evaluation.

A child with meningocele or myelomeningocele is at risk for injury due to the exposed spinal cord. Cover the sac with sterile, saline-moistened, non-adherent dressing. Place infant prone with the hips flexed.

A child with meningitis is likely to have a fever, headache, nausea, vomiting, irritability, nuchal (neck) rigidity, photophobia, and + Kernig's and Brudzinski's signs. 

A child with Sickle Cell Anemia experiencing vaso-occlusive crisis should be treated with scheduled opioid analgesia (non-opioid analgesia will not be sufficient!).

A child with Meckel's Diverticulum is likely to exhibit painless rectal bleeding and stool with the consistency and appearance of "currant jelly."

A child with infective endocarditis will require IV antibiotics via PICC line for 2 - 6 weeks, and may require a valve repair or replacement.

A child with Hemophilia A is deficient in Factor VIII. In Hemophilia B the deficiency is with Factor IX. Treatment of these conditions will include replacement of the missing factor, desmopressin, and aminocaproic acid.

A child with Growth Hormone Deficiency would have an average birth weight/length, but show delayed growth through childhood.

A child with a head injury is at risk for elevated intracranial pressure (ICP). Nursing care to decrease ICP includes reducing hypercapnia by hyperventilating the patient, avoiding oral suctioning, keeping the HOB at 30 degrees, and keeping the head in a neutral/midline position.

A child with Chickenpox (Varicella) is contagious until all lesions have crusted over. Educate families to keep them at home and away from others until this time.

A child with ADHD may be treated with CNS stimulants such as amphetamine mixtures or methylphenidate. 

A child who presents with an abnormal tuft of hair, a dimple, or a birthmark on the spine should be evaluated for spina bifida occulta, a form of spina bifida. Report these findings to the provider.

A child who appears to be frequently "day dreaming" or often exhibits blank staring, eye fluttering, lip smacking, or picking at clothes should be evaluated for absence seizures.

A child demonstrating oliguria, cola-colored urine, and signs/symptoms of hypervolemia following a recent streptococcal infection (strep throat) should be evaluated for Acute Glomerulonephritis.

KEY symptoms of Coarctation of the Aorta: elevated BP and bounding pulses in the arms, decreased BP and pulses in the legs.

KEY symptoms of a Patent Ductus Arteriosus: machine-hum murmur, bounding pulses, and wide pulse pressure.

Key signs/symptoms of Autism: Lack of eye contact Repetitive motions/actions Delayed speech and language skills Strict adherence to routines Unusual eating or sleeping habits Digestive problems.

IMMUNIZATIONS IN FIRST 6  MONTHS Birth = "B" Hep B 2 Months = "B. Dr. HIP" Hep B, DTAP, RV, Hib, IPV, PCV 4 months = "Dr. HIP" DTAP, RV, Hib, IPV, PCV 6 months = "B. Dr. HIP" Hep B (6-12 months), DTAP, RV, Hib, IPV (3rd dose: 6-18 months), PCV

In toddlers, parallel play is expected. Parallel play means that children play independently NEXT to other children.

A child who is crying without producing tears should be evaluated for severe dehydration.

For intramuscular injections under 1 year old, use vastus lateralis muscle!

Educate families that when giving medication to children, they must use a calibrated device

Early signs of increased ICP in infants: irritability, high-pitched cry, poor feeding, “setting-sun” phenomenon, bulging fontanels, separation of cranial sutures.

Crib safety: Infants on back to sleep, nothing in crib, and width of crib slats

2 Key beliefs of preschoolers: (1) Magical thinking: thoughts can cause events to occur, and (2) Animism: inanimate objects are alive.

Infants should DOUBLE their birthweight by 6 months, and TRIPLE their birthweight by 1 year.

After a tonsillectomy, monitor for frequent swallowing or clearing of the throat. This can indicate bleeding at the incision site!

Tooth eruption typically begins around 6 months of age. You can calculate the child's estimated age by the number of teeth they have!

Nursing care for the child with cystic fibrosis

Risk factors for Sudden Infant Death Syndrome (SIDS)

Patent Ductus Arteriosus (PDA) is a congenital heart defect where the fetal ductus arteriosus fails to close.

Signs that a child is ready for toilet training.

A child's posterior fontanelle closes first, then the anterior fontanelle closes.

When assessing a child's pain, be sure to use an age-appropriate pain scale.

Signs of physical abuse. Always report ANY suspicion of abuse!

Signs of child neglect: poor hygiene, inappropriate dress (for weather), malnourishment, withdrawal, school absences.

Major risk factor for rheumatic fever: untreated or partially treated upper respiratory infection with Group A beta-hemolytic streptococcus (GABHS).

If you suspect that a patient has epiglottitis, DO NOT take a throat culture or place a tongue blade in the patient's mouth!

Major risk factor for Reye's syndrome: Use of aspirin to treat fever associated with a viral infection.

Signs of abuse in children: bruising in unusual locations (bruising on arms/legs expected!), bruising in different stages of healing, forearm spiral fractures.

The following foods pose a choking hazard for small children: popcorn, raisins, peanuts, grapes, raw carrots, hotdogs, celery, peanut butter, candy, tough meat.