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maternity: care for childbearing mothers and their family, teach about pregnancy, labour and recovery process
Paediatrics: deals specifically with children, their development, childhood diseases, and their treatment
Play:
Facilitates mastery over an unfamiliar and scary situation
Provides some control
Provides opportunity to learn about body parts, their own disease / illness / injury
Allows exploration of medical equipment
FCC:Recognises the family as a constant in a child’s life.
Nurses support, respect, encourage, and enhance the family’s strength & competence by developing a partnership with parents
Atraumatic Care: The provision of therapeutic care in settings using interventions that eliminate or minimize the psychologic and physical distress experienced by children and their families
Primary role is directed towards the child and family, make sure the care meets the physical and emotional needs of the child and family.
Pain relief: Water injections, Heat, Water, Epidurals, N202, Morphine, TENS machine, Maternal Positioning
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First trimester - conception (Week 1) until Week 12.
Otherwise known as the embryonic phase
This is the phase where the fetus’ body and organs develop and the placenta develops
Second trimester - Weeks 13-27.
Otherwise known as the fetal phase.
The fetal organs mature
Third trimester - Week 28 until birth
The fetus grows and lays down fat stores.
Naegele’s Rule-Adding 9 months and 7 days to the date of the first day of the woman’s last normal menstrual period
Possible signs of pregnancy
Ammenorrhoea (missed period)
Nausea and vomiting
Breast enlargement and tenderness
Frequency passing urine, especially at night
Quickening- fetal movements felt
Cravings for some foods, dislike for others
Fatigue
The common discomforts by systems include:
Digestive system:
Morning sickness
Heartburn
Constipation
Pica
Nausea and vomiting.
Musculoskeletal system:
Backache, Symphysis pubis dysfunction/pelvic girdle pain, Round ligament pain, Leg cramps.
Renal and reproductive systems:
Frequency of micturition, Vaginal discharge
Leucorrhoea, Pruritus.
Circulatory system:
Fainting, Varicose veins and haemorrhoids, Skin changes
Nervous system:
Carpal tunnel syndrome, Insomnia.
endorphins, which help with the management of pain avoid= active labour positioning
First stage of labour (contractions and cervix dilates) have [ blood stained mucus discharge= show, loose bowel motions, A greenish or bloody colour water break can indicate a problem with the baby]- stay home, regular snacks for energy, rest, relax in bath/ shower, go toilet regularly/ empty bowels
second stage (baby is born) have [longer and stronger contractions, increased pressure in your bottom, the desire or urge to push, shaky cramps, nausea and vomiting]- concentrate on your contractions, try to let go, try different positions, bath or shower, drink and rest.
3rd stage (birth baby done, birth of placenta) have [more contractions to expel the placenta, feel fullness in vagina]- sually pull on the cord to deliver the placenta
4th stage (postpartum period)- eat, drink and rest, pain relief, personal hygiene, emotional and psychological wellbeing
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Antenatal care is the care a mother recieves during pregnancy
The First Appointment: allow the midwife or doctor to check the health of the pregnant women and the baby’s health so they can find and treat any problems early on
Ongoing Appointments: checks, scans, tests and discussions
Lochia: blood loss Rubra[red]1-3 days post birth
Serosa [pink] 4-10 days post birth
Alba [white] 11-21 days post birth
First-degree tear perineal skin and/or vaginal mucosa, can heal on their own
Second-degree tear injury to perineum involving perineal muscles
Third degree tear
Injury to perineum involving the anal sphincter complex
Injury to perineum involving the anal sphincter complex and anorectal mucosa
Mastitis is an inflammation of the breast that can lead to an infection.
‘baby blues
PND) occurs in approximately 12% of new mothers
breastfeed:regulation of newborn temperature
Regulation of heart rate and breathing
initiation of breastfeeding
enhance maternal/newborn bonding
APGAR (appearance, pulse, grimace, activity, respiration)
pee once in first 24 hours
bowel yellow
vital signs 3.5kg, 60-95BP, 120-185 Beats/M, 25-60 breathes/M
Formula should not be pre-prepared and refrigerated
DO NOT heat formula in a microwave
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Premature birth or other illness and injury that affect brain development are some of the things that might cause developmental delays.
newborn 0-28D
infant 28D-12M (age in months + 9)/2=kg
toddler 12M-23M
children 4 x age in years=kg
Head circumference reflects brain size and is
routinely measured up to 2 yr.
Fine motor skills: Picking up small objects, Drawing
* Gross motor skills: Walking, Climbing stairs
factors affect G/D? Nutrition, Hormones
Environment, Familial influences,
Emotional & Social Development,
Parenting Style Learning & Reinforcement
Culture Language, Education, Exercise
Illness / Injury, Siblings
Piaget
Cognitive Development
- How a person perceives, thinks, & understands their world through the
interaction of genetic & learned factors
FCC is a way to provide health care that recognises the importance of family for a hospitalised child. Maintain and strengthen family roles and the natural bond the family has with the child, in order to promote a healthy family functioning
[reat patients and families with dignity and respect, Share information clearly and openly, Involve the patient and family in decision making, Share the provision of care
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Airway: Shorter/ fatter neck, Large head compared to body, Smaller, funnelled, narrow airway, nose breather, The trachea is short,Trachea is more cartilaginous and soft, Larynx is soft, higher and more anterior
Breathing: Ribs are positioned more horizontally
Thin chest wall and more compliant
Respiratory rate, Heart rate and hypoxia, Diaphragmatic breathing, Small amount of elastic and collagen tissue in lungs, Even mild airway edema can dramatically impact a child’s WOB
Circulation: HR decreases with age, BP increases with age, Systemic vascular resistance is lower, parasympathetic tone is the most dominant which makes infants more prone to bradycardias, Left Ventricular muscle not fully developed until 6 yrs. – may not have palpable radial pulse, Smaller vessels / more subcutaneous tissue, High risk of fluid overload, Hypotension is a late sign
Disability/CNS/Neurological: Immature Blood-Brain Barrier, 2/3 of fetal brain cell growth occurs before birth, Cognitive and psychological development varies with age, Rapid development continues during infancy – slows by late childhood
90% of brain growth has occurred by aged 6 years
At birth the brain has limited control over body movements – controlled by primitive reflexes
Persistence of reflexes may indicate problem with brain development, Spaces between bones – known as ‘soft spots’
Exposure: Relative small size= risk of multiorgan injuries, Higher BMR, Larger SA to body-mass ratio (Lose heat & fluids more rapidly), Increased glucose requirements, Decreased glycogen stores
Renal: Immature kidney function,Plasma osmolality
Abdomen: Thin abdominal wall Organ proportions and placement, Diaphragm is more horizontal
Major stressors include:
Separation, Fear, Loss of control, Anxiety, Fear of bodily injury and pain
strategy: Play therapy, including medical play
Distraction such as TV, games, bubbles, toys
Involving parents, Mobilise their coping strategies
Give some choices
Verbal Communication
Language – medical words, what is the person’s native language
Tone
Relevant to educational understanding
Non-Verbal Communication
Positioning
Gestures
Eye contact
Solitary: Plays alone (normal at any age)
Parallel: Toddler plays beside another child without interacting but often with imitation
Imitative: Children copy each other or an adult
Social: Well before 24 months, toddlers will offer toys, looks, or words to other children as a way of communicating.
Co‑operative Play: Start to play with other children. Many children are not ready for this kind of play until they are 36 months
0-6 months
Facial expressions & tone of voice are key
6-18 months
Use stimulating objects to attract attention and for distraction
18 months – 3 years
Play & curiosity are big motivators
3-6 years
Can be talkative and verbally enthusiastic
Like having choices
Magical thinkers
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Focused Assessments
Respiratory Assessment
Asthma:
Asthma is a common condition caused by narrowing of the small air passages in the lungs
Bronchiolitis is an acute viral infection of the lower respiratory tract
assessment:
Level of Respiratory Distress
Central and Peripheral Capillary Refill Time
Colour – i.e.: pink, pale, grey, cyanosed, flushed
Feeding / Hydration Status / urine output
Level of consciousness
gastro) is a bowel infection that causes diarrhoea and sometimes vomiting
Points to consider
pain history
location of pain
intensity of pain
relieving factors
exacerbating factors
cognitive development and understanding of pain
FLACC scale Wong Baker Faces & Neonatal PAT non verbal;
health promo:
he provision of information to parents through written or audio-visual resources;
a discussion between the worker and the family, or demonstration of a health- promoting behaviour;
role modelling through specifically set up groups and through experiences of other parents; and
community awareness activities.
Parallel play where a toddler is near to another person but does not actively engage with them.
Per Axilla (PA) as a Tympanic thermometer cannot be used for children with an ear infection due to purulent discharge that prevents contact of the thermometer to the TM
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assessment in middle child
Children like to think they are grown up (and brave) - BUT
They should be given the choice of having parent present
Remove own clothing – offer gown (very body conscious) & encourage involvement
Involve them - in asking & answering questions throughout assessment
Explain procedure & equipment – allow child to handle it
Head – Toe assessment with explanation at each stage (use strategies like diagrams to assist)
Literal interpretations – “Cat Scan”
Treatment may be viewed as punishment
Distraction is important (developmentally appropriate)
older middle child: chool-aged children may question parents & rebel against authority figures
They can understand the past & foresee future consequences
Major fears include bodily injury, mutilation, separation, and death
Death is understood more fully during the school-age years
Early in this stage, children view death in terms of a dark magical force that would remove them from their parents
Later they view death as a permanent state and by the end of the school-age years have an adult concept of death
HEEADSSS (home, education, eating, activities, drug, sexuality, suicide, safety) obtain PROS for adolescent patient with mental health concerns
child in pain= increased HR, BP, RR
mature minors 16-18y/o
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impact of med choices: The composition of intestinal fluids gut permeability vary during childhood
Absorption of orally administered drugs is affected by changes in gastric pH which decreases during infancy – reaches adult values by 2 years
Infants are at higher risk of toxicity via skin absorption due to a larger surface area to volume ratio and thinner epidermis
Distribution:
The volume of distribution changes throughout childhood as stores of fat and water change
Infants have a higher percentage of extracellular water, and stores of body fat increase throughout childhood
Changes in volume of distribution can alter the drug’s half-life - adjustment of the dosing interval
Infants have lower concentrations of circulating plasma proteins reducing protein binding
Metabolism:
The metabolism of drugs is the most complex difference between adults and children.
Cytochrome P450 are lower in childhood - reach or exceed adult levels at around 2 years of age
Liver blood flow may be relatively high in infants. This could affect first-pass metabolism particularly for some drugs
Metabolic rate increases dramatically in children & is often greater than in adults.
Compared with adults, children may require more frequent dosing or higher doses on an mg/kg basis
Elimination:
Excretion is an important step in the final removal of the drug and any metabolites from the body
It relies on effective renal and hepatic function that develop over time
Complete maturation of renal function is not reached until 6-8 months of age
Preterm neonates develop renal excretion pathways more slowly than term neonates
Glomerular filtration rates reach adult levels by about two years of ag
Practical:
Increased frequency of feeding (interaction between feeds and medication)
Increased number of stools
Strength of available medication formulation
Interaction with foods the child likes
Compliance is influenced by taste, appearance & ease of administration
Prescribed regimens should be tailored to the child’s daily routine
Where possible, treatment goals should be set in collaboration with the child
Avoiding the need for administration during school hours should be considered
Oral Medications: Drip medication into the mouth slowly along the side of tongue, Check to ensure the child has taken the medication, Dip the syringe tip into something sweet to mask the initial taste
Give something sweet or tangy or ice prior to / after medication
Ear Drops:
Straighten the ear canal
Gently pull Pinna up & back
Lie on side for > 1 minute. Remember to warn child dizziness & nausea may occur (epecially with cold drops)
Nose Drops:
Blow nose
Tilt head back
Aim dropper to back of nose and administer drops
Keep head back for 30 seconds
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The age of majority is the threshold of adulthood as recognized or declared in law. It is the moment when minors cease to be considered such and assume legal control over their persons, actions, and decisions
Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child (a person under 16 years of age) is able to consent to their own medical treatment
The Information Privacy Act It sets standards for how personal information & sensitive information is collected, handled and disposed of.
Health Records Act 2001 (Vic) applies to organisations who hold health information in Victoria. It sets standards for how health information about a person is collected, handled and disposed of,
Mandatory Reporting
The legal requirement to report suspected cases of child abuse and neglect.
he four Guiding Principles of the CRC are:
* respect for the best interests of the child as a primary consideration
* the right to survival and development
* the right of all children to express their views freely on all matters affecting them
* the right of all children to enjoy all the rights of the CRC without discrimination of any kind.
