Pedatric Lecture - Exam 1 Flashcards Preview

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Infant Normal Heart Rate



Infant Normal Respiratory Rate



Toddler Normal Heart Rate



Preschooler Normal Heart Rate



Toddler Normal Respiratory Rate



Preschooler Normal Respiratory Rate



School-age Normal Heart Rate



School-age Normal Respiratory Rate



Adolescent Normal Respiratory Rate



Adolescent Normal Heart Rate



Infant Age

Birth-1 year


Toddler Age



Preschooler Age



School Age



Adolescent Age



Erikson Stage 1

Birth - 1 year

Trust VS Mistrust

Establishment of trust dominates the first year of life. Consistent loving care by a mothering person is essential for development of trust. Mistrust develops when trust-promoting experiences are deficient or lacking or when basic needs are inconsistently or inadequately met. Although shreds of mistrust are sprinkled throughout the personality, from a basic trust in parents stems trust in the world, other people, and oneself. The result is faith and optimism.


Erikson Stage 2

1 - 3 years

Autonomy VS Shame & Doubt

The development of autonomy during the toddler period is centered on children's increasing ability to control their bodies, themselves, and their environment. They want to do things for themselves, using their newly acquired motor skills of walking, climbing, and manipulating and their mental powers of selecting and decision making. Much of their learning is acquired by imitating the activities and behavior of others. Negative feelings of doubt and shame arise when children are made to feel small and self-conscious, when their choices are disastrous, when others shame them, or when they are forced to be dependent in areas in which they are capable of assuming control. The favorable outcomes are self-control and willpower.


Erikson Stage 3

3 - 6 years

Initiative VS Guilt

Children explore the physical world with all their senses and powers and develop a conscience. No longer guided only by outsiders, they have an inner voice that warns  and threatens. Children sometimes undertake goals or activities that are in conflict with those of parents or others, and being made to feel that thier activities or imaginings are bad produces a sense of guilt. Children must learn to retain a sense of initiative without impinging on the rights and privileges of others. The lasting outcomes are direction and purpose.


Erikson Stage 4

6 - 12 years

Industry VS Inferiority

Having acheived the more crucial stages in personality development, children are ready to be workers and producers. They want to engage in tasks and activities that they can carry through to completion. They need and want real achievement. Children learn to compete and cooperate with others, and they learn the rules. It is a decisive period in their social relationships with others. Feelings of inadequacy and inferiority may develop if too much is expected of them or if they believe that they cannot measure up to the standards set for them by others. The ego quality developed from a sense of industry is competence.


Erikson Stage 5

12 - 18 years

Identity VS Role Confusion

Rapid and marked physical changes. Previous trust in their bodies is shaken, and children become overly preoccupied with the way they appear in the eyes of others as compared with their own self concept. Adolescents struggle to fit the roles they have played and those they hope to play with the current roles and fashions adopted by their peers, to intergrate their concepts and values with those of society, and to come to a decision regarding an occupation. Inability to solve the core conflict results in role confusion. The outcome of successful mastery is devotion and fidelity to others and to values and ideologies.


Expected Developmental Level VS Actual Developmental Level


Developmental Level on Admission VS Throughout Admission


What should you expect in a sick/hospitalized child in reference to developmental levels?

Regression to a prior developmental level



Expected stressors in the infant

Separation anxiety, stranger anxiety


Expected stressors in the toddler

separation anxiety, stranger anxiety, lack of familiarity environment and routines


Expected stressors in preschool aged children

separation anxiety, fear of mutilation and bodily injury, may view hospitalization as a punishment


Expected stressors in the school aged child

fear of mutilation and pain, fear of death, concerns of body image, loss of control


Expected stressors in the adolescent

loss of control and independence, threat of change in body image, restriction of physical activities, fear of rejection from peers, fear of death


TNI Infant *

Encourage parents to room in

Utilize primary nursing

Speak in gentle tone and maintain eye contact

Use gentle touch/swaddle for comfort and/or procedures

Gently rock in arms


TNI Toddler

Encourage parents to room in

Adapt hospital routines to home routines

Provide a "lovey" from home

Provide time for play

Perform procedures in sitting position


TNI Preschooler *

Encourage parents to room in

Bring favorite articles from home

Repeatedly explain reasons for procedures and evaluate child's understanding

Provide distractions for child during procedures (bright objects, noises, games, blowing bubbles, etc.)


TNI School-age *

Provide special objects from home

Encourage school-work and visits from friends/relatives

Explain procedures clearly while eliciting child's understanding

Involve child in planning their care (menu selection, keeping their room clean, playing with younger hospitalized children, assisting with their treatments)


TNI Adolescents *

Encourage teen to bring in favorites from home

Promote their independence (assist with planning their care, allowing street clothes, making their meal choices, continuing school work, room in with peers, encouraging visits from friends/family)

Thoroughly explain procedures and what they will see/smell and feel

Describe any scars they may incur on their body


Where should all painful procedures be done for children (especially younger children)?

Procedure room/treatment room


Post-Hospital Behaviors

General anxiety and regression

Separation Anxiety

Sleep Disorders

Eating Disturbances

Aggression toward authority




Factors influencing outcomes of hospitalization

Ability of child to maintain baseline functioning/ADLs

Degree of communication among all providers with parents/caregivers

Parent and child participation in care and decision making

Amount of past hospitalization experiences and the outcomes

Number of concurrent stressors

Pre-hospitalization coping

Length of hospital stay

Specific interventions during hospital stay to support child/family

Emotional state of child/family


How nursing can help families cope with a hospitalized child

Strongly encourage communication with child's health care team

Review the parent/caregiver's role during their child's hospitalization

Review the parent/caregiver's role to their non-hospitalized children

Encouraging the parent/caregivers' to care for themselves during child's hospitalization

Listen carefully


Parent/Caregiver response to hospitalization of a child

Loss of control

Range of emotions (fear, guilt, helplessness, anger, confusion, worry)

Emotional unavailability to others

Loss of work/sense of belonging

Loss of normal routine

Inability to maintain home/family life

Loss of martial relationship


Pain Management

Older children: numeric

Toddlers: FACES

Infants: body mechanics

Help children communicate and control pain

Take VS to look for elevations which indicate pain

Assess for sweaty palms, irritability, appetite and mobility

Routes: Tablet, liquid, IV

Assess and monitor respirations after administering narcotics

Consider safety after narcotic administration

Non-pharmaceutical: distraction, touch therapy, splinting ("bridging")

Manage pain even if they cannot express it



Helps children to process things that have happened, to learn, to grow, to gain a sense of mastery and to decrease fear

If staff is involved, that is positive

Focus on play based on their limitations

Try to make it normal through play

Play can be directed or free, unstructured play

Therapeutic and medical play to gain a sense of control, correct misconceptionss

Child life specialist or nurse can use medical play

Play can be used for teaching and to give child sense of control

Can help children adjust and learn




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