- underdeveloped peripheral anxious device (negative thermoregulation, gross motor
movements)
Children:
- cognitive and psychological development varies with age (effect on the strategies used to
evaluate and control neurology)
Differences in HEENT
Infants:
- toddlers and small youngsters have smaller airlines (Minor accidents and mild swelling can
swiftly compromise their capability to breath.)
- newborns have 2 fontanels. The anterior closes at 10-16 months, and the posterior closes at
birth-three months (gives them a further manner for compensating within the occasion of
expanded intracranial stress)
Children:
- young kids have relatively huge heads and underdeveloped musculature (preserve higher
proportions of isolated head accidents than older children and attain extra upper C-backbone
location injuries)
- below the age of eight they may be prone to spinal cord harm with out radiological abnormality
(SCIWORA)
Differences in Respiratory System
Infants:
,- Infants < 6 months are obligate nose breathers (respiratory distress if object in nose)
- Higher oxygen requirements and smaller respiratory reserve (more prone to desaturation)
Children:
- Smaller airways and lung volumes (increased resistance to airflow and risk of obstruction)
- Limited energy reserves (RR is high which leads to fatigued chest wall musculature and
diaphragm)
- Immature development of respiratory musculature and compliant rib structure (compliant ribs
can cause chest wall to collapse and w/ increasing effort and ventilation can become
compromised)
Differences in Cardiovascular System
CO = HRXSV
Infants:
Children:
- Circulating blood volume is relatively larger and muscle mass of heart is immature (small blood
losses can have a greater impact and they cannot increase stroke volume to increase cardiac
output; they can only increase their heart rate)
- SV is lower in children so they compensate by increasing HR (when they begin to
decompensate they cannot sustain their cardiac output at a level that maintains their
cardiovascular functioning and deteriorate quickly) *low BP is a sign of decompensation
Differences in Gastrointestinal System
Children:
- children have smaller stomachs their stomach empties faster, and their small intestine is
proportionately longer than that of an adult ( secrete proportionately more fluids & electrolytes
into the intestine than adults do so when they have a GI illness they are prone to severe fluid &
electrolyte depletion due to the increase % of their body composition being water)
- the liver in children is immature (they are unable to reabsorb amino acids and hold onto fluids
so they are at an increase risk for dehydration)
,Differences in Genital-Urinary System
Infants:
- infants have immature kidneys until 12 months of age and have a decreased ability to
concentrate urine (heightened risk for severe dehydration)
Differences in Muscle-Skeletal System
Infants:
Children:
- bones are more elastic, bones bend more easily resulting in greenstick fractures, and faster
bone healing unless break is in epiphyseal plates which can cause impact on bone growth
- liver and spleen are less protected by the rib cage and are thus at greater risk from blunt
abdominal trauma
Differences in Skin
Infants
- acrocrocyanosis is normal (blood and oxygen are circulating to more important areas of the
body)
Children:
- larger surface area / volume ratio (greater risk of hypothermia after trauma)
Assessment techniques needed in pediatrics
- use warm hands and stethoscope
- use play strategies
- don't forget about modesty
- simple language to prevent confusion
- be honest
- include families as it allows children to trust you
- child life specialist can help engage the child
, - smile.
Role of a pediatric nurse
- therapeutic relationship
- family advocacy and caring
- disease prevention and health promotion
- health teaching and educator
- support counselling
- coordination and collaboration
- ethical decision making
- research
- direct care
- health systems manager
Challenges of pediatric nursing
- ethical challenges (family beliefs, values, religion)
- limited resources in the unit/hospital
- protective parents (don't trust nurses to go close to child)
- anxious parents
- emotional challenges/impacts of having child patient
- long hours
- non-verbal patients
- challenges of obtaining consent at times
- variability between different development stages (be aware of stages and VS differences
between ages)
- medication being weight based
- mental health population growing
- child being unable to communicate about their situation
- more susceptible and vulnerable to abuse
- children with chronic conditions
- children with birth defects
- how to engage with the children (have to be creative)
- anxious families
- substance abuse
- children of culturally diverse communities who are less likely to receive needed health care
- moral distress
Responsibilities of a pediatric nurse
- identify changes in signs and symptoms
- intervene in emergent situations
- maintain privacy and confidentiality in nurse/child relationships
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