Critical care nursing
BASICS OF PEDIATRIC NURSING
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| 3.BASICS OF PEDIATRIC NURSING
INTRODUCTION Pediatric nursing is part of the nursing profession, specifically revolving around the care of neonates and children up to adolescence. The word, pediatrics, comes from the Greek words 'paedia' (child) and 'iatrike' (Physician) is the British/Australian spelling, while 'pediatrics' is the American (Datta, 2017) Disciplines Nursing functions vary regionally, by individual education, experience, and individual career goals. These functions include the administration of procedures and medicines according to prescribed nursing care plans. Nurses observe vital signs and develop communication skills with children and family members, as well as with other medical personnel (Sterling, 2013). Awareness of the concerns of children and parents, physical presence at times of stress, and helping children and family members cope are common functions of direct nursing care. Neonatal nursing Neonatal nurses specialize in working with the youngest patients (infants). Neonatal nursing focuses on providing care and support for newborn babies delivered prematurely or who are suffering from health problems such as birth defects, infections, or heart deformities. Many neonatal nurses work in a Neonatal Intensive Care Unit (NICU) providing specialized medical care to at-risk conditions (Ball et al., 2013). A dysmature newborn is one whose developmental level is poor at birth. These newborns require a special type of care due to their health issues, such as Inadequate respiratory function Poor control of body temperature Increased tendency to bleed Poor resistance to infection Poor nutrition Immature kidneys and skin Jaundice – Neonatal nurses employ medical techniques, including the use of incubators. Essentially, the incubator provides proper heat, humidity, oxygen, and mist... and protection from infection. The medical apparatus provides essential medical care for at-risk newborns. Emergency nursing Pediatric nurses are expected to provide a quick response to stressful circumstances in life-threatening situations (Fraser, 2017). Key features of pediatric emergency nursing include: Handling multifaceted trauma, injury or illness cases without letting the patients succumb to the urgency of the situation Stabilizing patients Quickly diagnosing conditions and providing on-spot solutions Administering appropriate medications to address pain Upgrading skills and knowledge Remaining patient and caring for the traumatized families accompanying the patient Maintaining equanimity around patients who do not improve. Pediatric nurse practitioners and Psychiatric nursing Pediatric nurse practitioner must attend school for at least two years after earning a bachelor's degree, pass an examination, and apply to their state board of care. Some pediatric nurses can choose to return to school for their masters in psychiatric nursing. Pediatric psychiatric nurses are responsible for caring for children and adolescents with psychiatric problems (Majudmar, 2010). Goals of pediatric nursing Normalize the life of the child during hospitalization. Minimize the impact of the child's unique condition. Foster growth and development. Develop realistic, functional and coordinated home care plans. Respect the roles of the families. Prevent disease and promote health Training of pediatric nurses Training involves a mix of formal education and clinical experiences. Pediatric nurses can become certified in the field and may choose to further specialize. Students can enroll in an associate or bachelor's degree program. Some diploma programs offered exclusively through hospitals may also prepare students for the RN exam (Ball et al., 2012) GLOBAL DEVELOPMENT In the southern and eastern parts of Africa, strengthening the pediatric nursing workforce has been recommended as a primary strategy to reduce under-five mortality in African nations. Children make up close to half the population in many African countries, but research suggests that children's nurses often make up less than 1% of the nursing workforce (a 2019 workforce survey found approximately 4,000 qualified children's nurses in South Africa, Uganda, Zambia, Malawi and Kenya). The majority (80%) were in South (North et al., 2019). Career overview Examining a newborn baby Pediatric nurses work in settings including doctor's offices and community-based settings to hospitals and critical care facilities. Pediatric nurses may assist pediatricians or work alongside them. Pediatric nurses offer primary care services such as diagnosing and treating common childhood illnesses and conducting developmental screenings. Acute care and specialty services are also available for the chronically ill. Some pediatric nurses and nurse practitioners specialize in areas such as cardiology, dermatology, gastroenterology or oncology. Pediatric nurses are responsible for helping patients adapt to a hospital setting and prepare them for medical treatments and procedures. Nurses also coach parents to observe and wait for important signs and responses to therapies, to increase the child's comfort, and even to provide ongoing care (Sarah, 2016). Education Pediatric nursing specialties require specialized education. Nurses must first become a registered nurse (RN), gain experience in a pediatric health care facility and then pass the Certified Pediatric Nurse (CPN) exam. If a CPN wants to become a Pediatric Nurse Practitioner, they must return to school to receive their masters. 45% of undergraduate pediatric nursing students reported a lack of student direct care clinical learning opportunities with children. Counseling Injury-prevention strategies and anticipatory guidance are provided via counseling. Helping the child or family solve a problem is often a focus, usually provided by advanced practice nurses or other experienced nurses (Fraser, J. 2014). Advocacy The effective advocate nurse must be aware of the child's and the family's needs, the family's resources, and available health care services. Nurses help reinforce families to help them make knowledgeable choices about medical services and to act in the child's best interests (Yvonne, 2013). Critical Conditions of Pediatrics Critical conditions in pediatric patients can be life-threatening and require immediate medical attention. Some common critical conditions in children (Michael et al., 2012); Respiratory Distress: This can be caused by conditions such as asthma, pneumonia, or foreign body aspiration. Severe respiratory distress can lead to hypoxia and requires immediate intervention. Severe Sepsis: Bacterial or viral infections can progress to sepsis in children, leading to organ dysfunction. Signs include high fever, rapid breathing, and altered mental status. Trauma: Severe injuries like head trauma, severe fractures, or internal bleeding can be critical in pediatric patients. Cardiac Arrest: Cardiac issues like congenital heart defects, arrhythmias, or cardiac arrest can be life-threatening and require immediate resuscitation. Status Epilepticus: A prolonged seizure, lasting more than 5 minutes, can be critical. It requires prompt intervention to prevent brain damage. Anaphylaxis: Severe allergic reactions can lead to anaphylaxis with symptoms like difficulty breathing, swelling, and a drop in blood pressure. Meningitis: Bacterial or viral meningitis can cause high fever, severe headaches, and neurological symptoms. Metabolic Disorders: Conditions like diabetic ketoacidosis or inborn errors of metabolism can be life-threatening if not treated promptly. Oncologic Emergencies: Pediatric patients with cancer can experience critical complications, such as tumor lysis syndrome or neutropenic fever. Severe Dehydration: Dehydration from vomiting, diarrhea, or other causes can be critical, especially in infants and young children. PEDIATRIC CRITICAL CARE MANAGEMENT Medical management of critical pediatric conditions Medical management of critical pediatric conditions can vary widely depending on the specific condition. Here are some general principles and considerations: Airway, Breathing, and Circulation (ABCs): Ensure a patent airway, adequate ventilation, and stable circulation. This may involve intubation, mechanical ventilation, or oxygen therapy. Fluid Resuscitation: Assess and correct any fluid imbalances, but be cautious not to overhydrate, especially in conditions like congestive heart failure. Medications: Administer appropriate medications, such as antibiotics for infections, bronchodilators for respiratory distress, or inotropes for circulatory support. Monitoring: Continuously monitor vital signs, oxygen saturation, and other relevant parameters. Utilize advanced monitoring, such as arterial lines and central venous catheters, if necessary. Nutrition: Ensure adequate nutrition, either through enteral or parenteral routes, depending on the patient's condition and ability to tolerate feeds. Sedation and Analgesia: Adequate pain management and sedation are crucial to reduce stress and discomfort for the child. Surgical Intervention: Some conditions may require surgical intervention, such as congenital heart defects, abdominal emergencies, or trauma. Supportive Care: Maintain normothermia, provide wound care, and prevent complications like pressure ulcers in immobilized patients. Specialized Care: For conditions like severe burns or pediatric trauma, specialized care in burn centers or pediatric trauma centers may be necessary. Psychosocial Support: Address the psychological and emotional needs of both the child and their family. Social workers, child life specialists, and psychologists can play essential roles. Rehabilitation: For pediatric critical care survivors, rehabilitation may be required to address physical and cognitive impairments resulting from their illness. Family-Centered Care: Involve and educate the family in the care process, making them an integral part of the child's recovery. Ethical Considerations: In some cases, complex ethical dilemmas may arise, such as decisions about life support, which require careful consideration and communication with the family. Nursing management of critical pediatric conditions Nursing management of critical pediatric conditions plays a vital role in providing comprehensive care to pediatric patients in critical care settings. Here are key aspects of nursing management: Assessment: Thorough and ongoing assessment of the child's condition is essential. This includes monitoring vital signs, neurological status, respiratory status, and overall well-being. Communication: Effective communication with the healthcare team, including physicians, respiratory therapists, and other specialists, is crucial for coordinated care. Medication Administration: Administer and monitor the effects of medications, including dosages and potential side effects. Pay particular attention to pain management and sedation in pediatric patients. Ventilator Management: Nursing staff often play a central role in the management of mechanical ventilation. This includes adjusting settings, monitoring for complications, and ensuring proper sedation. IV Access and Fluid Management: Ensure proper IV access and manage fluid administration according to the child's needs. Prevent infections and complications associated with intravenous therapy. Wound Care: In cases of burns, trauma, or surgical interventions, nurses are responsible for wound care, including dressing changes, infection prevention, and monitoring healing. Nutritional Support: Collaborate with dietitians to provide enteral or parenteral nutrition as needed. Monitor for tolerance and complications related to feeding. Family Support: Offer emotional support, education, and clear communication to the child's family. Include them in the care plan and decision-making process. Infection Control: Strict adherence to infection control protocols to prevent hospital-acquired infections is critical, especially in the context of pediatric critical care. Pediatric-Specific Care: Understand the unique needs of pediatric patients, including their developmental stage, communication abilities, and psychological support. Safety: Ensure a safe environment for the child, taking measures to prevent falls, pressure injuries, and other potential hazards. Documentation: Maintain accurate and detailed records of the child's condition, interventions, and responses to treatments. Advocacy: Be an advocate for the child's best interests, ensuring they receive appropriate care and are protected from harm. Stay updated on the latest advancements and best practices in pediatric critical care through ongoing education and training. End-of-Life Care: If necessary, provide sensitive end-of-life care, addressing the emotional and spiritual needs of the child and their family. NURSING CARE PLAN FOR A PEDIATRIC CRITICAL CONDITION PATIENT Nursing Diagnosis Goals/Expected Outcomes Interventions Rationale Evaluation Impaired Gas Exchange related to respiratory distress. Improved oxygen saturation - Normal respiratory rate 1. Monitor vital signs, especially oxygen saturation. 2. Administer bronchodilators and medications as ordered. 3. Encourage deep breathing exercises. 1. To monitor the child's response to treatment.. 2. To ensure adequate oxygenation.. 3. Promotes easier breathing. 4. To assess the effectiveness of oxygen therapy Patient airway has been improved Ineffective Breathing Pattern Improve respiratory function 1. Assess respiratory rate, depth, and effort regularly. 2. Administer oxygen therapy as prescribed. . 3.Elevate the head of the bed. 4. Monitor oxygen saturation continuously. 1. To monitor the child's response to treatment. 2. To ensure adequate oxygenation. 3. Promotes easier breathing. 4. To assess the effectiveness of oxygen therapy Patient breathing pattern improved Ineffective Airway Clearance Promote effective airway clearance 1. Monitor for signs of airway obstruction. 2. Administer respiratory treatments as ordered. 3. Encourage hydration to thin secretions. 4. Assist with chest physiotherapy 1. Early intervention to prevent airway compromise. 2. To mobilize and clear secretions. 3. Thinning secretions facilitates easier clearance. 4. Promotes removal of mucus from the airways. Patient airway has been cleared within the speculated nursing intevention Summary for pediatric nursing Pediatric nursing is a specialized field of nursing that focuses on the care and treatment of children, from infancy through adolescence. Pediatric nurses are trained to provide age-appropriate medical care, emotional support, and education to young patients and their families. They work in various healthcare settings, including hospitals, clinics, and pediatricians' offices, and their responsibilities may include administering vaccinations, conducting assessments, managing pediatric illnesses, and promoting child development and well-being. Pediatric nurses play a crucial role in ensuring the health and well-being of children, collaborating with healthcare teams, and communicating with parents or guardians to provide comprehensive care for young patients. Conclusion for pediatric nursing In conclusion, pediatric nursing is a vital and specialized branch of healthcare that revolves around the compassionate and skilled care of children. These dedicated healthcare professionals play a pivotal role in ensuring the well-being, growth, and development of our youngest patients. By combining medical expertise with empathy and communication skills, pediatric nurses contribute significantly to the health and future of children, providing not only medical treatment but also emotional support to both the young patients and their families. Their work is indispensable in the field of pediatric healthcare, making a lasting impact on the lives of children and their communities. Recommendation for pediatric nursing For those considering a career in pediatric nursing, here are some recommendations: Educational Preparation: Pursue a solid educational foundation by obtaining a nursing degree, typically a Bachelor of Science in Nursing (BSN). This will provide you with a strong clinical and theoretical knowledge base. Pediatric Specialization: Consider further specialization in pediatric nursing through additional coursework or certifications. This will equip you with the specific skills needed to care for children effectively. Clinical Experience: Gain hands-on clinical experience in pediatric settings. This can be done through internships, clinical rotations, or entry-level nursing positions in pediatric units. Effective Communication: Develop strong communication and interpersonal skills to interact with young patients and their families. Compassion and patience are essential in this field. Continuing Education: Stay updated with the latest advancements in pediatric healthcare. Attend workshops, seminars, and pursue certifications to remain at the forefront of the field. Cultural Competency: Understand and respect the cultural diversity within pediatric populations. This is crucial in providing culturally sensitive care. Team Collaboration: Pediatric nursing often involves working closely with other healthcare professionals. Learn how to collaborate effectively within a multidisciplinary team. Emotional Resilience: Prepare to handle emotionally challenging situations, as working with sick children can be emotionally taxing. Seek support and self-care strategies to maintain your well-being. Advocacy: Be an advocate for children's health and well-being. Ensure their rights and needs are met, and work to improve pediatric healthcare practices and policies. Lifelong Learning: Pediatric nursing is a dynamic field. Embrace a commitment to lifelong learning to adapt to changing medical practices and technologies. Download 98.49 Kb. Share with your friends:
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