PEDIATRIC NURSING

MARK BILLY L. PERPETUA, MAN, RN

•Pediatric Nursing or Child Health Nursing
•is the nursing specialty of caring for
infants, children and adolescents.

•A nurse who specializes in this area is

usually referred to as a pediatric nurse.
 •Roles of the Pediatric Nurse:
•Primary Caregiver – provide promotive,
preventive, curative and rehabilitative nursing
care in all levels of health services.

•Coordinator and Collaborator – maintains

good interpersonal communication with the
child, family, and health team members.
•Nurse Advocate – safeguard’s the child’s
rights, to assist and provide the best care from
the health care team

•Health Educator – provide information to

children, parents, and significant others, about
the prevention of illness, health promotion, or
maintenance.
•Nurse Consultant – guides parents for
maintenance and promotion of health.

•Nurse Counselor – provides guidance to

parents in hazards of children and health team
for own decision making in different situations
CLASSIFICATION ACCORDING
TO GESTATIONAL AGE
MARK BILLY L. PERPETUA, MAN RN
• Premature (preterm) infant – an infant born before
the completion of 37 weeks of gestation,
regardless of birth weight.

• Full-term infant – an infant born between the

beginning of 38 weeks and the completion of 42
weeks of gestation, regardless of birth weight

• Postmature (postterm) infant – an infant born after

42 weeks of gestational age, regardless of birth
weight
 PRETERM VS FULL TERM
PRETERM FULLTERM

POSTURE Lies in RELAXED attitude, limbs are More subcutaneous fat and rests in a more
more extended; body size is small, head flexed attitude
is somewhat larger in proportion than
the body

EAR Ear cartilages are poorly developed; Ear is well formed, hair is more firm and
may fold easily; hair is fine and grows in separates strands
feathery, lanugo may cover the back
and face

SOLE Appears more turgid and may only have Well and deeply creased
fine wrinkles

FEMALE GENITALIA Clitoris is prominent, labia majora is Labia majora are fully developed, clitoris not
poorly developed prominent
 PRETERM VS FULL TERM
PRETERM FULLTERM

MALE GENITALIA Scrotum isn underdeveloped and not Scrotum is well-developed, pendulous, and
pendulous, MINIMAL RUGAE are rugated and are down in the scrotal sac
present, testes may be in the inguinal
canal or in the abdomen

SCARF SIGN Infant’s elbow may be easily brought Infant’s elbow may be brought to the midline
across the chest with little or no of the chest, resisting attempts to bring the
resistance elbow past the midline

GRASP REFLEX Grasp is weak Grasp is strong

HEEL-TO-EAR Heel is easily brought to ear with no The maneuver is not possible, there is
MANEUVER resistance considerable resistance
RESPIRATORY DISTRESS
SYNDROME
a.k.a HYALINE MEMBRANE DISEASE

❑A condition of surfactant deficiency and physiologic

immaturity of the thorax

❑Seen almost exclusively in PRETERM infant (multifetal

pregnancies, infants of diabtic mother, C/S delivery,etc)
✓Chest indrawing and retractions

✓Tachypnea

✓Labored breathing

✓Substernal retractions

✓Flaring of nares

✓Fine respiratory crackles

✓Central cyanosis (late and serious sign)

✓Pulse oximetry (determines hypoxia)

✓Radiography

✓L/S ratio

✓TDx Fetal Lung Maturity assay

(determines PG level in amniotic fluid or
neonatal tracheal aspirate)
✓Administration of exogenous surfactant

✓Nitric oxide (pulmonary dilation)

✓Oxygen therapy (maintains correct PO2

and pH)
✓IV therapy (hydration and nutrition)
✓Close monitoring

✓Keep oxygen consumption as low as

possible (handle infants as little as
possible)

✓Suction only when necessary (gently but

quickly)

✓Encourage parents to verbalize feelings

MECONIUM ASPIRATION
SYNDROME
❑Relaxation of the anal sphincter and
passage of meconium into amnitic fluid
due to intrauterine stress

❑Occurs primarily in full-term and

postterm infants
✓Stained from meconium stool

✓Tachypneic

✓Expiratory grunting, nasal flaring,

retractions

✓Initially cyanotic

✓Classic Barrel chest

✓Respiratory distress with gasping

✓Laryngoscopy

✓Chest radiographs

✓Pulse oximetry

✓echocardiography
✓Tracheal suctioning (poor respiratory effort, low heart
rate, poor tone)

✓Ventilatory support

✓Exogenous surfactant administration

✓IV fluids

✓Systemic antibiotics

✓Same with other high-risk neonate

APNEA OF PREMATURITY
❑Common phenomenon in preterm infant

❑Characterized by apneic spells

 TYPES
❑Central apnea
-CNS does not transmit signals to the respiratory
muscles

❑Obstructive apnea
-airflow ceases due to upper airway obstruction

❑Mixed apnea
-combination of central and obstructive apnea
(*most common)
✓Methylxantines (aminophylline, theophyline,
caffeine)
✓CNS Stimulants to breathing
✓Observe for Sx of toxicity (tachycardia ar rest,
vomiting, irritability, diuresis)

✓Cafcit (caffeine citrate)

✓Urine output should be closely monitored (mild
diuretic effect)
✓Observation combined with monitoring is the most effective
means of identifying neaonatal apnea

(if apnea begun)

✓Gentle tactile stimulation (rubbing the back or chest gently)

✓Flow-by oxygen and suctioning

✓Chin is raised gently to open airway

✓Infant is NEVER SHAKEN

✓Record episodes of apnea

SUDDEN INFANT DEATH
SYDROME
❑Sudden death of an infant under 1 year of age

❑“crib death”

❑Etiology: UNKNOWN
Contributing factors:

✓Prone sleep position

✓Soft bedding

✓Use of pillow

✓Brainstem abnormality

✓Co-sleeping with parents

✓Maternal smoking
Manifestations:
May be seen:
✓Frothy-blood tinged fluid in the
mouth
✓Lying face down in the secretions
✓Hands clutching the sheets

Diagnosis:
✓Autopsy
✓Investigation of the scene
✓Allow the parents to say good-bye

✓Encourage to hold their infant

✓Encourage verbalization of feelings

✓Provide a quiet room with dim lighting

✓Explain that the death is due to SIDS and it

is not preventable or predictable
✓Place infants on their back when sleeping
(plagiocephaly: change head position periodically)

✓Use firm mattress

✓Avoid exposure to smoke

✓Offer a pacifier for sleep

RETINOPATHY OF
PREMATURITY
❑A disorder involving immature retinal vasculature

❑Formerly know as:

“Retrolental Fibroplasia”

❑Etiology: hyperoxemia, hypoxia, hypercarbia,

hypocarbia, prenatal complications, exposure to
light
 ✓Strict oxygen management
✓Cryotherapy ablation
✓Laser therapy

✓Decreasing constant bright environmental light

✓Inform the parents that infant’s eyelid will be

closed and edematous post operatively