Pediatrics session 1 and 2: Principles of caring for children and Medication changes

Session 1: Principles for caring for children

 

Principles of pediatric care

  • Broad scope, developmental, can treat until 21, disease promotion and prevention, Parent is the expert on the child, Social issues, and ethical issues.
  • Family conflicts tend to increase in the hospital.

 

Developmental stages

  • Infant and toddler in the hospital
    • Parental relationship disturbed, unpredictable routines, fear of unknown/pain, separation anxiety.
  • Preschooler
    • Separation anxiety, fear of pain, loss of control, and may think that illness is a punishment for something.
  • School aged
    • loss of control, fear of pain, fear of school issues
  • Adolescents
    • Fear of: loss of independence, pain, acceptance.

 

Communication

 

  • Verbal and nonverbal communication techniques are needed to communicate well with children and families.
  • Timing, wording, body language, tone, and proximity to the patient.
  • Establish a rapport with the patient and family
  • Teach backs are useful to demonstrate knowledge.

 

 

Session 2: Medication changes in peds

 

Absorption changes

  • GI pH is higher in a neonate, and gastric emptying is slowed (often unpredictable)
    • Neonate – under one month old
  • Variable enzyme levels and effectiveness such as in pancreatic enzymes, and bile.

 

When giving an oral suspension consider the taste of the medicine so that  the child will not reject that route.

 

Neonates have higher water % and lower fat and protein %

 

Blood brain barrier is not mature until 2 years of age. All medications can cross until the BBB is matured.

 

Metabolism in the liver is not mature and may vary in premature or neonates

 

Use least invasive route whenever possible.

  • Measured spoon, syringe to push medications into the back of the mouth.

 

Use teach back as much as applicable.

 

Toddler –

  • Use simple explanations
  • Getting vaccinations can be difficult, do not use the parents to “bear hug” the child because the child will associate that with the shots and fear.

 

Medication Basics

  • No standard dose, all is based on weight, Body surface area, age.
  • Once the child weighs over 50 kg adult doses are applied
  • 30 ml = 1 oz
  • Rounding rules: round for the final answer only, to the hundredth
  • Safe dosing is in a range and also a 24 hr max dose.
  • DO NOT give a med that you did not draw up.

 

Fluid and electrolytes in peds

  • 80% total body water in infants
  • More ECF than ICF
  • Fluid shifts are more drastic in the infants than adults
  • Water is lost at a higher rate through the lungs and skin in infants.
  • Immature kidneys cannot fully concentrate urine, so there is a higher volume output
  • Infants cannot conserve water as well as adults due to these drawbacks

 

Dehydration causes

  • GI tract: intestiception, vom/dia, NG suction, motility issues, Transesophageal fistula

Endocrine

  • DKA(peeing vomiting), cystic fibrosis (creates blockages in the GI resp tract), fever (sweating, increased RR)

Lungs – tachypnea

Skin – burns

 

The fontanel can be used to assess for dehydration (depressed starting as moderate dehydration)

 

s/s of dehydration

  • Mild: diarrhea, decreased Output,
  • Moderate: fontenell depression, skin turgor,
  • Severe: tachycardia, little to no output

 

Normal urine outputs

  • 3-10 kg 100 ml
  • 10-20 kg 1000 ml + 50 ml/kg over 10 kg
  • 20+kg 1500 ml + 20 ml/kg over 20kgs

Acute vs chronic diarrhea – chronic is usually due to gastroenteritis, acute can be any infection

 

Pain

 

  • Scales
    • Facial expression, self report, observational scale,
  • 0-10 scale may be too abstract for the child to understand.
    • Never use this scale on a child less than 8
  • Opioids are used only when absolutely necessary
  • Opioids do not have a ceiling effect and commonly cause itching.
  • Meperidine can be used as an alternative pain reliever is allergic to morphine.
  • Dependence/tolerance can occur in as little as 5 days
  • Route of opioids is IV prefered to control the analgesia more closely, and decrease IM injections.  

 

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