Paediatrics: A Clinical Guide for Nurse Practitioners

Paediatrics: A Clinical Guide for Nurse Practitioners
Edited by Katie Barners

Contents
Contributors
Preface
Part I Clinical Issues in Paediatrics:

1. A developmental approach to the history and physical examination in paediatrics
2. Anatomical and physiological differences in paediatrics
3. Care of the adolescent
4. General principles in the assessment and management of the ill child
5. Pharmacology in paediatrics
6. Internet resources for the nurse practitioner
7. Paediatric telephone advice and management for the nurse practitioner
8. Transcultural nursing care

Part II Common Paediatric Problems
Dermatological problems:

1. My child has a rash?
2. Acne
3. Atopic eczema
4. Birthmarks
5. Burns
6. Cellulitis
7. Food allergy
8. Fungal skin infections
9. Impetigo
10. Infantile seborrhoeic dermatitis (ISD) or infantile eczema (including cradle cap)
11. Nappy rash
12. Pediculosis humanus capitus (head lice)
13. Psoriasis
14. Scabies
15. Viral skin infections (warts and molluscua contagiosum)

Problems related to the head, eyes, ears, nose, throat or mouth:

1. Congenital blocked nasolacrimal duct
2. Eye trauma
3. The'red eye'
4. Common oral lesions
5. Common oral trauma
6. Acute otitis media
7. Amblyopia and strabismus

Respiratory and cardiovascular problems

1. Asthma and wheezing
2. Bronchiolitis
3. Pneumonia
4. Stridor and croup (laryngotracheobronchitis)
5. Syncope
6. Chest pain

Gastrointestinal and endocrine problems

1. Acute abdominal pain
2. Childhood constipation and encopresis
3. Acute gastroenteritis (vomiting and diarrhoea)
4. Jaundice
5. Threadworms
6. Diabetes mellitus
7. Delayed sexual development (delayed puberty)
8. Premature sexual development (precocious puberty)
9. Short stature
10. Ingestions and poisonings

Musculoskeletal problems, neurological problems and trauma

1. Limp and hip pain
2. Lacerations
3. Pain assessment and management
4. Febrile seizures
5. Head injury

Genitourinary problems and sexual health

1. Urinary tract infection
2. Enuresis
3. Vulvovaginitis in the prepubescent child
4. Adolescent contraception
5. Sexually transmitted infections
6. Painful male genitalia

Infectious diseases and haematology

1. Acute fever (<7 days duration)
2. Glandular fever (Epstein-Barr infection)

Product details
Paperback: 288 pages
Publisher: Butterworth-Heinemann (18 Aug 2003)
Language English
ISBN-10: 0750649577
ISBN-13: 978-0750649575


sampel Chapter 1
A Developmental Approach to the History and Physical Examination in Paediatrics
Katie Barnes And Fiona Smart

INTRODUCTION

Children are not miniature adults and as such, the nurse practitioner (NP) caring for children will require an appreciation of age and developmentrelated issues that impact the care of children. This includes an understanding of the anatomical and physiological differences across the age groups (see Ch. 2) and a working knowledge of child development (see Appendix 1). This section will outline the developmental springboard from which the paediatric history and physical examination are launched. Note that Chapter 3 (Care of the Adolescent) discusses this unique group in greater detail.

Flexibility is an important prerequisite to paediatric consultations; observe the child's response and let this guide your interactions.

Considerations of safety are likewise imperative when working with children. Think about the proximity of electrical outlets, equipment in the examination area (otoscopes, ophthalmoscopes) and other hazards that are easily reached by inquisitive fingers (electrical cords, lamps, needles). Never leave a, child unattended on the examination table.

Be organised (without forgetting about flexibility). Equipment should be accessible and in working order; things can easily slip into chaos, especially with toddlers or families with numerous children in the consultation room at the same time.

Table 1.1 summarises important developmental considerations.

INFANTS (BIRTH TO 12 MONTHS)

Attachment and trust are the key developmental issues of infancy and the infant-carer dyad is pivotal. Therefore, it is important that the NP respects this relationship and involves the parent(s) in all aspects of the physical examination. In addition, stranger and separation anxiety play an increasingly important role when assessing children older than 7 months. Stranger anxiety tends to peak at 9 months, whereas distress related to a separation from caregivers may continue to influence social interactions into the toddler period. Note however, that there are wide variations with both of these behaviours.

A birth history (gestational age at birth, birth weight, prenatal care, intrauterine exposures, problems during labour, delivery or the neonatal period) is particularly relevant in this age group as an assessment of potential vulnerability may be necessary (e.g. traumatic birth and risk for developmental delays). In addition, the parent's observations regarding the infant's growth, development and illness-related behaviours are required in order to assess the infant within a broader context. Lastly, information about the family's ability to cope with a sick infant is requisite for the negotiation of a realistic plan of care.

The physical examination of a young infant (less than 5 months of age) is relatively straightforward and can usually proceed in a cephalocaudal manner. The examination of older infants will likely require flexibility in the examination sequence. However, if presented with a sleeping infant, the NP should take advantage of the opportunity to assess the heart, lungs and possibly the abdomen. It is important to provide a warm, protective environment for the infant, as she will not be happy if the examination room is cold and she is undressed and exposed. Young infants can be examined on the table, whereas older infants (especially those that can sit) may be happier on the parent's lap. It is often helpful to position yourself opposite the parent (putting knees together) to form a 'human examination table.' Note that if the older infant does need to be placed on the examination table, be sure to keep the parent in full view and keep the infant in a sitting position (she will not like lying down). Smile at the infant—she'll smile back. Likewise, be sure to use a gentle touch and tone of voice. Cooperation can be assisted by the use of distracters such as rattles, snapping fingers or tongue depressors.

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