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NCLEX PART 3

CH 09. Pediatric Nursing
(Development & Heart)

Kids are not just small adults!
The NCLEX asks: "Is this child developing normally?"

Also, memorizing the Congenital Heart Defects is scary,
but there is a simple trick: "The letter T = Trouble!"

1. Key Developmental Milestones

If a child cannot do these by the specified age, it requires investigation.

Age Gross Motor (Movement) Fine Motor & Social
2 - 4
Months		 - Holds head up (Head control).
- Rolls over (4 months). 		- Social Smile (2 months).
- Cooing sounds.
6
Months		 - Sits with support.
- Weight bearing on legs. 		- Passes objects hand-to-hand.
- Stranger Anxiety begins.
9
Months		 - Crawls.
- Pulls to a stand. 		- Pincer Grasp (Thumb & Finger).
- Object Permanence (Peek-a-boo).
12
Months		 - Walks (first steps).
- Sits from standing. 		- Says "Mama/Dada" specifically.
- Uses a cup.

2. Congenital Heart Defects (CHD)

Is the baby "Pink" or "Blue"?

① Acyanotic vs. Cyanotic

  • Acyanotic (Pink):
    - Blood flows Left to Right (High pressure to Low).
    - Lungs get too much blood (Pulmonary Congestion).
    - Examples: VSD, ASD, PDA. (Not emergent).
  • Cyanotic (Blue) = "Trouble":
    - Blood flows Right to Left (Deoxygenated blood goes to body).
    - Examples: Tetralogy of Fallot, Transposition of Great Arteries.
    - Spells: "Tet Spells" (Hypercyanotic) -> Knee-Chest Position!

3. Pediatric Respiratory Emergencies

A child's airway is smaller and swells easily.

① Epiglottitis (Emergency!)

  • Signs (The 4 D's):
    1. Drooling (Can't swallow).
    2. Dysphagia.
    3. Dysphonia (Muffled voice).
    4. Distress (Tripod position).
  • CRITICAL ACTION:
    NEVER inspect the throat with a tongue blade.
    It can cause complete airway obstruction. Prepare for intubation/trach.

② Croup (Laryngotracheobronchitis)

  • Signs:
    - Barking Cough (Seal-like).
    - Inspiratory Stridor.
  • Home Care:
    - Cool mist humidifier.
    - Take the child outside into cool night air or open the freezer door (Cold air shrinks swelling).

4. Specific GI Signs

  • Pyloric Stenosis:
    - Projectile Vomiting immediately after feeding.
    - Olive-shaped mass in the abdomen.
  • Intussusception (Telescoping Bowel):
    - Currant Jelly Stool (Blood + Mucus).
    - Sausage-shaped mass.
    - Sudden screaming/drawing knees to chest.

Tip: If a defect starts with the letter T, it's Trouble (Cyanotic).
Tip: Never look in the throat of a drooling child (Epiglottitis).
Next is the final chapter: Psychiatric & Final Review!

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