4 Maternal and Child Health Nursing i

PREFACE
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This learning packet is designed to assists students understand the concepts,

theories, and principles in the nursing care of at-risk/ high risk and sick mother
and child (Acute and Chronic). It incorporates learning activities that will help
students meet the objectives with the corresponding textbook chapter.

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NCM 109 CARE OF THE MOTHER, CHILD AT RISK OR WITH

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PROBLEMS (ACUTE AND CHRONIC)
Prepared by: BEGONIA C. YBOA, MAN

CONTENT

NURSING CARE OF AT RISK/ HIGH RISK/ SICK CLIENT

o NEWBORN
o Infant and Young Infant
o Toddler
o Preschool
o School Age
o Adolescent

INSTRUCTIONS:
This COURSE is divided into 4 learning packets (2 midterm period, and 2 final Period). It is
important for the student to acquire a textbook (see requirements). Access to the internet is
advantageous but in its absence, any Maternal and Child Health Nursing book will suffice. Each topic
includes an overview about the topic, along with student learning objectives. Self-assessment questions
and activities (SAQA) are provided. It is required that students should answer all SAQA and Related
Learning Experience (RLE) Activities (RLEA). Answers should be handwritten on a separate
notebook/journal. Students should acquire 4 or more notebooks (PINK Cattleya ) for the whole
semester (4 learning packets/semester). It is important that students accomplish the reading
activity before proceeding with the text/discussion. All activities in SAQA should be answered since
this will be included as a summative evaluation of student’s performance. After posting of the
learning packets in ssuclassroom.com, students should submit their activity notebook/s within
seven (7) days. Late submission is tantamount to failure for the corresponding learning packet.

REQUIREMENTS:
• Textbook: Maternal and Child Health Nursing by JoAnne Silber-Flagg and Adele Pillitteri or
any Maternal and Child Nursing textbook published in 2010-present.
o Unit 4: The Nursing Role in Caring for A Family During Complications of
Pregnancy, Birth, or the Postpartal Period
 Chapter 7, 25
• 4 or more Learning Activity Notebook
Note: Write the following on the cover of your activity notebook
SURNAME, FIRST NAME, MI
YEAR SECTION- SUBJECT CODE (NCM109)
INSTRUCTOR: MS BEGONIA C. YBOA
LP1

GRADING SYSTEM:
Major Examination - 40%

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Summative Quiz - 25%

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Class Participation - 15%
Term Project/Requirements - 20%

1.0 INTENDED LEARNING OUTCOME

Upon completion of this learning packet, the student will be able to:
 Assess the at-risk/high risk mother and child with the use of specific methods and tools to
address existing health needs.
 Formulate with the client a plan of care to address needs/problems of at-risk/high risk mother
and child
 Implement safe and quality nursing interventions to address needs/problems of at-risk/high risk
mother and child

1.1 INTRODUCTION
 This learning packet will focus on the nursing role and care to families with pregnancy
complications. This will include pregnant women with chronic conditions and who experience
unintentional injury or develop a chronic illness during pregnancy.

DISCUSSION

SAQA-1

What are the primary nursing goals for the following hospitalized/sick clients:
 NEWBORN
 Infant and Young Infant
 Toddler
 Preschool
 School Age
 Adolescent

Classification of infants on the basis of risk

1. Well infants.
2. High-risk infants.
3. Sick infants.

High-risk infant
 A high-risk infant is an infant that appears well but has a much greater chance than most
infants of developing a clinical problem, such as hypothermia, hypoglycaemia, apnoea,
infection, etc. in the new-born period.
 High-risk infants appear clinically well on examination

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Infants should be regarded as High Risk

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 Infants that are born preterm or postterm.
 All low birth weight infants.
 Infants who are underweight or overweight for gestational age.
 Wasted infants.
 Infants who have a low 1 minute Apgar score (i.e. need resuscitation after birth).
 Infants who are born to mothers with a complicated pregnancy, labour or delivery.
 Infants who have had one or more clinical problems since delivery.
 Infants who were sick but have now recovered.

Sick Infant
 A sick infant does not appear well and has abnormal clinical signs. The infant may previously
have been well or may previously have been identified as a high-risk infant.
 Therefore, if a well or high-risk infant develops one or more abnormal clinical signs, or the
infant appears ill, then it is reclassified as a sick infant.

Assessment
 A sick infant does not appear well and has abnormal clinical signs. The infant may previously
have been well or may previously have been identified as a high-risk infant.
 The most important clinical signs that indicate that an infant is sick are:
o Heart rate. The infant may have a:
 Tachycardia (a heart rate more than 160 beats per minute)
 Bradycardia (a heart rate less than 120 beats per minute)
o Respiration rate and pattern. Abnormal signs are:
 Slow, shallow, irregular respiration
 Rapid respiration (tachypnoea) more than 60 breaths per minute
 Grunting, recession or gasping
 Apnoea
o Colour. The infant may be:
 Pale
 Plethoric (very red)
 Cyanosed. Centrally or peripherally
 Severely jaundiced
o Temperature. The infant may be hypothermic (cold) or pyrexial (hot).
o Activity. The infant may be:
o Lethargic and respond poorly to stimulation
o Hypotonic and less active than before
o Feeding poorly
o Jittery with abnormal movements or fits
 You should recognise these most important or vital signs that are usually monitored routinely
in a sick or high-risk infant. The sick infant may also be recognised by other, less common
but abnormal signs on clinical examination, e.g. bleeding, oedema, abdominal distension,
loose stools.
 The recognition of a sick infant is one of the most important clinical skills that nurses and
doctors must learn.

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 Infants that have a congenital abnormality but are otherwise well are often grouped together
with sick infantsNursi
when management is planned.

Causes of a sick infant

 Infection.
 Hypoxia.
 Hypothermia
 Hypoglycaemia.
 Acute blood loss.
 Anaemia.
 Trauma.
 Marked hyperbilirubinaemia.
 Intraventricular haemorrhage.

Management
 Resuscitate the infant if needed.
o The method of resuscitating a sick infant is similar to that of resuscitating an infant
with a low Apgar score at birth. The most important steps are:
 Clear the airway by suction, especially if the infant has vomited.
 Provide a source of oxygen if the infant is cyanosed.
 Stimulate respiration if the infant is not breathing adequately. Ventilation by
face mask or endotracheal tube may be needed.
 Assess whether the infant is shocked. Treat if signs of shock are present
 Immediately treat the abnormal signs, e.g. give oxygen for cyanosis.
 Attempt to make a diagnosis of the cause of the clinical signs.
 Treat the cause if possible.
 Give the infant general supportive care.
 Monitor the vital signs.
 Discuss the problem with the parents.
 Decide whether to transfer the infant to a level 2 or 3 nursery.

Diagnosis
 Review the history.
 Examine the infant carefully.
 Do any special investigations that are indicated, such as:
 Measure the blood glucose concentration.
 Determine the packed cell volume or haemoglobin concentration.
 Determine the acid base status by measuring the blood gases if possible.
 Order a chest X-ray.

General Supportive Care: Sick infant

 Maintain adequate respiration and circulation.
 Maintain a normal body temperature.
 Handle the infant as little as possible.
 Provide extra oxygen only if needed.
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 Observe the infant carefully, paying special attention to the vital signs.
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Provide fluid and energy by giving intravenous fluid. Usually the stomach is emptied via a
nasogastric tube.
 Prevent infection by washing your hands or spraying them with a disinfectant before touching
the infant.

Care for Sick Infant

 Do not feed the infant by mouth as this may cause vomiting or apnoea. Most sick infants are
given an intravenous infusion.
 Do not handle the infant unless it is necessary.
 Do not bath the infant.
 Do not take the infant out of oxygen for a procedure, e.g. a chest X-ray.

Monitoring a Sick Infant

 Heart rate
 Respiratory rate and pattern
 Colour
 Temperature of the infant and the incubator
 Activity of the infant
 Look for any other abnormal signs that are present, such as vomiting, loose stools, etc.
 The blood glucose concentration is usually monitored.
 The type and volume of the fluid intake (both oral feeds and intravenous fluids) are recorded.
 The frequency with which the infant passes urine must be charted. In severely ill infants the
urine is collected in a urine bag or urethral catheter so that the volume of the urine passed can
be measured.
 The content of the urine (protein, blood and glucose) is determined with a reagent strip.
 The blood pressure should be recorded in severely ill infants in level 2 or 3 nurseries.
 If the infant is receiving oxygen, then the FiO₂ (fraction or percentage of inspired oxygen)
must be noted. The SaO₂ should also be recorded if the infant is being monitored with an
oxygen saturation monitor.
 The packed cell volume or haemoglobin concentration should be measured if the infant has
lost blood.
 The infant’s weight should be recorded every day.

Family Responses to Illness and/or the Hospitalized Child

 It is the nurses’ responsibility to promote a sense of security in pediatric patients. In fact, it is
the most important item on our to-do list in the healthcare environment of pediatric patients.
Feeling secure depends on a sense of physical and psychological safety.
 Parents are the most vital key to promoting this safety in the pediatric patient. Parent’s
presence at the bedside is the best way to decrease anxiety and increase this sense of security
in children. Nurses must do everything in their power to decrease parental stress and anxiety
and that will directly impact the child’s positive coping abilities.
 In order to help families adapt to the hospitalization of the child the nurse should:
o Build trust with the family by communicating frequently with them including siblings.
This includes education in simple, concrete facts that encourages parents to ask

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questions. The nurse should ask questions that are open ended to the child, parents,
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and siblings.
o Understand that parent’s presence in their child’s hospitalization is an extension of the
child in order for the child to make sense of what is happening to him/her.
o Encourage parents to stay in touch with siblings at home if parents are staying at the
hospital.
o Establish a relationship with the sibling and explain the medical condition of his/her
sibling in simple terms. Also, include the sibling in therapy with the patient so the
sibling feels he/she is helping his/her sick sibling.
o Instill a sense of hope in parents by carefully choosing words that elicit hope.
o Focus on the positives in every situation.
o Encourage parents to visit their child anytime, stay overnight, and/or call the nurse for
an update. Nurses need to assess how much parents would like to be involved and
support their choice. The primary goal should be no separation of parent and child in
children under 5 years of age
o Identify key family members and decision makers in the child’s care.
o Teach parents how to talk to their child about the medical procedures, equipment,
status, and health concerns. Prepare parents ahead of time for tough conversations
with children to lessen both the parent’s and the child’s anxiety level.
o Teach parents how to talk calmly, how to touch to calm the child, and the power of
eye contact during procedures . Parents have a key role in lessening anxiety through
coping skills. Children can sense parent’s emotional upheaval so working to lessen
parent’s emotionality is crucial to helping children cope.
o Parents and nurses need to respond to an anxious child with empathy, compassion and
acknowledgement.

General Nursing Care of Pediatric Patients Across the Developmental Stages

 There are some interventions and principles that hold true for children of all ages. To provide
the best nursing care to pediatric patients, pediatric nurses should strive to incorporate these
principles into their practice regardless of the age of the developmental stage of the child.
 Children grasp information best when it is appropriate to their cognitive level of
development.
 Offer choices to every child when performing even routine tasks such as obtaining his/her
blood pressure. This will promote a sense of control in the child.
 Create a daily schedule so that the child is aware of what to expect throughout his/her day.
 Use humor and laughter to lighten up the air with children.
 Use time-out coupons, for example three per procedure that the child can use to halt the
procedure for 2 minutes. This gives control to the child to better cope with the procedure.
 A pre-surgical tour of the hospital can lessen anxiety and promote cooperation.
 Children need a regular schedule in the hospital that mirrors home life as much as possible,
but that is also consistent from day to day in the hospital setting. Research has shown that
without a regular schedule for children of all ages, a child can feel confused and insecure
adding to emotional upheaval, stress, and adaptability .
 Nurses should stoop down to the child’s level physically. Eye to eye contact is important to
develop a trusting relationship. The use of a short stool works well to get at their eye level.
 Introduce yourself and ask the child personal questions.
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 Nurses should smile at their pediatric patients. Children of all ages appreciate this approach
Nursi Who doesn’t like a friendly, calm approach?
from babies to adolescents.
 Regardless of the age of the child, use his/her name. It soothes children and parents alike. It
shows respect for individuality and lessens anxiety in children and parents. Never refer to a
child by his/her diagnosis.
 Children of all ages from toddlers through adolescence love to help. Through their role in
their own care, it can alleviate stress and build trust. For example you could ask the child to
hold your otoscope until you need it. Teach them the tools of the trade. At the same time you
are educating about a possible career choice for one of them.
 Consider using a therapeutic dog in the hospital setting as a distraction and calming technique
when appropriate. Animal assisted therapy has shown to improve the level of anxiety in
parents and children. Check with your facility for approval of canine therapy. Or perhaps get
permission for the child’s dog to visit in the playroom.
 Give children the same time and respect you would give to adult patients (10). This includes
decision-making even when they are not able to make decisions on their own. This will
enhance their sense of control over their own health.
 Secrecy and dishonesty increases a child’s sense of anxiety and fear and undermines trust
with the nurse.
 Nurses should coach children to ask more questions and thereby increase satisfaction with
their healthcare providers and more compliance with their disease processes.
 Never talk down to a child for example in a singsong voice. This is demeaning to him/her.
 Encourage parents to bring in posters, photographs, and other items from home to personalize
the bedside. This may help the child to feel more comfortable in the hospital setting.
 Choose roommates for children, if possible, to promote socialization and foster growth in
children. Sometimes nurses can advocate for children with similar disease processes or
hobbies to room together in the hospital. This promotes a sense of community facilitating
recovery and belonging.
 Remind children that their illness is not punishment. Explore this confusion in your pediatric
patients. Sometimes children do not have the words to express their fears that they did
something wrong to cause their illness or hospitalization.
 Use words and sentence length that matches the child’s level of understanding. A common
way to measure this is the number of words in a child’s sentence should equal his/her age
plus one.
 Use crayons and paper freely. First demonstrate by drawing yourself and encourage child’s
expression.
 Give children time to feel comfortable with you. Speak to the parents first.
 Help children understand they can face their fears. Promote courage.
 Give hope and courage to children through praise by stating how “brave” and/or “good” they
are.
 Communicate with puppets, dolls, or stuffed animals first before asking questions directly of
a young child.
 If a child is ticklish when you are examining his/her abdomen, place the child’s hand down
first on his own abdomen and place your hand on top of his. Then slowly deviate off of his
hand to examine the abdomen.
 Parents should not be asked to restrain their child. This interferes with the trust relationship
the child has with his/her parent.
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 Allow children to pick a toy out of the toy box to play with during the procedure and then
afterwards they Nursi
can pick a gift out of the box and return the toy.
 Involve the medical social worker to assist in therapy with pediatric patients.
 Tell children it is okay to cry, do not shame them for expressing this emotion.
 Stress the positive benefits of procedures.

Developmental Strategies with Toddlers (1- 3 years old)

 To care for toddlers in the healthcare setting the nurse should:
o Allow the toddler to sit on the parent’s lap during the procedure or exam.
o Give the toddler a choice such as “Would you like me to listen to your heart first or
look at your ears?”
o Refrain from asking the toddler permission to examine him/her because the answer is
most likely going to be no. Instead, state calmly and firmly what area you are
examining next.
o Use distraction such as the parent blowing bubbles or reading to the child during the
procedure.
o Prepare the toddler no more than one day ahead of time for the procedure otherwise it
can increase anxiety at this age level.
o Ask the child to point to a body part that you are going to examine.
o Show the child the equipment you will use.
o Praise the child using his/her first name for cooperating.
o Allow the toddler to dress self, use potty-chair, and self feed.
o Name objects with simple explanations.
o Perform treatments in a separate room rather than toddler’s bedroom so his/her bed is
a safe haven.
o Allow the toddler to choose a sticker after the procedure.
o Provide a nightlight in the child’s room.
o Give the toddler a choice by saying, “Once I have listened to your heart, you can
choose to ride in the cart or walk to the playroom” to decrease resistance from the
child.
o Comfort the toddler after a painful procedure by rocking, singing, offering a snack, or
holding him/her.

Developmental Strategies with Preschool Children (3 years – 6 years)

 To care for preschoolers in the healthcare setting the nurse should:
 Allow the child to touch or play with equipment you will use
o Have the preschooler sit on the parent’s lap
o Give the child choices in your approach to him/her
o Make up a story about what you are examining or doing such as, “I’m seeing how
strong your muscles are” when checking his/her blood pressure (6).
o Use drawings to help explain procedures and allow the child to draw both before and
after the procedure to process the information.
o Expect cooperation by using positive statements such as, “Open your mouth.”
o Read books to the child to help him/her process what is happening.
o Use the doll or stuffed animal to practice what is happening to him/her.

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o Be alert to the comfort level of the child with male or female nurses and try to
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accommodate the child if possible.

Developmental Strategies with School Age Children (6 years – 12 years)

 To care for school age children in the healthcare setting the nurse should:
o Answer all their questions and demonstrate the equipment. Your patience with this
age group will usually pay off.
o Allow the child to express his/her concerns and provide reassurance.
o Focus on positive behaviors and reinforce these behaviors.
o Encourage the child to resume schoolwork as quickly as feasible.
o Be alert to manipulation by the child to avoid a treatment or procedure. Sometimes
this age group is prone to bargaining to delay procedures, so the nurse should be
flexible but aware of this possible occurrence.
o Knock on the door before entering the room.
o Encourage the child’s friends to visit or call the patient.
o Allow the child to choose his/her reward after the procedure.
o Teach techniques like counting, breathing or visualization to manage difficult
situations.
o Use small talk as a means of distraction during the procedure.

Developmental Strategies with Adolescent Children (12 years – 18 years)

 To care for adolescent children in the healthcare setting the nurse should:
o Allow for regressive behavior and expect it
o Respect their need for privacy
o Encourage socialization with peers from within and outside the hospital
o Allow wearing of street clothes in the hospital setting, if possible
o Allow the child to use electronic equipment such as cell phone, I-pad, and/or
computer
o Offer written and verbal complete explanations of the disease and necessary
procedures
o Introduce the teen to other teens with the same health problem
o Be sure snacks are available since this group tends to require more calories
throughout the day
o Be alert to manipulation by the child to avoid a treatment or procedure. Sometimes
this age group is prone to bargaining to delay procedures, so the nurse should be
flexible but aware of this possible occurrence.
o Promote competence and independence in the child and should not focus on the
negative. The nurse must build up the child’s spirit.
o Encourage the child to express his/her feelings about his/her experiences in the
healthcare setting.

Therapeutic Play in Nursing Care of Pediatric Patients

 Children use play to make sense of their world, to categorize the collective whole of their
being with their interactions, dreams, missteps, and joyful attitudes. As nurses, we must
facilitate this play through our contact with our youngest patients. Play is very individualized,
each child deciding his/her favorite play activity. Therapeutic play decreases negativity,

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provides motor activity outlet, and helps the child cope. Play provides the child with an active
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of the situation, and distracts from procedures that cause stress.
 Some examples of therapeutic play:
o The child using the IV catheter on his/her doll or stuffed animal. Allowing the child to
play with the equipment for several days prior to the procedure assists in processing
the procedure successfully.
o Stories can be read to the child or the child can make up his/her own story about the
healthcare event.
o Puppets are especially useful for children to act out what they are experiencing in the
hospital setting. Nurses can also have the puppets ask personal questions of the child,
and it’s more likely the child will answer them.
o Expressive therapy works well with children oftentimes because they are hands-on
learners and express their emotions the same way. Here are some examples of
expressive therapies that can help children address fear, anxiety, stress, and pain:
 Art therapy
 Drama therapy
 Play therapy
 Music therapy
 Poetry therapy
 Sand play therapy
 Specific Play Activities for Specific Procedures
o Increasing fluid intake can be accomplished by cutting gelatin into fun shapes; using
small medicine cups and decorating them; color water with food coloring; make a
poster and give rewards when drinking a prescribed amount.
o Deep breathing can be encouraged through blowing bubbles; blowing a pinwheel or a
party blower; suck paper from one container to another using a straw.
o Range of motion activities can be simulated with activities such as throwing bean
bags into a basket; hang balloons and have the child kick them; play Twister or Simon
Says; play kickball with a foam ball; provide clay for fine motor exercises; paint or
draw on large sheets of paper on the floor; play beauty shop and comb or set hair.
o Soaks can be imitated by playing with toys in water; washing his/her dolls; picking up
marbles in the bath water.
o Injections can be simulated by letting the child play with the syringes with his/her
doll; use syringes to decorate cookies with frosting; allow the child to have a
collection of different sized syringes to manipulate.
o Giving the child something to push like a stroller or wheelchair, and holding a parade
can encourage ambulation.
o Children in traction can have their environment expanded by turning the bed into a
pirate ship or airplane with decorations; or moving the bed to the playroom.

SAQA-2
Formulate a nursing care plan to reduce stress of illness, such as helping parents plan for
ambulatory care or therapeutic play.

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Reducing Pain and Discomfort

 Include parents Nursi
in pain control techniques and teach them their role in pain control for their
child. Parents are the most important part of pain management. This role is very child-parent
specific and includes coping styles of both the parents and the child.
 Consider using a device called “Buzzy” to decrease the sensation of pain during IV insertion
or venipuncture . This device uses a combination of cold and vibration to replace pain with
movement and temperature. Research has shown this device to be effective in decreasing pain
and discomfort during some procedures.
 Provide an outlet through serious gaming for these children. Serious gaming is defined as
video games that require active participation by the child through problem solving that has
shown to be very effective as a distractor during painful procedures .
 Be open and honest to children in their care. It is better to say, “Sometimes this feels like
pushing or pinching and sometimes it doesn’t bother people. You tell me how it feels” instead
of, “This is probably going to hurt.”
 Provide distraction for children to decrease their pain experience, examples include listening
to the radio or music; the child singing, deep breathing, blowing bubbles to blow the pain
away, yelling as loud or soft as it hurts, visiting with friends or watching TV
 Teach relaxation techniques to the child and parents such as gently swaying a child, rocking,
or having him/her take a deep breath then relaxing his/her body on exhalation.
 Teach guided imagery to children and parents, examples include asking the child to verbalize
relaxing experiences, or have the child pre-tape his/her story of a relaxing event and listen to
it during the painful procedure.
 Encourage positive self-talk with the child. For example, having the child say, “I’m going to
feel better soon” or “I know I can do this.”
 Use topical anesthetics on any age child to decrease the pain sensation during IV insertion or
venipuncture procedures.

Lessening Pain and Discomfort

 Infants
o Encourage holding, cuddling, allowing infants to suck a pacifier, use of sucrose while
sucking, and massaging.
 Toddlers
o Encourage reading them stories, massages, blowing bubbles, touching, holding,
rocking, listening to music, and coloring.
 Preschoolers
o Encourage playing, reading stories, listening to music, child pretending to be a
superhero, watching TV or a video, and engaging in arts/crafts.
 School Age Children
o Encourage the child to breathe rhythmically, use guided imagery, talk about fun
experiences, play games, listen to TV, radio or music, and engage in arts/crafts.
 Adolescents
o Encourage the child to breathe rhythmically, use muscle relaxation, use guided
imagery, listen to music, watch TV, have visitors, play games, and arts/crafts.

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SAQA-3
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Use the following scenario to respond to questions 1 through 4.
Imagine that you are a nurse on the staff of a pediatric group practice. A mother comes in
to discuss her son who is not quite 3 years old. He will attend the preschool program at a
local private school this year. He has attended a home day care program since he was a
baby, while his mother worked in her own carinderia. An older woman runs the day care
that the child has attended until now. The woman and her helper both treat the 12 children
in her program as if they were family. The program is very structured in regard to
schedule and routines. The child's mother tells you that she is looking forward to Jacob's
new environment. His teacher is very creative and approaches the classroom from the
perspective of the child's development. There will be a lot of choices for activities during
the day.
1. Based on the information above, analyze the data presented in relation to the child's
needs and the concerns for a smooth transition.
2. Develop an expected outcome that is reasonable to establish for this mother and her
child.
3. Describe interventions and strategies that are appropriate for you to suggest to this
mother and her child.

Nursing Care of Pediatric Patients with Special Healthcare Needs

 To leave any labels at the door and interact with this population as individuals with distinct
needs similar to the pediatric population at large.
 Even though a child may have a cognitive diagnosis he/she still shares dreams, hopes, and
feelings. These children desire to be seen as individuals who relish conversations with people
and interactions. Talk in a normal tone and give them eye contact.
 A child’s loud verbalization does not necessarily mean pain. Get to know these individuals on
a personal level. Oftentimes this verbalization could be laughter. Trust in your own senses to
determine the difference.
 Respect these children’s bodies regardless of ability. Explain to this child what you are doing
before doing it.
 Even though a child with special needs might not interact or talk; provide care, respect, and
compassion as you would any other patient.
 Provide comfort as you would any patient, even though these children express themselves
differently. They need love, kindness, and patience.
 Show advocacy for each child you care for regardless of ability, diagnosis, or IQ. Involve
special needs children in the conversation; even though they do not participate verbally, they
understand what is happening.
 Use the checklist developed for non-communicating children to assess the pain level of these
special needs children
 Treat each child with the special care and a patient approach that they so deserve and require.
 Communication is vital with the child and his/her family members.
 Nurses must not place judgments on patients but keep an open mind and an open heart to
guide patients towards their best healthcare outcome.
 Nurses have expressed concern with having adequate time to care for the special needs
pediatric patient in a holistic manner. Nurses desire to engage in a thorough way with these
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patients and their families in nursing care of pediatric patients, but time constraints limit
over-involvement Nursi
and sometimes lead to frustration and guilt on the nurses’ part. They
describe it as an art to balance the time factor with the multiple needs of these patients, and
the other patients on the nurses’ caseload.
https://nursingcecentral.com/lessons/caring-for-pediatric-patients-developmentally-
appropriate-interventions-and-techniques/

SAQA-4
1. Describe why it is necessary for the nurse to assess the family's specific perceptions
concerning their child's illness or disability.
2. Describe how a preschooler who becomes seriously ill is likely to perceive their
illness.

REFERENCES:

 "Pillitteri, A. (2014). Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing family. (7th ed.): Philadelphia: Lippincott Williams &
 Wilkins.
 Hockenberry, M. J. & Wilson, D. (2015). Wong's Nursing Care of Infants and Children (Vol.
1-Vol. 2). Winsland House, Singapore: Elsevier
 Maternal And Child Health Nursing 8th Edition PDF Download.
https://collegelearners.com/ebooks/maternal-and-child-health-nursing-8th-edition-pdf/
 VanPutte, C. Regan, J. & Russo, A. (2016). Seeley's Essentials of Anatomy & Physiology. (9th
ed.).:Penn Plaza, New York NY: McGraw-Hill Education
 Rizzo, D. C. (2016). Fundamentals of Anatomy and Physiology (4th ed.): Andover: Cengage
Learning
 https://emedicine.medscape.com/article/262063-overview
 https://nurseslabs.com/gestational-trophoblastic-disease/
 https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk
 https://nurseslabs.com/gastrointestinal-disorders-pregnant-woman/
 https://quizlet.com/284097234/ob-postpartum-care-flash-cards/
 https://nursingcecentral.com/lessons/caring-for-pediatric-patients-developmentally-
appropriate-interventions-and-techniques/

Acknowledgement
The images, figures and information contained in this learning packet were taken from the
references above.

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Nursi

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