Child Health Nursing (Child Health

Nursing: Partnering with Children &

Families) 3rd Edition, (Ebook PDF)
Visit to download the full and correct content document:
https://ebookmass.com/product/child-health-nursing-child-health-nursing-partnering-w
ith-children-families-3rd-edition-ebook-pdf/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Community/Public Health Nursing Practice E Book: Health

for Families and Populations (Maurer, Community/ Public
Health Nursing Practice) 5th Edition, (Ebook PDF)

https://ebookmass.com/product/community-public-health-nursing-
practice-e-book-health-for-families-and-populations-maurer-
community-public-health-nursing-practice-5th-edition-ebook-pdf/

Health & Physical Assessment in Nursing 3rd Edition,

(Ebook PDF)

https://ebookmass.com/product/health-physical-assessment-in-
nursing-3rd-edition-ebook-pdf/

Health Promotion in Nursing Practice (Health Promotion

in Nursing Practice ( Pender)) 7th Edition, (Ebook PDF)

https://ebookmass.com/product/health-promotion-in-nursing-
practice-health-promotion-in-nursing-practice-pender-7th-edition-
ebook-pdf/

Neeb’s Mental Health Nursing 5th Edition, (Ebook PDF)

https://ebookmass.com/product/neebs-mental-health-nursing-5th-
edition-ebook-pdf/
Community & Public Health Nursing: Promoting the
Public’s Health 9th Edition, (Ebook PDF)

https://ebookmass.com/product/community-public-health-nursing-
promoting-the-publics-health-9th-edition-ebook-pdf/

Adult Health Nursing 9th Edition Kim Cooper

https://ebookmass.com/product/adult-health-nursing-9th-edition-
kim-cooper/

Policy & Politics in Nursing and Health Care – E-Book

(Policy and Politics in Nursing and Health) 7th Edition
– Ebook PDF Version

https://ebookmass.com/product/policy-politics-in-nursing-and-
health-care-e-book-policy-and-politics-in-nursing-and-health-7th-
edition-ebook-pdf-version/

(eTextbook PDF) for Health Promotion in Nursing

Practice 8th

https://ebookmass.com/product/etextbook-pdf-for-health-promotion-
in-nursing-practice-8th/

Contemporary Health Promotion In Nursing Practice 2nd

Edition, (Ebook PDF)

https://ebookmass.com/product/contemporary-health-promotion-in-
nursing-practice-2nd-edition-ebook-pdf/
iv  About the Authors

Kay J. Cowen
Kay J. Cowen received her BSN from
East Carolina University in Green-
ville, North Carolina, and began her
career as a staff nurse on the pediat-
ric unit of North Carolina Baptist
Hospital in Winston-Salem. She
developed a special interest in the
psychosocial needs of hospitalized
children and preparing them for hospitalization. This led to the focus
of her master’s thesis at the University of North Carolina at Greens-
boro (UNCG) where she received a master of science in nursing edu-
cation degree with a focus in maternal child nursing.
Mrs. Cowen began her teaching career in 1984 at UNCG where
she continues today as clinical professor in the Parent Child De-
partment. Her primary responsibilities include coordinating the
pediatric nursing course, teaching classroom content, and super-
vising a clinical group of students. Mrs. Cowen shared her passion
for the psychosocial care of children and the needs of their families
through her first experience as an author in the chapter “Hospital
Care for Children” in Jackson & Saunders’ Child Health Nursing: A
Comprehensive Approach to the Care of Children and Their Families
published in 1993.
In the classroom, Mrs. Cowen realized that students learn
through a variety of teaching strategies and became especially inter-
ested in the strategy of gaming. She led a research study to evaluate
the effectiveness of gaming in the classroom and subsequently con-
tinues to incorporate gaming in her teaching. In the clinical setting,
Mrs. Cowen teaches her students the skills needed to care for patients
and the importance of family-centered care, focusing on not only the
physical needs of the child but also the psychosocial needs of the
child and family.
During her teaching career, Mrs. Cowen has continued to work
part time as a staff nurse: first on the pediatric unit of Moses Cone
Hospital in Greensboro and then at Brenner Children’s Hospital in
Winston-Salem. In 2006 she became the part-time pediatric nurse
educator in Brenner’s Family Resource Center. Through this role she
is able to extend her love of teaching to children and families.
Through her role as an author, Mrs. Cowen is able to extend her
dedication to pediatric nursing and nursing education. She is mar-
ried and the mother of twin sons.

We dedicate this book to our partners:

~our families for their unwavering support
~colleagues who have grown and learned with us, and continue to help expand our thinking
~families and children with whom we work, for teaching us the essentials of child health nursing
~students who are our collaborators now and in their future careers as nurses

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. iv C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
 Thank You
We would like to express our deep gratitude to our colleagues from schools and hospitals across the country for their time over the past 3 years.
These individuals assisted us in the revision of this book by contributing and reviewing manuscript chapters and contributing to the supple-
ments that accompany this title. Child Health Nursing: Partnering with Children & Families has benefited immeasurably from your efforts,
insights, and willingness to share your expertise as teachers and nurses.

Contributor
Chapter 4: Genetics and Genomics Sharon Koval Falkenstern, PhD, CRNP, Brenda Millet, MSN, RN-BC
PNP-C, CNE Staff Development Specialist
Influence Assistant Professor, Coordinator of NP Option Children’s National Medical Center
Linda D. Ward, MN, ARNP The Pennsylvania State University Washington, DC
Clinical Assistant Professor University Park, Pennsylvania Cheryl Shaffer, RN, MS, PNP, ANP, PhD(c)
Washington State University College of Nursing Leslie Holmes, RN, BSN, MSN Associate Professor
Spokane, Washington Instructor, Family and Community Nursing Suffolk County Community College
Nell Hodgson Woodruff SON Emory University Selden, New York
SUPPLEMENTAL CONTRIBUTORS Atlanta, Georgia Lisa D. South, RN, DSN
Jane Brown, MSN, RN Mary Jo Konkloski, RN, MSN, ANP Assistant Professor
Associate Professor Coordinator, RN Program The University of Alabama at Birmingham
Walters State Community College Finger Lakes Health College of Nursing Birmingham, Alabama
Morristown, Tennessee Geneva, New York Jane K. Walker, BBA, RN, CLNC, PhD(c)
Laura L. Brown, RN, MSN, CPN Patricia Kuster, PhD, RN, CPNP Associate Professor of Nursing
Nursing Instructor Assistant Professor Walters State Community College
Asheville Buncombe Technical Community College Samuel Merritt College School of Nursing Morristown, Tennessee
Asheville, North Carolina Sacramento, California Jeannie Weston, MS, CNS, BSN
Pamela P. DiNapoli, PhD, RN Brenda Lykins, RNC-NIC, BSN Assistant Clinical Instructor
Associate Professor Neonatal Outreach Coordinator Emory University
University of New Hampshire MultiCare Regional Perinatal Outreach Program Atlanta, Georgia
Durham, New Hampshire Tacoma, Washington
Donna Eberly, RN, MSN Adelaide R. McCulloch
Instructor
Western Iowa Tech Community College
Sioux City, Iowa

Reviewers
Mike Aldridge, Concordia University Texas Sarah Kulinski, Lenoir-Rhyne University
Kim Amer, DePaul University Patricia Kuster, Samuel Merritt University
Janice Bidwell, San Diego State University Lin Lin, The University of Texas Health Science Center at Houston
Patricia Bobbitt, Wake Forest University School of Medicine Antoinette McCray, Norfolk State University
Sally Brooks, The University of Louisiana at Monroe Cheryl Mele, Drexel University
Michael Brown, The University of Texas Health Science Center at Houston Mary Ellen Mitchell-Rosen, Nova Southeastern University
Karyn Casey, The University of Tennessee Heidi Monroe, Seattle Pacific University
Teresa Chase, University of Kentucky Brenda Pavill, University of North Carolina Wilmington
Jennifer Compere, Brenner Children’s Hospital Sue Perkins, Washington State University
Joseph De Santis, University of Miami Kathleen Peterson, The College at Brockport
Linda Esposito, Wake Forest Baptist Medical Center Janice Pitman, Brenner Children’s Hospital
Melissa Ethington, The University of Texas Health Science Center at Houston Kari Crawford Plant, Levine Children’s Hospital
Niki Fogg, Texas Woman’s University Deborah Roberts, Sonoma State University
Betty Freund, Kent State University T. Kim Rodehorst-Weber, University of Nebraska Medical Center
Julie Garcia, The University of Texas Health Science Center at San Antonio Carol Rossman, Calvin College
Carol Hall Grantham, Georgia State University Michele Shaw, Washington State University
Debbie Hancock, The University of North Carolina at Greensboro Anita Smith, Wake Forest University School of Medicine
Kristen Harrison, Wake Forest Baptist Medical Center Daphnee Stewart, Mercer University
Amy Zlomek Hedden, California State University, Bakersfield Phyllis Thatcher, Wake Forest Baptist Medical Center
Michelle Howell, Wake Forest Baptist Medical Center Debra Thomson, Wake Forest Baptist Medical Center
Kim Hutchinson, Wake Forest Baptist Medical Center Maureen Tippen, University of Michigan-Flint
Arlene Johnson, Clemson University Theresa Turick-Gibson, Hartwick College
Eleanor Kehoe, College of Staten Island Diane Van Os, Westminster College
Mary Kishman, College of Mount St. Joseph Darla Vogelpohl, University of Toledo
Julie Kordsmeier, The University of North Carolina at Greensboro Beverly Bockstruck West, University of Memphis
Heidi Krowchuk, The University of North Carolina at Greensboro Melissa Williams, Augusta State University
Laura Kubin, Texas Woman’s University Cecilia Wilson, Texas Woman’s University

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. v C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
 Preface
The world children grow up in today is vastly different from the world
we experienced in our early years. Our evolving social environment
has resulted in diverse family structures and roles. Multiple racial and
ethnic groups now commonly share communities, work environ-
ments, and recreation. A variety of technology applications are part
of children’s daily routines. Nutritional patterns have changed due
to the complexity of daily lives and food marketing, and the environ-
ment is identified as an increasing influence on child and adolescent
health. The geospatial design elements of communities, including
schools, modes of transportation, and safety in neighborhoods, have
altered daily behaviors. Life in complex societies offers new challenges
to mental health, and homes provide diverse risk and protective factors
in managing the health and illness of child family members. New ways
of treating diseases, from applications of genomics to a current genera-
tion of medications, influence youth health. Healthcare reform, elec-
tronic health records, new approaches to chronic and acute condition
management, and a focus on prevention have contributed to changes
in the information that nurses and other healthcare providers need.
We draw heavily upon Healthy People 2020 in this text to guide our
suggested interventions and evaluation of goals for health conditions.
In addition to an evolution of influences on child health, there have
been incredible achievements in nursing education. The American As-
sociation of Colleges of Nursing (AACN) published the E ­ ssentials of Bac-
calaureate Education for Professional Nursing Practice in 2008. While we
know that many Associate Degree Nursing programs use our books, we
also are aware that a number of those programs also use “the Baccalaure-
ate Essentials” in establishing their curricula. We have therefore applied
the Essentials throughout the book and cite them in a new feature (see
a description later in this preface). In 2009, the “Carnegie Report” on
Educating Nurses: A Call for Radical Transformation was published. This
long-awaited study emphasized the importance of connecting classroom
and clinical learning, focusing on clinical reasoning when working with
students, and fostering career ladders and lifelong learning. These recom-
mendations inform our clinical judgment and clinical reasoning features.
Finally, in 2010, the Institute of Medicine (IOM) released The Future of
Nursing: Leading Change, Advancing Health. The IOM recommended
that nurses function to the full extent of their education and training,
achieve higher levels of education, be full partners with physicians and
other healthcare professionals in the redesign of health care, and work to
plan policies that ensure data collection and information infrastructure.
Child Health Nursing: Partnering with Children & Families is a
contemporary pediatric nursing textbook. Excellence in pediatric
nursing care, whether it is in the acute care setting or in the commu-
nity, is a challenge and the major objective guiding today’s pediatric
nurse. You, as a student, will be challenged to synthesize previous
information with new knowledge, apply evidence-based findings,
collaborate with other healthcare professionals and families, and in-
tegrate current knowledge to use clinical reasoning skills in planning
pediatric nursing care. You will be challenged to lead, examining
ways in which you can positively influence the health care of chil-
dren and their families in the challenging times of healthcare reform.
The third edition of Child Health Nursing builds upon the strong
foundation and planning of the first two editions and addresses the
# 108438 Cust: Pearson Au: Ball Pg. No. vi
Title: Child Health Nursing Server:
need for fresh approaches to child and adolescent health care and
nursing education in several ways. Themes in this book include:
■ Partnering with Children and Their Families
■ The Roles and Essential Functions of the Nurse
■ Health Promotion and Health Maintenance
■ Collaboration with Families and Healthcare Providers
■ Evidence-Based Practice
■ Clinical Reasoning
The subtitle, Partnering with Children & Families, reflects the core
value of our textbook—emphasizing family-centered care, recognition of
the family as the central influence in each child’s life, and respect for fami-
lies from all cultures. Families are viewed as case managers, as partners
with healthcare providers, and as integral participants in care in all pedi-
atric nursing settings. Partnership and interprofessional collaboration are
other key concepts of our textbook. In the past, we introduced the Bindler-
Ball Child Healthcare Model as a paradigm with which to view health care
of children. This model illustrates an important core value—that all chil-
dren need health promotion and maintenance interventions, no matter
where they seek care or what health conditions they may be experiencing.
Families may visit offices or other community settings, specifically to ob-
tain health supervision care; or nurses may integrate health promotion
and maintenance into the care for children with acute and chronic illness
in a variety of inpatient and outpatient settings. The Bindler-Ball Health-
care Model places health promotion and maintenance at the foundation
of a pyramid to demonstrate the need to apply these concepts with all
children. See Chapter 1 for an introduction to this model.
WHAT’S NEW IN THIS EDITION
■ Baccalaureate Essentials Boxes highlight the nine essentials of
nursing education identified by the American Association of
Colleges of Nursing.
■ NANDA-I 2012-2014 nursing diagnoses for multiple conditions.
■ Updated Healthy People 2020 goals for the pediatric population.
■ More Evidence-Based Practice features emphasize nursing re-
search and offer a critical thinking element.
■ Clinical Judgment speed bumps to encourage critical thinking.
■ Clinical Reasoning section at the end of chapter to help with
application of concepts and synthesis.
■ New statistics, and integration of current health care implica-
tions and environmental considerations.
Organization
The six units in this textbook have a unifying theme. The first unit,
Nurses, Children, and Families, lays the foundation for a thorough un-
derstanding of pediatric nursing in today’s world. It discusses the nurse’s
roles in caring for children in the hospital, community, and home, as
well as the concepts of family-centered care and cultural considerations.
The second unit focuses on Child Concepts and Application, meld-
ing theory with application so that concepts can be applied to pediatric
nursing care in a variety of settings. Genetics and genomics are cur-
rent concepts that will be increasingly employed in future health care.
We describe concepts of growth and development and child/family
DESIGN SERVICES OF
C/M/Y/K
S4carli le
Short / Normal Publishing Services
s

communication in separate chapters, and examine applications to pe-
diatric nursing. The pediatric assessment chapter provides basic and de-
tailed information that will be applied in all pediatric healthcare settings.
The third unit focuses on Health Promotion and Maintenance
Through Childhood. The first chapter introduces basic concepts, and
each of the remaining five chapters applies health promotion and
maintenance concepts with specific approaches for children at each
developmental stage from newborn through adolescence. Nurses
assess children thoroughly, establish goals in partnership with the
family, intervene to promote and maintain health and foster devel-
opment, and evaluate the outcomes of care. This unique approach
minimizes repetition throughout the book, and underscores the
need for all children to receive routine health promotion and health
maintenance to achieve optimal health.
The fourth unit, Child Healthcare Settings and Considerations,
explores the various settings in which care occurs. In addition to the
hospital, nurses and nursing students are likely to provide care in com-
munity settings, such as health centers, schools, and homes, where
health promotion and maintenance activities predominate. Special
considerations for the care of children during disasters are also dis-
cussed. Shorter hospitalizations have become the norm, thereby
increasing the need for more comprehensive care in community set-
tings, such as specialty outpatient centers where nurses coordinate care
for children with various health conditions. Children need special at-
tention when they have chronic health conditions, when they have life-
threatening illnesses or injuries, or when they need end-of-life care.
The fifth unit discusses Nursing Care for Common Health Condi-
tions. The unit begins with a chapter on infant, child, and adolescent
nutrition, which discusses both nutritional requirements for health
and some common nutritional disruptions. A chapter on social and
environmental influences addresses topics pertinent to children and
Visuals That Teach
The art program of this book continues to use a thoroughly inte-
grated approach, beginning with the cover and carried through the
interior of the textbook. The cover of Child Health Nursing features
hand-painted tiles from Rydal Elementary School in Abington,
Pennsylvania. Art is both a method of expression and a healing
modality, and the feelings, design, and colors of the tiles integrated
throughout this book will help you identify with children and their
families, and understand their experiences.
A Day in the Life of a Nurse helps identify the roles and focus of
nursing care in each of three settings: the hospital, the healthcare
center, and the school setting.
# 108438   Cust: Pearson   Au: Ball  Pg. No. vii
Title: Child Health Nursing   Server:
Visuals That Teach  vii
their families in today’s world, such as violence and substance use. A
chapter on pediatric pain assessment and management provides gen-
eral nursing care concepts that are woven through the remainder of
the book. Another chapter focuses on the prevention and treatment
of infectious and communicable diseases, a significant role in pediatric
nursing care.
The sixth unit consists of 14 chapters that address Nursing Care
of Specific Health Conditions. Information about health conditions,
including both illnesses and injuries, is grouped by body systems,
eliminating the need for duplication at various places in the text.
This streamlined approach builds on previous concepts rather than
repeating them, integrating a developmental approach with perti-
nent conditions affecting all age groups from newborn to adolescent.
The chapters fully describe diseases and injuries beginning with
an anatomic and physiologic overview, pediatric differences, and
system-specific assessment guidelines. This is followed by a dis-
cussion of the etiology, pathophysiology, clinical manifestations,
and collaborative care, including diagnostics and clinical therapy
sections for each of the major conditions. Nursing management
of major conditions contains detailed sections on assessment and
diagnosis, planning and intervention, and evaluation of care. The
book is readable and understandable, taking the student from pres-
ent knowledge level to mastery of new material. The many features
further enhance the readability of the material for students coming
from various backgrounds and nursing programs and curricula.
Sample nursing care plans will assist you in applying develop-
mental, psychosocial, and physiologic concepts to the care of chil-
dren with specific conditions. North American Nursing Diagnosis
Association (NANDA International) diagnoses are used, as well as
the current Nursing Intervention Classifications (NIC) and Nursing
Outcomes Classifications (NOC).
366 Unit IV | Chapter 14 | Nursing Care of the Child in the Community
A DAY IN THE LIFE
of a School Nurse
Left. Johnny’s teacher sent him to the school nurse because he complained about a sore throat. Ellen performs an assessment to determine if his
parents should be called to take him home or to his healthcare provider. Right. Kevin gets medication each day at lunchtime for attention deficit
hyperactivity disorder. The timing of the medication is important to improve his concentration and learning during the afternoon.
T he school nurse is the only health professional in the school environ-
ment. Thus Ellen Gorges has very broad responsibilities for main- Ellen Gorges has very
taining the health of all the children attending the school (and in some
cases multiple schools). Because all children are entitled to an education broad responsibilities for
by federal law, Ellen may provide care to children who are healthy and to
those who have health conditions. Many children with special healthcare maintaining the health of
needs and chronic conditions attend school regularly, as well as children
all the children attending
who are recovering from acute illness and injury episodes.
Activities that Ellen often performs include the following:
the school.
■ Assessing student health complaints
■ Providing emergency care and first aid to students and faculty Ellen also gives attention to the health of the school faculty, by assess-
■ Administering medications ing and counseling them about their health needs.
■ Ensuring immunization compliance Because the scope of school nursing is so
■ Screening students for health conditions broad, it has become a specialty within pediatric
■ Educating faculty and health aides to rec- nursing, often requiring additional education and
ognize illnesses or health problems among certification as a school nurse or school nurse
students in the classroom and to provide practitioner.
needed health care as appropriate for a child
with special healthcare needs
■ Documenting health care provided to
students
Participating in development of student in-
■
dividualized health plans and health-related
accommodations needed for learning
■ Ensuring a safe environment for students
and faculty The school nurse performs scoliosis screen-
■ Serving as a student advocate ing of all students in the fifth grade to enable
early identification of the condition and refer-
ral as necessary to a student’s healthcare
provider.
DESIGN SERVICES OF
C/M/Y/K
Short / Normal
S4carlisle Publishing Services

Unit VI | Chapter 32 | Alterations in Endocrine and Metabolic Function
32–4 Diagnostic Tests for Short Stature
PURPOSE RELATED TO SHORT STATURE
d IGFBP-3 Screens for growth hormone deficiency A scale with a chair■attached
e pituitary gland Detects pituitary malformation or tumor
ve growth hormone testing Tests for growth hormone deficiency
Identifies other potential causes
growth
e (girls) Detects Turner syndrome (seecontrol
unction studies Detects hypothyroidism (see page
d cortisol levels Detects other pituitary hormonal
deficiencies
atinine, pH, specific gravity, Detects chronic renal failure
ogen, electrolytes (see Chapter 31 )
e blood count and Screens for inflammatory bowel disease
te sedimentation rate with anemia
n antibodies Screens for celiac disease
Photo Stories helpendocrinologist
ata from Parks, J. S., & Felner, E. I. (2011). Hypopituitarism. In R. M. Kliegman, B. F.
velop a deeper understanding
W. St. Geme III, N. F. Schor, & R. E. Behrman, Nelson textbook of pediatrics (19th ed.,
1881). Philadelphia, PA: Saunders Elsevier; Cooke, D. W., Divall, S. A., & Radovick, S.
on the child and family.
mal and aberrant growth. In S. Melmed, K. S. Polonsky, P. R. Larsen, & H. M. Kronenberg,
xtbook of endocrinology (12th ed., pp. 935–1053). Philadelphia, PA: Saunders Elsevier.
or situation to demonstratenormal growth ratetheforchallenges
face
tions (arginine, clonidine, glucagon, inL-dopa)
insulin, managing
are ad- the
red to stimulate release of growth hormone, may be used to
m growth hormone deficiency. Confirmation of the disorder
d on failure to demonstrate a growth hormone response (with
evel greater than 10 ng/mL) after presenta-
two provocative stimuli as previously men-
However, some endocrinologists believe
t is less reliable than other tests, such as low
evels. Growth hormone deficiency may oc-
ne or with one or more other pituitary hor-
deficiencies. It may be total deficiency (no
hormone produced) or partial deficiency
growth hormone produced, but not enough
ort normal growth).
y diagnosis and treatment are important
ure attainment of maximum adult height
al. Bone age (an estimation of skeletal ma-
is used to evaluate the child with a growth
m and can be used to predict final height.
raphic imaging of the hand or wrist bone is
evaluate the stage of bone ossification and
e bone age of the child. Using standardized
for bone ossification, radiologists can de-
e if the child’s chronologic and bone ages
Significantly delayed (less than the child’s
advanced (greater than the child’s age)
ge may be indicative of a systemic chronic
or hormone abnormality requiring inves-
n (Figure 32–4 ■). FIGURE 32–4 ■ The radiograph of the hand and wrist of a 3-year-old and 13-year-old girl reveal significant dif-
Therapy
wth hormone deficiency, replacement ther-
h GH is administered to promote growth
velopment. Growth hormone replacement
these reasons
of the behavior of someone else. Individuals make decisions about health
behaviors based on thought about the consequences and outcomes of those 3. Transtheoretical Stages of Change Model. This model suggests that
behaviors. The person’s characteristics, such as self-efficacy and outcome individuals engage in stages prior to taking any actions that lead to change
expectancy, interact with the external environment and the behavioral choices in health behaviors. The five stages are precontemplation, contemplation,
available. All of these components interact to determine health behaviors, and preparation, action, and maintenance (Erol & Erdogan, 2008). Those in early
all can be influenced to promote health. If you were seeking to promote physi- stages are unlikely to begin behavioral change before about 6 months, while
cal activity behaviors in youth, some essential components would be: the action phase includes immediate readiness to change. Understanding
■ Encourage youth to believe they could perform the activity (self-efficacy).
the adolescent’s stage of change can guide the nurse to approach teaching
and motivation activities in a more realistic manner. If you were planning an
■ Point out the positive aspects of the behavior (outcome expectancy).
intervention with adolescents who smoke, some strategies could include the
■ Show youth how to do the activity (modeling). following:
■ Provide a physical setting and opportunity for performing the behavior ■ Ask if the teen is ready to take steps now to stop smoking, or would like
(environment). to do it in the future.
■ Allow trial and error, and choice in time and extent of activity (behavioral ■ Assist the adolescent to move from precontemplation and contemplation
viii  Visuals That Teach choices).
2. Health Belief Model. This theory attempts to explain why some individu-
phases to the action phase by providing information and resources about
smoking dangers and cessation programs.
als take actions to prevent disease or promote health while others do not. ■ Assist the adolescent in the action phase with strategies to remain
Factors that influence the likelihood of taking on preventive behaviors include smoke-free.
the perceived susceptibility to disease, seriousness of the disease, perceived ■ If the individual has recently quit smoking, ask about times when tempted
Structural Defects 1183 benefits of preventive action, and barriers to preventive action. Modifying to smoke and strategize to increase the potential for maintenance.
PHOTO STORY. . .
MANAGING MYELODYSPLASIA
Initial observations will guide some of the interactions with the
teen. For example, if a teen is overweight, provide a quiet and private
location while taking the weight, and do not announce the weight
aloud. Being alert, quiet, and sensitive are all important qualities of
the nurse working with adolescents.
In the discussion of health promotion and health maintenance of
the school-age child (see Chapter 12 ), it was noted that the health-
Daily exercise using crutches is
8
care partnership grew from one with parents to one encompassing
important for Sam to maintain the the child as a partner as well. By adolescence, children should be as-
strength to continue bearing weight suming more of a partnership role in their own health care. As the
visit begins, greet adolescents warmly, ask about their concerns and
and walking independently. questions, and ask for their opinions and reactions throughout the
visit. This will demonstrate that their thoughts are valued and that
S am is a 7-year-old child with myelodysplasia. Sam and his parents are seen every few months in
the multidisciplinary spina bifida clinic located in the university medical center about 100 miles
from his home. The health professionals in this clinic help the family coordinate care for Sam with his Sam has been placed on the exam-
they play an important role in guiding the healthcare visit. When
adolescents are visiting the same office or clinic that they came to
ining table so his lower extremities
local pediatrician and physical therapy center. An important part of the health visit is to measure his can be evaluated. Next his socks during childhood, they usually know and feel comfortable with the
height and weight and to determine that growth is occurring as expected. In particular, it is important to will be removed so his feet can be
monitor for signs of excessive weight gain as this would potentially reduce his mobility. inspected.
care providers. If the setting is new to them, explain procedures and
introduce personnel so they feel more at ease.
GROWTH AND DEVELOPMENTAL
SURVEILLANCE
Adolescence spans several years, and growth and developmental is-
FIGURE 13–2 ■ Parents often accompany teens with a healthcare problem in for the
sues vary throughout the period. For young adolescents, those from
examination. Provide an opportunity to see both the teen and parent privately, and in- about 12 to 13 years of age, growth measurement remains important.
tegrate general health promotion and health maintenance into the visit. What questions Many youth are still growing, and use of percentile grids continues
can you ask this teen? What teaching might be needed? to be an important part of care. Growth should remain in the same
BOX 32–2 FDA-Approved Uses of Growth Hormone in Children
Growth hormone deficiency
■
Renalis failure
often used to mea- Assessing height is also important to
sure the weight of children with an inability to stand contrast with weight and to calculate a
without support. ■ Turner syndrome body mass index. In this case Sam is us-
ing crutches to stand erect.
■ Noonan syndrome
■so Short
Sam’s lesion is at the L4 to L5 level, stature
he can flex from
his hips and Prader-Willi
extend his his skin.syndrome (PWS) his socks will be removed to check for
As this visit is completed, The photographs and drawings throughout the textbook do more
knees,ofbutdelayed
he has weak ankle extension, toe flexion, and hip extension. He has signs of redness or lesions on his feet and lower extremities, especially
minimal sensation in his lower legs and feet.Children
■
are also affected. Sam and his parents■have
with
His bladder and
Idiopathic
worked hard short
a history
bowel sphincters of intrauterine
stature
to establish bowel
where braces maygrowth
rub. retardation
The health professionals at the spina bifida clinic are encouraging Sam
than illustrate concepts and examples. You will find critical thinking
page with1139)
opportunities among the figure captions. These unique highlights,
a high-fiber diet and to establish a specific time of day for bowel to be as mobile as possible. Daily exercise using crutches is important
Source:
evacuation. Sam has learned to perform Dataself-catheterization
intermittent from Cooke, D.forW., Divall,
for himS.to A., & Radovick,
maintain S. to(2011).
the strength continueNormal
bearing and
weightaberrant
and walking
1108)to reduce the risk for kidney
bladder control growth. In S. Melmed, K. S. Polonsky,
damage. P. R. Larsen,
independently. & H. M.
This enables SamKronenberg,
to interact with Williams textbook
his environment of
and other
During the health visit, Sam’s general health is reviewed, along with
changes in muscle tone, joint range of motion, and any signs of damage to
children in school. As the visit is finishing, Sam’s mobility is evaluated by
endocrinology (12th ed., pp. 935–1053). Philadelphia, PA: Saunders Elsevier; Ferguson, L. A.
watching him walk down the hall with his crutches.
(2011). Growth hormone use in children: Necessary or designer therapy? Journal of Pediatric
also appearing in the text itself, encourage you to apply information
Health Care, 25(1), 24–30; Sperling, M. A. (2010). Treatment of short children with GH plus
IGF-1: Are two hormones better than one? Infectious Diseases in Children, 23(1), 46–48. and analyze the nursing implications needed to provide care for chil-
dren and their families, thus adding true learning value to the visuals.
8
requires subcutaneous injections 6 to 7 times per week and generally
continues for several years until growth is complete. The pediatric
bring information
adjusts the dosage and
based on concepts “alive” to de-
response to treatment The text explains in-depth pathophysiology of pediatric conditions,
about
(Ferguson, 2011). See Box 32–2
the
. effect of a specific condition
The child usually experiences increased growth velocity for the and accompanying Pathophysiology Illustrated figures allow you
first yearThese stories
followedinclude
of treatment,
by a gradualphotographs of a child
decrease in growth for to see into the body to visualize the causes and effects of conditions
subsequent months or years. Growth should progress at least at the
age while the childa ischild
continuedand family may
on growth on children. These elaborate drawings illustrate conditions on a cel-
condition.
hormone treatment. If growth is slower than anticipated, compli-
ance to therapy must be considered before the dosage is increased. lular or organ level, and may also portray the step-by-step process of
Replacement therapy is continued until either the child achieves an
acceptable height or growth velocity drops to less than 2 cm (1 in.)
a disease. Drawings or photos with artistic overlays relate disease to
its anatomic location and action.
As They Grow Bone Age
Chronic Lung Diseases 771
According to the hygiene hypothesis, these protective
Pathophysiology Illustrated Asthmatic Episode factors increase exposure to infections in early life that
enable the child’s immune system to develop along a
nonallergic pathway (National Asthma Education and
Prevention Program, 2007, p. 23).
Mucous
gland Inflammation causes the normal protective mecha-
Capillaries
Normal bronchiole nisms of the lungs (mucous formation, mucosal swell-
and alveoli ing, and airway muscle contraction) to overreact in
response to a stimulus and cause an acute asthma epi-
sode (sudden onset of breathing difficulty with cough,
wheeze, or breathlessness) and airway obstruction. The
trigger, a stimulus initiating an acute asthma episode,
Normal can be inflammatory or noninflammatory. Triggers
bronchiole
increase the frequency and severity of smooth muscle
contraction (bronchospasm), and airway responsive-
Mucus ness is enhanced through inflammatory mechanisms.
Normal production
Inflammatory
Asthma triggers include exercise, viral or bacterial
alveoli reaction such as
Mucous membranes
increases.
increased capillary agents, allergens (mold, dust, pollen, furry pets, birds),
permeability and
become inflamed histamine release fragrances, food additives, pollutants, weather changes
and edematous.
(humidity and temperature), and emotions or stress.
The asthma triggers may vary for individual children.
With exposure to a trigger, IgE and sensitized mast
cells may be activated, leading to the release of many
ferences in skeletal maturation that are closely tied to physiologic maturation. The 3-year-old has many bones
inflammatory mediators (e.g., histamines, prostaglan-
in the hand and wrist that have not fully developed. The secretion of estrogen during puberty has resulted in the
dins, and leukotrienes). The inflammatory mediators
development and calcification of secondary ossification centers of most of the bones in the hand and wrist of the release pro-inflammatory cytokines, causing chronic
13-year-old. airway inflammation that may be associated with air-
Source: Courtesy of Dorothy Bulas, M.D., Children’s National Medical Center. way remodeling (permanent airway damage that
involves thickening of the subbasement membrane,
Thickened Mucous glands subepithelial fibrosis, airway smooth muscle hyper-
basement hypersecrete trophy and hyperplasia, blood vessel proliferation and
Airway membrane and proliferate.
narrows, dilation, and mucous gland hyperplasia and hyperse-
restricting cretion) (Brashers, 2010a). This results in decreased
As They Grow illustrations help you visualize the important ana- airflow.
Smooth muscles Restricted airflow
airway elasticity and decreased lung function. These
permanent alterations are not prevented by or fully
tomic and physiologic differences between a child and an adult.
constrict. prevents proper
filling of alveoli and responsive to currently available treatments (Brashers,
Hyperinflated gas exchange. 2010a; National Asthma Education and Prevention
These features illustrate the important ways that a child’s develop- alveoli
Collapsed
Program, 2007, pp. 16–19). The reactive airway re-
sponses to stimuli are present before the trigger initi-
ment influences healthcare needs and how the child progresses alveoli
ates the physiologic sequence that results in an asthma
episode.
through developmental stages. FIGURE 25–12 ■ What can cause an asthmatic episode? Some asthma triggers are exercise, infection, and
Airway narrowing results from bronchial con-
striction, airway swelling, and production of copious
allergies. This illustration shows how asthma obstructs airflow through bronchoconstriction and inflammatory amounts of mucus. Mucus clogs small airways, trapping
changes, narrowing the airway and thus increasing production of mucus. air below the plugs (Figure 25–12 ■). Decreased perfu-
sion of the alveolar capillaries results from hypoxic
vasoconstriction and increased pressure due to hyperinflation of the al-
Etiology and Pathophysiology veoli. Hypoxemia leads to an increased respiratory rate with a reduced
Asthma is a chronic inflammatory disease of the lungs in children minute volume (air breathed per minute) because of airway resistance.
who are genetically susceptible. More than 100 genes are associated
with the susceptibility and pathogenesis of asthma (Brashers, 2010a). Clinical Manifestations
Some of these genes regulate the inflammatory process. It is caused by The sudden appearance of breathing difficulty (cough, wheeze,
the interplay of multiple factors, including indoor air contaminants or breathlessness) is often referred to as an acute asthma episode,
(e.g., tobacco smoke, pet dander, and cockroach feces), outdoor air asthma flare, or asthma attack. The infant or child who has had fre-
DESIGN SERVICES
disease OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. viii C/M/Y/K
S4carlisle
pollutants, recurrent respiratory viral infections, and allergic quent episodes of coughing or frequent respiratory infections should
(e.g., atopic eczema, hay fever, and food allergies). Protective factors also be evaluated for asthma. Frequent coughing, especially at night,
Title: Child Health Nursing   Server: Short / Normal
that reduce the risk for asthma include a large family size, later Services
Publishing birth is the warning signal that the child’s airway is very sensitive to stimuli;
order, childcare attendance, dog in the family, and living on a farm. it may be the only sign in “silent” asthma.
 The full-term newborn has a complete but immature nervous sys- to physiologic changes such as fluctuating cerebral perfusion pres-
tem at birth. The infant is born with all of the nerve cells that will exist sure from decreased cardiac output, increased intracranial pressure,
throughout life, but maturation of these nerve cells continues after birth. or constriction of the neck’s blood vessels due to positioning. When
The number of glial cells and dendrites, which enable receipt of nerve blood flow and oxygenation are not maintained, the brain cells be-
impulses, continues to increase until approximately 4 years of age. Brain come damaged in a very short time. Because the nervous system helps
growth results in the increasing head circumference in infants and tod- to control and coordinate many body functions, alterations in neuro-
dlers. Brain growth continues until the child is 12 to 15 years of age. logic function can have widespread effects on the body’s metabolism.
Myelination, the progressive covering of axons with layers of Disorders of Pancreatic Function 1133
myelin or a lipid protein sheath, is also incomplete at birth. Lack of
myelination is associated with the presence of primitive reflexes. NEUROLOGIC FeaturesASSESSMENT
That Help You Use This Book Successfully ix   
TABLE 32–9 Laboratory FindingsAsinthe themyelination
Child progresses, the primitive reflexes Nursing
disappear. Assessment
Performing a and
nursing Diagnosis
assessment of the child with a potential or ac-
See Table 7–19 for the expected appearance and Continuously
disappearance tual neurologic
monitor the condition involves
child’s vital a careful
signs, review of the
respiratory signs and
status, per-
Features That Help You Use This Book Successfully
with Diabetic Ketoacidosis

8
of primitive reflexes during early infancy. This process continues symptoms in many body systems and analysis of their relationship to
Respiratory Distress and Respiratory Failure 747 fusion, and mental status. Assess for changes in neurologic status, re-
LABORATORY STUDY throughout
RESULTS childhood, proceeding in a cephalocaudal direction. The neurologic functioning. Use the guidelines in Table 33–3 to perform
myelination process accounts for the progressive acquisition spiratory pattern,
of fine blood pressure,
a comprehensive andofheart
assessment a childrate.
with Monitor
a neurologicfor cardiac
condition.
ciation Curve cricoidSerum glucose
cartilage, andGreater
is often performed if long-term than
gross motor 200 mg/dL
skills
airway and coordination during early childhood,
management arrhythmias and it associated
Numerous diagnostic procedures andAssess
with hypokalemia. laboratory
fortests
signsare of
used for
dehy-
Nursing students
is needed.
Serum face
ketones challenges in their education—managing
is ultimately
Positive
responsible for the speed and de-accuracyof pediatric
of nerve impulses.nursing
dration, in today’s
the diagnosis
including dry about world.
of neurologic
skin these We
conditions
and diagnostic
mucousprocedures developed
(Table 33–4).aAdditional
membranes, textbook
and depressed
in- that
In infants and young children the vertebral bodies are wedge formation and laboratory tests can
mands on
Assistedtheir
Arterial time,
ventilation
blood gas pHapplying
must beresearch
provided
shaped,findings,
until
Acidotic—pH evaluating
theless
the ligaments child
permit
than andcom-
breathes
7.3more movement,
bicar- is the
and easy to learn
fontanels
articulating from
in infants.
be foundand easy to use
in Appendixes D andasE a professional
. reference. The

8
PaO2 SpO2 ponents of evidence-based
spontaneously practice,
or until mechanical and
facets
ventilation atdeveloping
bonate C1less
isandinitiated.
C2 permit
than their
15 mEq/L critical
more sliding
Children in cases offollowing
injury. The guide
child’
Nursing will help
s diagnoses thatyouapplyusetothethe features
child withand resources
diabetic ketoaci- from
spinal cord attains adult characteristics after 10 years of age when the
(mm Hg) (%) thinking
are oftenskills.
sedated
Urine Thus instructors
to optimize and students
ventilation. Continuous
Positive alike
for value
positive
ketones the in-text
airway
(ketonuria) Child
dosis
vertebral body loses its wedge shape and the facets become more ver-
Health
may Nursing
include:
ALTERED to succeed
STATES in
OF the classroom,
CONSCIOUSNESS in the clinical set-
100 98 learning
pressureaids
Serum that
(CPAP) we
potassium include
is one formin
ofour
PEEP textbooks
used
tically todecreased,
to improve
aligned
Elevated, (meet
Mathison, the challenges
oxygenation
orKadom,
normal& Krug, 2008). ting, on the NCLEX-RN®
■ Injury, Level
Risk examination,
forofrelated
consciousness and
(LOC)cerebral
to altered in function
is perhaps nursing practice.
the most important indi-
90 97 and lung compliance. When respiratory failure The braincannotdependsbe on managed,
a continuous blood flow to meet its high cator of neurologic dysfunction. Consciousness, the responsiveness
■ Fluid Volume: Deficient related to osmotic diuresis
Serum chloride Elevated
demands for oxygen. Through an autoregulatory process, the cerebral or awareness of the mind to sensory stimuli, has two components:
80 95 it results in cardiopulmonary arrest. blood vessels dilate to maintain the cerebral blood flow in■response Nutrition,(1)Imbalanced: Lessthe
Alertness, or arousal, than Body
ability Requirements
to react related
to stimuli, is controlled
6 70 93 Serum sodium Decreased
When acute respiratory failure becomes life threatening, extra- to catabolism of protein and fat for fuel
4 60 90 Serum phosphate oxygenation (ECMO) Decreased
50 84
corporeal membrane may be initiated (Ayad, ■ Knowledge, Deficient related to recognition, treatment, and
2 Dietrich, Serum& Mihalov,
osmolality 2008). ECMO is a cardiopulmonary Elevated bypass sys-
40 75 TABLE 33–3 Assessment Guidelines for the Child with a Neurologic prevention
Condition of diabetic ketoacidosis
30 60 tem with external oxygenation and a pump mechanism
ASSESSMENT FOCUS
that provides
ASSESSMENT GUIDELINES NANDA-I © 2012
Source: Data from Cooke, D. W., & Plotnick, L. (2008b). Management of diabetic ketoacidosis in
20 35 respiratory
Assessment and hemodynamic support.Level It allows the lungs to ■ Isrest andor child difficult to arouse?
children and Guidelines
adolescents. Pediatrics in Review, 29, 431–436; of consciousness
Jerreat, L. (2010). the infant
Managing diabetic
10 14 heal. However, several significant complications may result ■ Isfrom itsor child
theofinfant Planning
irritable or difficult and Implementation
to calm or console?
for the Child tables in
ketoacidosis. Nursing Standard, 24 (34), 49–55; McFarlane, K. (2011). An overview diabetic keto-
use, such as inbleeding,
acidosis stroke,
children. Paediatric renal
Nursing, insufficiency,
23(1), 14–19. hypertension, sei-
■ Is the child oriented? Can the Intravenous fluids
child tell the examiner his or herare
namegiven
and age?in boluses of 10 to 20 mL/kg rapidly over
each
zures,ofelectrolyte
the systems chap- pneumothorax, cardiac dysfunction,
abnormalities, ■ What is the child’s ability to concentrate? Can the young child name pictures of animals? Can the older child answer simple math
5 minutes if the child is in hypovolemic shock. Adequate fluids are
80 90 100 110 120 ters
and provide
infection an (Ayadoverview
et al., 2008). This is a complex and ■expensive
questions or spell words?
given to reverse the fluid deficit. The
The Glasgow Coma Scale provides a numeric score for future comparison. See Table 33–5insulin
. infusion must be carefully
Hg) (PaO2) of the keyavailable
treatment aspectsinofspecial an centers, Cranial so the child may have to be
Collaborative Care nerves ■ Assess the cranial nerves. See titrated
Table 7–18 to. control
See Table 33–6the
for gradual
methods to reduction
indirectly assess in
cranial hyperglycemia.
nerves in the unconsciousMonitorchild.

8
essure of oxygen in arterial integrated
transferred assessment
to another hospital for to receive this and
Fontanels therapy.
sutures ■ Palpate fontanels and suture lines blood glucose
on the infant’s scalp. levels hourly or as indicated. Frequently monitor the
The immediate Altered States of Consciousness 1155
ear. When hypoxia exists, the conditions within goal theof collaborative care is to normalize
Cognitive function
the pH level,
electrolytes and acid–base status, as well as urine glucose and ketone
■ Are the child’s verbal skills developmentally appropriate for age?

hypoxia does not exist, oxygen Nursing restore blood

Management glucose to target level, and correct fluid and
■ Does theelectrolyte
child follow directions and respond appropriately?
body system. levels as indicated. Intake and output are monitored hourly. Assess for
ry reading is associated with a TABLEimbalance.
33–6 The long-term
Assessment of Cranial goal of management includes
Pupils
Nerves
■ Check thepreventive intubation
pupils for size and reaction toislightperformed.
and accommodation. A tracheostomy
See Figure 33–4 on may be. performed for long-
page 1154
Nursing care is focused on the recognition of progression from respi- signs of hypoglycemia which may occur during insulin infusion.
ssociation curve demonstrates education to reduce the risk of further
Vital signsdiabetic ketoacidosis ■ Assess heartepisodes. term
rate, respiratory airway
rate, and bloodmanagement.
pressure. Frequent suctioning may be required. Keep
ortant in correctly interpreting the ratory distressintothe Unconscious
respiratory failure Childand supportive care to■ the Monitorchild
for an increasedsuction apparatus
systolic blood with pulse
pressure, a widened catheters at the bedside
pressure, bradycardia, and irregularalong with
respirations oxygen,
(late signs of increased
and
CRANIAL Diagnostic
family.
NERVES REFLEX Tests ASSESSMENT PROCEDURE intracranial pressure). Practice Alert
resuscitation
■ Inspect the infant’s posture and Only
bag
regular
and
insulin
mask, and extraintravenously
is administered
endotracheal or tracheostomy
for treatment of hyperglycemia
AND REFLEX See Table 32–9 for laboratory
AND NORMAL FINDINGSfindings Posture and in diabetic ketoacidosis.
movement CT movement by using the primitive reflexes. See Table 7–19 .

8
entration is adequate, and the pH
Nursing Assessment and Diagnosis tubes (if applicable). Pulse oximetry or arterial blood gas analysis
lower is
of in- developmentally appropriate for age? Were motor skills acquired at the appropriatethey
or diabetic ketoacidosis. Do not use other insulin types as may the blood
■ Observe the child’s play or other spontaneous activity to assess strength as well as symmetry and smoothness of movements.
ated with a PaO2 of 90 mmHg or II, III scan of the Shine braina and light possible
source in the intubation
eye. and implementation
performed
■ Are the child’s motor skills glucose at too
regular
rapidly intervals to ensure that gas exchange
or too slowly. age?isHas
adequate.
the child lost a
Pupillarytracranial
Monitor the child pressure
for changes
Rapid,
(ICP) in
concentrically
lowering
vital strategies
signs,
constricting respiratory
pupils
will bestatus,
required.
indicate intact
previouslyand acquired skill?
Assisted ventilation may be required (refer to the Skills Manual ).
aO2 of 60 mmHg or less. level of responsiveness. cranial Perform
nerves II, III. the respiratory assessment using
■ Evaluate muscle strength and tone, comparing side to side. Is any weakness present?

with a PaO2 of less than Clinical Therapy ■ Test the child’s coordinationAnticipate
for smoothness and thatsymmetry
seizures may occur. Pad the side rails to protect the
of response.
guidelines in Table 25–1with . Signs and symptoms of respiratory com- The child is tapered off intravenous insulin and transitioned to
II, IV, VI The child with Performketoacidosis eyes heldisopen hospitalized.
(doll’s eyes) and Medical
head■ moved management
Assess childforfrom
deep tendon reflexes injury.
smoothness and symmetry of response. See Table 7–20 .
promise may progress rapidly. Detection of earlier subtle signs is subcutaneous insulin when clinically stable. Oral feedings are rein-

8
reater than 95% can indicate Oculocephalic
includes isotonic horizontally or vertically. fluids
intravenous and electrolytes
Neck stiffness forfordehydra-
■ Assess neck stiffness (nuchal rigidity).
important so interventions can be initiated to prevent progression to Perform Routine
troduced Nursing
when Careis alert enough and the glucose level is stabi-
the child
tion and acidosis.When head is turned suddenly
Short-acting Pain to the
insulin (0.1right, the eyesper
unit/kg ■ of an
Assess in- of is
hour)
level painad-
when present.
respiratory failure.fant Attach a cardiorespiratory themonitor and■pulse If the
ox- history of headaches, corneal
lized.seizures,reflex plan variesorplace
is absent,
Thisneurofibromatosis, accordingartificial
other neurologicto
tears
the in the eyes
primary and cover
healthcare provider
as easily release the oxygen to ministered by orcontinuous comatose patient look
Family
intravenous tohistory left, and similarly
infusion pump looktoatofamily
Is there
decrease with gauze, taping over so they remain
condition?
closed. Perform routine mouth
on curve shifts to the left, and imeter. Serial blood gases may be needed to monitor the child.
the right when the head is turned to the left. Absence of this or endocrinologist.
the serum glucose reflex suggestslevel brainstem
at a rate dysfunction
not to exceed 100 mg/dL/hr.
in comatose patients. Faster care by brushing the teeth and using swabs with water. Gently clean
Hg.
reduction of hyperglycemia and serum osmolality increases the risk the oralClinicalmucosaTip in newborns and keep secretions from accumulating.
dily releases oxygen to the tis- Practice Alert Precaution: Cervical spine injury must be ruled out before
ve shifts to the right, and the for cerebralchronic
When the child has a this
edema.
assessment When
respiratory
glucose is lowered too rapidly, water is Provide
is performed.
or neuromuscular condition, development Insulin adequate
binds to IV tubing.nutrition. Run 50 Initially,
to 100 mL nutrients may bethesupplied
of insulin through new IV tubing to
n 70 mmHg. of freed failure
and attracted to the glucose, which haswith accumulated in large saturate allAthe
intravenously. binding sites.
nasogastric orThis ensures thattube
transpyloric the fullmay dose beofinserted
insulin reachesif the
III, respiratory
VIII may be
Place thegradual
head in as muscles
a midline andassociated
slightly elevatedbreathing
position. may
be quantities
weakened.
Oculovestibular Signs in willthe
beice
Inject brain.
subtle.
waterBeintoBicarbonate
particularly
the ear canal. is not
alert routinely
to behavior changesusedin for ad- treat- child from the outset.
the infant or child remains unconscious or is not alert enough to take
dition toment of DKA
respiratory signs.asPulse
it places oximetry the child
and serialat increased
blood gases riskmay forbehypokalemia,
needed
to monitor the child.
Eyes deviating toward the irrigated ear indicate intact cranial food by mouth. A gastrostomy tube may be inserted if it is anticipated
must be considered simul- acidosis, and cerebral
nerves III, VIII. edema (Cooke & Plotnick, 2008b). As insulin that enteral feeds will are
Electrolytes be needed
replaced foraslonger
needed. than 3 months.is(See
Potassium not the adminis-
status. Hypercarbia in the is administered, potassium shifts to the cells, resulting in hypokale-
Precaution: Ensure that the tympanic membrane is intact Skills Manualtered until the.)child has voided to confirm renal function. Monitor
failure. Hypoxemia unre- mia.
If the Potassium
child hastoankeep supplementation
fluid from entering
endotracheal tubethe is given
or middle only
ear. aftertube,
tracheostomy confirmation
assess of Prevent complications associated with immobility (muscle atro-
gn of respiratory failure. Clinical
for signs Tips andare “pearls” of
symptoms from clinical nursing
hypokalemia, including experts embedded
hypotension,
renal function.
for secretions thatNote:
mayAfurther
physicianobstruct the airway.
usually performs this assessment. phy,throughout
contractures, and skin respirations,
breakdown) and as described in Box 33–2 .
weak pulse, the shallow
textbook. muscle weakness. Continu-
Practice
V, VIIExamples
Corneal
Cerebral
Alerts ofwarn edema
Gentlyyou
nursing isthesafety
of
diagnoses
touch
thecornea
most
associated common
precautions
with a sterile with cause
and
respiratory
cotton swab.
of DKA-related
other nursing Nursesous
failure support physical therapy efforts withtoextra passive range of
cardiac monitoring is performed detect cardiac conduction
g the cause of respiratory include:
alerts to deaths.
considerMannitolinA blink
providing is kept oncare.
indicatessafe
standby for treatment of neurologic
intact cranial nerves V, VII. motionchanges exercises. related to hypokalemia. Weigh the child daily. Provide emo-
with oxygen, mechanical symptoms secondary to cerebral
■ Breathing Pattern, Ineffective associated with prolonged tachy-
edema (Cooke & Plotnik, 2008b).
IX, X Gag
See ChapterIrritate 33 thefor pharynx with a tongue depressor or cotton swab.
information about cerebral edema. Provide Sensory and
tional care support to the child and family.
Stimulation
essure (PEEP) to increase pnea and muscle fatigue
8

A gagging response indicates intact cranial nerves IX, X. Because Care theinchild with a severely altered level of consciousness may
the Community
n are admitted to the pedi- ■ Airway Clearance, Ineffective related to sedation and loss of
Nursing Management still beThe ableprevention
to hear, talking to him
of future or her may
episodes be beneficial.
of diabetic ketoacidosis Listening is impor-
protective cough reflex to music or tapes of family members talking or reading can soothe
he level of responsiveness Nursing care focuses on administering insulin, fluids, and electro- tant. Partner with the child and family to ensure they learn strategies
Clinical Judgment Verbal, Impaired related to artificial airway
■ Communication:
a childtowhen
e airway patent decreases. Some lytes,ofand
■ signs
Family the monitoring
intact
Processes, neurologic
Interruptedthestatus
childrelated
offor ansigns
infant and symptoms
(newborn
to child’ to 2 months
s life-threatening of associated
of keepfamily membersepisodes
hyperglycemic cannot be frompresent. Explaintoalldiabetic
progressing proce- keto-
age) are complications.
a cry with a loud and Once the child
energetic quality,is astabilized,
strong suck,the andfocus of care shifts to
suck-swallowing
dures and
acidosis. (See Partnering with Families: Preventing DKA.)toParents
actions to the parents and child. Encourage the parents
ertion of an endotracheal illness stroke should and touch thespecific
child ininstructions
a soothing manner.
e tube must be protected educating
coordination.
NANDA-I © 2012
What isthe onechild
additional and family
sign? on methods to prevent further epi- NEW!
When
have
Clinical
the and childwhen
Judgment speedon
becomes morethealert,
how often
bumps
gradually
appear to when
and when
check an
repeatedly
theopportu-
blood
End-tidal CO2 monitor- sodes of diabetic ketoacidosis. glucose
nity for critical thinking arises. to check urine for ketones the child is
Planning and Implementation orient the child to time, place, and person, depending on his or her
iration to ensure that the Following are nursing diagnoses that may be appropriate for the age and level of understanding. Encourage parents to bring objects
oned in the trachea. See Position
child withthe an child
alteredwith levelrespiratory
of consciousness: distress in an upright position or toys from home to make the environment more familiar and pro-
eostomy, the creation of (by elevating the head of the bed) with the head in midline to help mote a feeling of security.
■ Breathing Pattern, Ineffective related to neuromuscular dys-
h the anterior neck at the maintain the airway. Administer oxygen as ordered (Figure 25–9 ■).
function associated with increased intracranial pressure Provide Emotional Support
■ Aspiration, Risk for related to poor control of secretions with
Explain the child’s condition to the family in simple terms. Encourage
decreased level of consciousness parents to take part in the child’s care and therapy as much as possible.
■ Skin Integrity, Risk for Impaired related to agitation and skin

rubbing against bedding

■ Communication: Verbal, Impaired related to physiologic con-

dition of decreased level of consciousness BOX 33–2 Care of the Child Who Is Immobile
■ Family Processes, Interrupted related to care of a child with an DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. ix ■ Help keep the body in proper C/M/Y/K alignment with splints orS4carlisle rolls made of towels
acquired disability Title: Child Health Nursing   Server: Short / Normal
or blankets. Publishing Services
 therapeutic play 407 3. Describe the child’s and family’s adaptation to hospitalization.
1100 therapeutic
Unit VI recreation 409
| Chapter 32 | Alterations in Endocrine4.and Metabolic
Apply Function
family-centered care principles to the hospital setting.
treatment room 399
5. Identify nursing strategies to minimize the stressors related to hospitalization.
GHRF = Growth Hormone 6. Integrate the concept of family presence
TABLE 32–2 during procedures
Assessment and nursing
Guidelines strategies
for the Child to pre-
Releasing Factor Sleep pare the family.
Hypothalamus with an Endocrine Condition*
rhythms
7. Summarize strategies for preparing children
ASSESSMENT and families
FOCUS for discharge
ASSESSMENT from the hospital
GUIDELINE
Stress
Glucagon setting.
α-adrenergic
Growth ■ Carefully measure weight, length, or height and plot
x  Features That Help You Use This Book Vasopressin
Successfully neurons
8. Evaluate the effectiveness of teaching strategies used with
on athe hospitalized
growth curve. child and his or
Hypoglycemia
her family. ■ Compare measurements at different ages to assess
GHRF the growth pattern over time and to assess the
letal Function Somatostatin growth velocity.
+ –
Bloodmy
“Why do they need to take pressure/pulse
tonsils out? ■ Assess blood pressure and compare to expected
equirements related to They’re fine where they are!” norms for age. See Appendix B .

8
Case Legal
Scenarios andand Ethical
photosConsiderations
at the be- Facial characteristics Inspect the face for unusual features such as a pro-
■
—Tiona, age 5
tuberant tongue, protuberant eyes, or moon face.
inal illness ginning Muscular Dystrophy
of the chapter engage Careyou with Anterior
– pituitary Neck ■ Palpate the neck for an enlarged thyroid or goiter.
– Five-year-old Tiona Lewallen has a history of frequent tonsillitis and
a child’s real-life
The child experience
with muscular with
dystrophy has aa spe-
shortened life span. Parents is scheduled
providefor a tonsillectomy and Muscles adenoidectomy in the morn-■ Assess strength and muscle tone.
cific comprehensive
health challenge. Additional
care and require support both in-physically and emotionally
Negative ing.Growth
Herasmother
the has brought her in today for preoperative evaluation■
Genitalia and secondary Assess external genitalia for signs of ambiguous
feedback andhormone
instruction. Tiona has no other health problems. Her experience
usually long term and child’s condition
formation aboutprogresses.
the child The child
and continues
family to develop in many with ways, espe- sexual characteristics genitalia, or inappropriate size for age.
health care is limited to well-child checkups and immunizations
d emotional health of cially cognitively, as the years pass. Therefore, the needs for explanation and+ ability Target ■ Determine the child’s stage of development for
appears throughout the chapter to illus-
to understand the diagnosis change for the child over time. Parents
as well as several visits to the otolaryngologist in the past year. She has no
the child is diagnosed priormay have organs
hospitalizations. Tiona will return at 6:30 a.m. for surgery. She will eachbe characteristic
admit- (breast and pubic hair for girls,
tratedifficulty
application
initiatingof nursingwith
discussions care.
theUse thechild about desire fortedend-of-life
growing genital
to the pediatric day short-stay unit for a few hours following surgery and will andthen
pubicbehair for boys)home
discharged by comparing
as long to the
s often provide home images in Figures
care (Penner,
questions Cantor, & Siegel,
embedded 2010).scenario
in each An ethical approach to care demands thatto drink fluids and take oral pain medication. How should
as she is able the nurse assess7–43what, 7–44
Tiona ,knows
and 7–45about .

8
them in school nurs- such a complex chronic disease be managed by an interdisciplinary herteam thatWhat techniques should be used to teach Tiona about■ the
surgery? Assess the sexual
surgery? maturity rating
What instructions shouldwith information
Tiona’s
ics and other facilities to apply pathophysiologic,
collaborates on a regular basis. Thepsychoso-
child, family, and a variety of health,mother social,
receive from the nurse in the preoperative clinic related to care in Figure
prior to7–46
References 415
surgery?. Compare the stage of develop-

8
as the child grows; this cial, and
family, culture,
educational developmental,
professionals should all be partorof the team. The plan of care will ment to the age of the boy or girl to determine early

the care;Clinical Reasoning in Action

includeprocess
physical, emotional, cognitive, and or delayed onset of puberty.
r the child, family, and nursing considerations. Atpalliative it will evolve and change
as the child grows older. Nurses are essential members of theHeart team and may work Body odor ■ Assess body odor for unusual smell (e.g., sweet,
nce Overview on page end with
of the chapter,
families a detailed Clinical
as team managers. INTRODUCTION 2. As Tiona andmusty, cheesy,
her mother sweaty
are preparing feet).the hospital, Tiona says, “I
to leave
her therapies to main- ­Reasoning in Action exercise picks up Skin
Recall Tiona, the child described in the beginning of the chapter. She is a 5-year- am going■to Assess
be good so I docolor,
skin not have to come
noting areasto theofhospital
unusual anymore!”
How should the nurse respond?
family as needed (see the opening scenario and asks youLiver to ap-
old girl who was admitted to the hospital for a tonsillectomy and adenoidectomy
(T&A).
pigmentation.
3. Tiona’s mother states that she is worried that her daughter will not drink
ystrophy Care). ply whatParents
you may
haveexhibit
read. feelings of guilt and hopelessness.
DESCRIPTION
The mother Mental status ■ Note affect. Assess for anxiety, irritability, or
enough at home. What can the nurse suggest to Tiona’s mother to encour-
lethargy.
age her to drink fluids? What are the symptoms of dehydration that Tiona’s
who learns she has carried the gene that affects Followingher son can
Tiona’s be devas-
operation, she refused to drink liquids because it hurt when
mother should watch for over the next few days?
she swallowed. After receiving intravenous pain medication, TionaFamily realizedhistory
that ■ Assess for family history of metabolic or endocrine
evaluations are per- tated. Encourage parents to express their feelings. she
Genetic
could swallow
counseling
without too much pain and began to eat Popsicles and drink 4. Children Tiona’s age have many fears and stressors related to hospitaliza-
disorders.
Pancreas
ter oxygen or respira- is recommended for the entire family, and it isliquids. especially was thenimportant
SheKidney switched to oral pain medication. Later in the day, Tiona tion and surgery. How can her mother assist Tiona to express her feelings
was drinking liquids well enough to be discharged home. about the hospital experience once she is home?
tube feedings may be to identify women who are carriers of one of the X-linked disorders. Note: *Refer to Chapter 7 for the actual techniques of assessment mentioned in this table.

8
DISCUSSION
dystrophy of infancy Siblings may feel neglected because their brother or sister is receiving
1. What information should the nurse include in the discharge teaching plan
function with fluids, so much attention. They may be concerned that they willmother?
for Tiona’s develop the The anterior pituitary gland is considered to be the “master gland”
Monitor and ensure disease. Sometimes multiple children in a family are affected with the of the body. The major function of the anterior pituitary gland is the
tion. Perform range of condition and as one child worsens, the effect on siblings is profound.
On the other hand, siblings without the disease may feel guilty for their
NCLEX-RN® Review production and release of thyroid-stimulating hormone (TSH), ad-
renocorticotropic hormone (ACTH), luteinizing hormone (LH),
vel of ability. Physical
oint contractures. It is good health. Encourage the parents to involve siblings
1. The nursein isthecaring for a female child who is recovering follicle-stimulating
affected from a motor 3. Which hormone
behavior by a(FSH), growth
child’s parents hormone
is the best indicator that(GH),
they un- and
FIGURE 32–2 ■ Feedback mechanism in hormonal stimulation of the gonads during
vehicle accident. The child’s parents ask if it is okay to bring the child’s derstand how to administer medication to the child at home following
posture by keeping the child’s care to reassure them of their importance. (See
puberty. Chapter
siblings to visit. What 16 is the most appropriate response by the nurse? surgery?
8

wheelchair. Splints may
r position.
for ideas about involvement of siblings in care.) 1. “No, it would not be good for your child to see her siblings asTABLE it may make 1. The parents sign the written discharge instruction verifying understanding of
32–3 Diagnostic Procedures and Laboratory Tests
her worse.” the instructions.
As the child’s condition weakens, the family again needs
2. “No, it would be very addi-
upsetting for your child’s siblings to see her this way.” for 2.theTheEndocrine
parents give the System
medication to* the child using the appropriate technique in

tional support. They experience

Inborn grieving,
errors of each person
metabolism
Tables of Diagnostic Procedures and Laboratory Tests perti- someone
in
(inherited
to
their
watch
own
3. “Yes, it is okay to bring your child’s siblings to see her as long as you bring
them.”biochemical ab- DIAGNOSTIC PROCEDURES
3.
the nurse’s presence.
The parents state they LABORATORY
understand TESTS
how to administer the medication and deny

and provide parents way. They have lived with chronic

normalities of the sorrow
urea and
cycle now
and amino need
4. “Yes,
acid toand
it is okay toprepare
organic acid me-
bring your child’s siblings for a visit as long as we educate questions.
nent to the specific systems assist you in clinical when them on what you need
to expect the
when they visit. ACTH stimulation test Fasting plasma glucose
4. The parents state they can give the medication to the child using appropriate
velopment. Arrange a for the child’s death.tabolism)
The child is usually
often old enough
have a significant impact to recognize
on the endocrine the system’s technique.
information.
deteriorating condition.
ability See Chapter
to support 18 andfor
growth
2. How can the nurse best limit the amount of separation anxiety
further
development. discussion
hospitalized Some
toddler of
willchromosomal
experience? ab-
Adrenal that (ACTH)
the suppression test Hemoglobin A1c
4. The nurse is caring for a 5-year-old male child who will be having a ton-
to evaluate the child’s Bone age Hormone levels
8

normalities care.
bereavement and end-of-life also result in disturbances in growth and sexual develop-
1. Reduce the amount of time spent with the child when the parents are not sillectomy performed. What teaching method is most appropriate for this
d to determine educa- present.
ment. These disorders are discussed2.on pagethe 1141
Computed tomography
. of time the parents hold their child while hospitalized.
(CT)
child Insulin-like growth factor (IGF-1) and
prior to the surgical procedure?
Discourage amount 1. Provide the child’s motherInsulin-like growth
with brochure about factor-binding
the procedure. protein
should be established. Evaluation Fluidprovided.
3. Encourage the parents to leave the child’s room when care is being deprivation test 2. Sit with the child while he watches a video about the procedure.
3 IGFBP-3
r home computers if Expected outcomesDISORDERS
of nursing care OFforPITUITARY
the child with FUNCTION
muscular dys-
4. Encourage parental involvement in the child’s care and suggest
possible.
rooming in if
Karyotype 3. Use dolls to teach the child about the procedure.
Newborn
4. Allow the child to talk to other metabolic
children who screening
have had the procedure.
arly intervention pro- trophy include maintenance of optimal mobility and development,
The pituitary gland consists of two lobes, an anterior lobe and a pos-
Magnetic resonance imaging (MRI)
See Appendix I for answers.Provocative growth hormone testing
8

Thyroid radioactive iodine uptake (RAIU)

positive self-imageterior
for thelobe. The functions
affected child, andofpositive
the posterior pituitary of
management gland include scan Thyroid antibodies
r as long as possible. regulation of fluid balance through release of antidiuretic hormone
h, and do not ask the
the emotional challenges by all family members. References
(ADH), which is stored in the hypothalamus; and production of oxy- Note: *See Appendixes D and E for information about these diagnostic procedures and for
8

ing. Reading books to tocin, which is also stored in the hypothalamus. expected laboratory tests values.
Bindler, R. C., Ball, J. W., Ladewig, P. W., & London, Crenshaw, J. T., & Winslow, E. H. (2008). Preoperative and resuscitation in the emergency department. Retrieved
evision offer the child M. L. (2011). Clinical skills manual for maternal &
child nursing care (3rd ed., p. 110). Upper Saddle
fasting and medication instruction: Are we improving?
AORN Journal, 88(6), 963–976.
from http://www.ena.org/IENR/ENR/Documents/
FamilyPresenceENR.pdf
tolerated contributes River, NJ: Pearson. Disch, J., Dreher, M., Davidson, P., Sinioris, M., & Fisher, M. J., & Broome, M. E. (2011). Parent-provider

being.
child needs. Surgery,
portation of the child
constant daily care are
this care, providing a
family members, and
many years creates a
er the family to respite
rtain that either a fam-
manager to coordinate
s to resource and sup-
Association. Ask what
o the child and family
ophy).
Complementary Therapy
Brain Injury Association of America. (2011). A guide to Wainio, J. A. (2011). The role of the chief nurse officer communication during hospitalization. Journal of Pedi-
selecting and monitoring brain injury rehabilitation ser- in ensuring patient safety and quality. Journal of Nursing atric Nursing, 26(1), 58–69.
Muscular Dystrophy
vices. Retrieved from http://www.biausa.org/Default.
aspx?SiteSearchID=1192&ID=/search-results.htm
Administration, 41(4), 179–185.
Drahota, A., & Malcarne, V. L. (2008). Concepts of ill-
Forsner, M., Jansson, L., & Söderberg, A. (2009). Afraid
of medical care: School-aged children’s narratives about
Chahal, N., Manlhiot, C., Colapinto, K., Alphen, J. V., ness in children: A comparison between children with
and without intellectual disability. Intellectual and Devel-
medical fear. Journal of Pediatric Nursing, 24(6), 519–528.
McCrindle, B. W., & Rush, J. (2009). Association be- Frisch, A. M., Johnson, A., Timmons, S., & Weatherford,
Many families who have a child with muscular dystrophy use different types of
tween parental anxiety and compliance with preop-
Complementary Therapy boxes
opmental Disabilities, 46(1), 44–53.
present
C. (2010). approaches
Nurse practitioner role in preparing other
families than tra-
erative requirements for pediatric outpatient surgery. Emergency Nurses Association. (2009). Emergency nurs- for pediatric outpatient surgery. Pediatric Nursing, 36(1),
complementary care. The nurse always assesses for such
Journalapproaches, provides
of Pediatric Health Care, 25(6), 372–377.
ditional medical
ing resource: Family prescriptions
presence during invasive procedures that
41–47. may be used by children and fam-
information as needed by the family, makes recommendations for complementary
therapies that may be helpful, and cautions against those that could be harmful ilies to maintain health or treat diseases. These boxes discuss research
due to interactions with medications or other problems. Common complementary when it is present to support or refute the efficacy of these modalities.
care used in muscular dystrophy includes dietary enhancement. This enhance- At other times, they alert you about information to gather from the
ment includes vitamins A, C, E, D, and B-complex; minerals such as calcium, mag-
nesium, zinc, and selenium; probiotic supplement; omega-3 fatty acids; herbal family and to consider when planning care.
remedies such as green and rhodiola rosea teas; muscular and immunologic en-
zymes such as coenzyme Q10, N-acetyl cysteine, acetyl-L-carnitine, creatine, and
L-theanine; melatonin to promote sleep; and massage to assist with reduction of
muscle spasms (University of Maryland Medical Center, 2011).

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. x C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle Publishing Services
 It is easy to gather the data and analyze results, and only a few min-
first aid and handling life-threatening allergy and asthma events FIGURE 14–4 ■ A, The school is often the setting for screening tests of large groups
utes are needed. Ask the parent or child to list all foods eaten during
of students at risk for a problem. Screening tests are often organized so all children in a
the past 24Screens
hoursstudents
(Figurefor19–11
conditions that impair learning, such as poor vision and
■
■ ). It is usually helpful to ask for
n either very low or very high hearing, and refers them for further evaluation particular grade are assessed, as in this test to detect vision problems. State laws man-
a description of activities in the last day. Then start with the most
■ Promotes a healthy school environment by ensuring immunization compli- date grades for screening and selected children who must be screened for conditions
recent eventance, monitoring playground equipment safety,food
and move backwards, integrating intake
promoting into the
infection control, such as visual or hearing problems, and scoliosis screening in public schools. B, The
d circumference are in similar daily schedule. For example,
and implementing you might
programs begin
for bullying andby saying,
violence “You men-
prevention school nurse treats this child with a nebulizer to determine if the asthma episode can be
tioned you got up early
■ Educates to about
students comehealthy
to thelifestyles,
clinic today. What exercise,
good nutrition, did Samoraleathealth, controlled before calling the parent to come and pick up the child and seek care from the
small. at home before
smoking you left? Did
cessation, he have
sexually a snack
transmitted as youand
infections, traveled here
pregnancy or
prevention Features
primary care provider. The parent shouldThat Help Youof Use
be informed This Book
nebulizer Successfully
treatment provided in   xi
case the child’s asthma episode continues and additional treatment is needed.
have continued over time or if ■ Manages students with chronic conditions, administers medications, and
participates in the development of individualized health plans (IHPs) and
if there is a lack of body pro- individualized education plans (IEPs) for those with disabilities
■ Refers students’ families to healthcare providers and insurance programs
the child to a physician, nurse
anges from one channel to an-
Developing Cultural Competence
and connects students with needed services (e.g., for substance abuse
Legal and Ethical Considerations
d has usually been in the 25th Growthtreatment,
Grids behavioral and mental health, and reproductive health) Child Nutrition Reauthorization Act
ddenly is in the 90th percentile ■ Serves as a leader in the preparation of policies for school-wide emergencies,
The Child Nutrition Reauthorization Act of 2010, titled the Healthy, Hunger-Free
assessment must be performed The growth school
grids now in use
health were standardized
programs, mental healthusing a cross section
intervention, of theand
and student U.S.
faculty Kids Act of 2010, continues the federal school meal programs (breakfast, lunch,
population and areemergencies
health generally reflective of most children. However, children from
after-school snack, and summer food service) for low-income children and in-
some other countriesand
■ Identifies or cultures
reports may fall outside
clusters these that
of symptoms curves.
mayFor example,
indicate new
an epidemic creases access to nutritional foods. The program also has goals for nutrition edu-
immigrants or adoptees may be in lower percentiles, and catch up over several
Source: DataChildren
from American Academy of Pediatrics Council on countries
School Health. (2008). Role of the cation and physical activity in an effort to address childhood obesity. School nurses
months or years. of immigrants from developing tend to be
school nurse in providing may work with food service personnel in the nutrition programs for healthy eating
ent provide clues to nu- larger than their parents. Evenschool
when health services.
small, Pediatrics,
children should 121follow
(5), 1052–1056; Robert Wood
normal growth
and in creating a nutrition education program for students (Sherry, 2008). See
patterns.Johnson Foundation. (2010). Unlocking the potential of school nursing: Keeping children healthy,
For example, a child may remain at the 10th or 25th percentile for
be affected by dietary in- in school, and ready to learn. Retrieved from http://www.rwjf.org/files/research/cnf14.pdf Chapter 19 .
height, but continue to slowly grow and not fall to a lower percentile.

8
oms may suggest specific

Developing Cultural Competence boxes challenge you to explore Legal and Ethical Considerations boxes identify laws and ethical
differences among racial, ethnic, and social groups, and to plan nurs- issues pertinent to pediatric nursing topics.
ing care that addresses the issues of health disparity.

778 Unit VI | Chapter 25 | Alterations in Respiratory Function

Medications Used to Treat Asthma

QUICK-RELIEF MEDICATION ACTION/INDICATION NURSING MANAGEMENT
Short-Acting Beta2-Agonists Relaxes smooth muscle in airway leading to rapid ■ Use this rescue medication before inhaled steroid, wait 1–2 minutes between
(SABA) bronchodilation (within 5–10 minutes) and mucus puffs, wait 15 minutes to give inhaled steroid. Child should hold breath
Albuterol clearing 10 seconds after inspiring. Then rinse mouth and avoid swallowing
Drug of choice for acute therapy and for prevention medication. Use a spacer.
Levalbuterol
of exercise-induced bronchospasm ■ Differences in potency exist, but all products are comparable on a per puff
Pirbuterol: basis.
Metered dose inhaler (MDI) or
Medications Used to Treat nebulizer ■ Some dose-related side effects include tachycardia, nervousness, nausea and
vomiting, and headaches.
boxes list the actions, indica- ■ Regular use more than 2 days a week for symptom control indicates a loss of
tions, and important nursing control and need for additional therapy.
Corticosteroids Diminishes airway inflammation, secretions, and
implications for medications. obstruction, enhances bronchodilating effect of
■ Short-term therapy should continue until child achieves 80% peak expiratory
flow rate personal best or symptoms resolve.
Methylprednisolone
beta2-agonists ■ Give with food to reduce gastric irritation.
Prednisone
Used for acute asthma episodes that are not com- ■ Give oral dose in early morning to mimic normal peak corticosteroid blood level.
Prednisolone: pletely responsive to beta2-agonists; helps reduce
Oral rate of hospitalization
■ Assess for potential adverse effects of long-term therapy: decreased growth,
unstable blood sugar, and immunosuppression.
Anticholinergic Inhibits bronchoconstriction and decreases mucus ■ Do not use for primary emergency treatment because of delayed onset.
Ipratropium: production with an onset of action in 30–90 minutes ■ Rinse mouth afterward to get rid of bitter taste.
Metered dose inhaler (MDI) ■ Side effects include increased wheezing, cough, nervousness, dry mouth,
or nebulizer tachycardia, dizziness, headache, and palpitations.
■ Prevent medication contact with eyes.
DAILY CONTROL MEDICATIONS ACTION/INDICATION NURSING MANAGEMENT
Long-Acting Beta2-Agonists Relaxes smooth muscles in airway, used for noctur- ■ Do not use for acute asthma episode.
(LABA) nal symptoms and prevention of exercise-induced ■ Take pre-exercise dose 30–60 minutes before activity. Do not use additional
Salmeterol bronchospasm. dose before exercise if already using twice-daily doses which should be
Formoterol: These medications should not be used as single 12 hours apart.
Dry powder inhaler (DPI) therapy for asthma in children, but prescribed in ■ Caution against overdosage as side effects such as tachycardia, tremor,
434 Unit IV |with
combination Chapter 16 | Nursing Care
corticosteroids of theFood
(U.S. Child with
andaDrug
Chronic Condition
irritability, and insomnia will last 8–12 hours.
Administration, 2010).
■ Report failure to respond to usual dose as this may indicate a need for

Inhaled Corticosteroids (ICS)

Evidence-Based Practice
Anti-inflammatory, controls seasonal, allergic, and ■
stepped-up therapy. for Children with Special Healthcare Needs
Care Coordination
Administer with spacer or holding chamber.
Beclomethasone exercise-induced asthma Separate partscoordination
and cleanbyinhaler daily.
Evidence-Based Practice boxes further enhance PROBLEM
Children with
Effectively special healthcare
reduces mucosal needs require
edema
■
assistance from a variety of pro-
in airways
nurses as an integral aspect of each visit decreased the number
of visits to the primary care provider and to the emergency department (Antonelli,
Budesonide ■ Rinse mouth and gargle following treatment to remove drug from oropharynx
grams and services to maximize their potential. Fragmentation of care may result Stille, & Antonelli, 2008).
the approach to research. We describe a particu-
Flunisolide in the child’s needs being unmet. to reduce chanceAoflongitudinal
cough, thrush, and dysphonia.
study compared the use of pediatric practice-based care coor-
dination to an agency-based model of care coordination. Six pediatric practices
lar nursing problem and investigate Fluticasone
the evidence EVIDENCE ■ Monitor growth; however, recommended doses do not have long-term or
participated in the study. Three of the practices continued agency-based care co-
Data were analyzed from the 2005–2006 National Survey of Children with irreversible
Special effects on vertical
ordination (comparisongrowth
group)(Fong & Levin,
while three 2007
practices had).a nurse care coordinator
from several studies that explore solutions
Mometasoneto the Healthcare Needs to determine the association between receiving adequate care
coordination, family–provider relations, and outcomes in the child and Prevent
■ family. placed onsite,
Dataeye exposure
who received
through propertraining
MDI, and quality improvement
nebulizer, (intervention group).
or DPI administration.
Triamcinolone: Children and youth with special healthcare needs were identified. At baseline, 262
problem. We emphasize nursing research, pro-(MDI)
Metered dose inhaler
indicated that 68.2% of the families reported receiving some type■of Monitor assistancefor headache,
with care coordination. Of these, 59.2% indicated they received adequate help, and
gastrointestinal
of these families/children wereupset, dizziness,
interviewed. and infection.
At 18 months, 76 families/children in
the intervention group and 68 in the comparison group were interviewed. Results
vide an interpretation explaining the orimplications
nebulizer 40.8% indicated the assistance was inadequate. Adequate care coordination■ Use exactly
associated with family-centered care, satisfaction with care received, and a partner-
was asofprescribed.
the study indicated that families who received practice-based care coordination
reported a higher level of satisfaction with care coordination, were more likely to
of the studies, and then invite you toMethylxanthines
apply criti- Relaxes
ship withmuscle
healthcarebundles that Families
constrictwhoairways; Tabletcareshould not be crushed or chewed.
professionals. ■
reported receiving adequate report that their experience with care coordination had improved, reported fewer
Theophylline: dilates airway;
coordination wereprovides continuous
less likely to airway
have problems relax- referrals,
with specialty family finan-
■ Use for long-term barrierscontrol. Worksservices,
to healthcare best when a therapeutic
and were treated betterserum
by the level
staff in the office
cal thinking skills to further identify Oral
nursing care cial burden,
ation; and reduction
sustained release in work hours. These families
for prevention also had less out-of-pocket
of nocturnal
expenses, fewer visits to the emergency department per month, and fewer
symptoms
(10–20 (Wood et al., 2009).
missedmcg/L) is maintained; give same time each day.

approaches.
Mast-Cell Inhibitors
Cromolyn sodium
Nedocromil:
Metered dose inhaler (MDI)
or nebulizer
# 108438   Cust: Pearson   Au:
Ball  Pg. a pediatric
Title: Child Health Nursing   Server:
days of school for the CSHCN than families who reported receiving ■
sistance with care coordination (Turchi, Berhane, Bethell, et al., 2009).
inadequate
Requires IMPLICATIONS
as- serum level monitoring and dose adjustment.
Practice-based care coordination in which the nurse works with families to fa-
A descriptive study of six pediatric primary care practices was■conductedLimit caffeine
to intake.coordination of services is effective and leads to greater satisfaction with
cilitate
evaluate the effectiveness of a care coordination measurement tool. ■ SideOther pur- care, reduced costs, and fewer barriers to healthcare services. The nurse assists
effects include tachycardia, dysrhythmias, restlessness, tremors, sei-
poses of the study were to describe care coordination activities that occurred families to identify needed programs and services and is in an excellent position
in a pediatric primary care setting, to assess the relationship of carezures, insomnia,
coordina- hypotension,
to serve as a liaison severe
between headaches,
these programsvomiting, andtodiarrhea.
and the family decrease the risk
tion activities in this setting to outcomes related to the use of resources, and to for fragmentation of care.
Anti-inflammatory, inhibits early and late phase ■ Do not use at time of symptom development or acute exacerbation.
measure personnel costs related to care coordination activities. The study found
asthma
that careresponse
coordination toactivities
allergens wereand exercise-induced
used by patients at all levels■ ofThe patient
acuity, in- mustCRITICAL THINKING APPLICATION
use up to 4 times a day to be effective.
bronchospasm;
cluding children and may be with
youth usedspecial
for unavoidable al- the care coordination
healthcare needs; Why is care coordination a vital aspect of care of CSHCN? What is an
lergen
tool wasexposure.
■ Therapeutic response
used effectively in the pediatric primary care setting; care coordination example ofis seen in 2 weeks;
coordination maximum
of services benefitHow
for CSHCN? maydonot be seen
nurses play a
provided by nurses instead of physicians in this setting decreased costs; forand
4–6careweeks.vital role in care coordination for CSHCN?
May be used as a substitute for inhaled corticoste-
■ Adverse reactions include wheezing, bronchospasm, throat irritation,
roids in mild persistent asthma, but evidence of their
effectiveness for pediatric asthma is weak nasal congestion, and anaphylaxis. Immediately report these symptoms to
from
No. healthcare provider
xi Asperen, 2009). to an adult healthcare provider
physician. in their decision to lead the careDESIGN SERVICES
coordination processOF
by helping the
C/M/Y/K
(Robinson & Van
(White & Hackett, 2009). (See Evidence-Based Practice: Care Coor-
dination for Children with Special Healthcare Needs.)
parents to become knowledgeable about the child’s condition and
Short /treatment
Normal regimen. Encourage thePublishing Services
parents to take
S4carlisle
an active role in the

Children admitted to a hospital
the following units:
ng about the hospital.
f any age for hospital-
ring a child for hospi- xii  Features
ng available to answer
at emotional risk for
ts that follow
ch as cystic fibrosis or
r hopelessness.
red for hospital admis-
m to the environment,
ng truthful responses,
Discuss the anticipated
in the child’s care. Give
and concerns. Refer to
onal support is needed.
ease including insulin administration, exercise, nutrition, and self-esteem issues A descriptive comparative pilot study explored the concepts of self-efficacy
may be
associated withcared
a chronicfor in one
illness. orself-efficacy
How can more of and quality of life be maxi- and resilience in 81 adolescents ages 10 to 16 years who attended a diabetes
mized in adolescents with type 1 diabetes? camp. The Self-Efficacy for Diabetes Scale was used. Results showed that both
self-efficacy and resilience scores were moderately high in this population. Afri-
■ General pediatric unit EVIDENCE can Americans scored significantly higher than Caucasians on both measures.
A randomized controlled trial measured how monitoring and discussing health-
■ Short-stay unit, outpatient unit, or ambulatory surgical unit Participants who lived in single-parent homes had poorer diabetic control, as in-
related quality of life (HRQoL) improved psychosocial well-being in adolescents dicated by a higher hemoglobin A1c, but had higher scores in resilience (Winsett,
■ Emergency department with type 1 diabetes. Ninety-one adolescents between the ages of 13 and 17
Stender, Gower, et al., 2010).
■ Neonatal intensive care unit with type 1 diabetes participated in the study and were randomly assigned to
(NICU) or pediatric intensive care
unit That
the HRQoL
Help You Use This Book
(PICU)
intervention group or the control group. During a 12-month period,
Successfully IMPLICATIONS
all participants had 3 scheduled visits for routine diabetes care at 3-month inter- Developmental tasks of adolescents focus on development of self-concept and
vals. The intervention group completed the Pediatric Quality of Life Inventory on a self-esteem. Adolescents with type 1 diabetes must also cope with the increas-
computer at each visit prior to being seen by the healthcare provider. The results ing responsibility for complex self-management, including insulin administration,
were discussed with the adolescent during the visit. Over the 12-month period, blood glucose testing, exercise, and nutrition. Self-esteem and self-concept
mean scores for psychosocial health, behavior, mental health, and family activities often become linked with the disease as peers react to the differences noted.
improved in the intervention group except for those adolescents with the high- Life satisfaction, perceived control, and worries associated with having diabetes
Baccalaureate Essential II est hemoglobin A1c values. Adolescents in the intervention group demonstrated are important considerations when counseling the teenager and family about the
higher self-esteem at follow-up visits and were more satisfied with care than
Basic Organizational and Systems Leadership
those in the control group (de Wit, Delemarre-van de Waal, Bokma, et al., 2008).
management of diabetes. Additionally, it is important to know that adolescents
value parental involvement and care rather than perceiving it as a reason for
for Quality Care and Patient Safety A cross-sectional design was utilized to determine the impact of family sup-
port and environment on quality of life, adherence to treatment, and metabolic
conflict. Parental involvement and supervision is important in helping adolescents
control in 157 adolescents ages 10 to 18 with type 1 diabetes. Four instru- NEW!
Baccalaureate Essentials
transition successfully boxesoffocus
to self-management on the
their disease. Peersnine essen-
are also
important to adolescents with diabetes. Continued involvement in school activi-
very
Quality improvement and safety is amentspriority for healthcare organizations. Nurses tials ofDia-nursing
were used in the study: a self-report questionnaire on adherence, education
ties and summer camps identified by avenues
provide excellent the American
for friendship Association
and promote a
at the bedside have a major influence beteson the Behavior
Family quality ofScale,
careFamily
provided and theScale, and Diabetes Quality
Environment positive quality of life.
of Life. Results of the study indicated that
safety of the patient; however, it is the responsibility of the organization’s lead- increased family of
support Colleges
predicted of Nursing.
ership to provide the staffing and aresources
better quality of lifesafe
so that in both
and males
qualityandcare
females,
can and higher family conflict CRITICAL THINKING APPLICATION
predicted a lower quality of life. Increased family support also predicted an What questions can be used to explore an adolescent’s perceptions of family
be provided (Disch, Dreher, Davidson, et al., 2011 ). Healthcare providers must
increase in adherence in females. Additionally, the study found that the longer involvement, care, and control? How can you address quality of life issues in
advocate for best practices that focus on risks unique to children. Children in the
the teen had been diagnosed with diabetes, the less likely he or she was to be adolescents with diabetes? What questions can be asked to determine the ado-
healthcare setting are at risk for harm relatedtotoa misidentification,
adherent management plan and adverse effects
to have good metabolic control. Results lescent’s self-efficacy and resilience?
from high-alert medications, and healthcare-acquired or associated infection
(Steering Committee on Quality Improvement and Management & Committee on
Hospital Care, 2011). Young children are especially vulnerable to injury because
of their developmental immaturity,necessary
includingfor
thehome
inabilitymanagement, including
to recognize safety risks.insulin administration, anxiety associated with needles and insulin administration in public
blood glucose
It is essential that the hospital environment testing,
be free meal planning,
of hazards and the
that pose risks for recognition and treat- (Hanas, de Beaufort, Hoey, et al., 2011). Rotating the injection sites
ment of both hypoglycemia and hyperglycemia. Partner with the is important to decrease the chances of lipoatrophy, loss of sub-
children.
child and family to identify barriers to management. cutaneous tissue, or hypertrophy, in which collagen is replaced by
Explain the goals of insulin therapy. Teach the parents and child fat cells (Figure 32–10 ■). The absorption rate of insulin varies by
(if age appropriate) how to draw up and administer insulin or how the site used. Insulin is usually absorbed most rapidly from the ab-
to use an insulin pen. Insulin pens might be accepted more read- domen; however, insulin absorption is increased in the extremities
ily than the traditional syringe and vial method; they are easier to with exercise. An understanding of the different types of insulin and
transport, they provide more accurate dosing, and they decrease their actions is essential.

BOX 32–6 Research: Communication Between Adolescents with Type 1 Diabetes and Their Parents

Transcripts of interactions between adolescents ages 11 to 15 years with type 1
RESEARCH boxes diabetes and their parents were analyzed. Participation in the study required that
the adolescent had been diagnosed with type 1 diabetes for at least a year and
focus on relevant have no other chronic illness, psychologic problems, or learning disability. Tran-
scripts were based on a 10-minute interaction between the adolescent and his
research studies to or her parents in which a diabetes management task, identified by the teen as a
give students addi- source of disagreement, was discussed.
Five themes were identified from the transcripts: fear, frustration, discounting,
tional information normalizing, and trusting. Parents demonstrated frustration, fear, and difficulty in
and background trusting the child with the daily management of diabetes. Parents were also fearful
of long-term complications. Adolescents demonstrated frustration because they did
information.
not feel their parents recognized their successes in their diabetes management.
Discounting was noted in statements by parents that showed a lack of respect
for the adolescents’ opinions and failure to include the adolescents in decisions
related to their care. These statements further added to the child’s frustration. The
theme of normalizing was noted in only a few families and included statements
indicating that the family was attempting to view diabetes as a normal aspect of the
adolescent’s life. The other themes of fear, frustration, trust, and discounting were
cited as barriers to achieving the goal of normalcy.
The study concluded that effective communication between parents and adoles-
cents with type 1 diabetes is essential and that nurses should work with families to fa-
cilitate communication related to diabetes management (Ivey, Wright, & Dashiff, 2009).

284 Unit III | Chapter 10 | Health Promotion and Maintenance of the Infant

Partnering with Families

Helping the Infant Sleep

Helping the Infant Sleep

Helping an infant to self-regulate and be able to sleep for longer periods is
often a stressful challenge for families. Parents need to have substantial sleep
Partnering with Families periods themselves to be refreshed and able to deal with daily life. When up
several times during the night with a baby, parents may become irritable
boxes help you to apply the and fatigued. Question the family about the baby’s sleep routine. The infant
concepts of family-centered passes into light sleep several times at night and may awaken; self-regulation
Video
■ Provide a consistent transitional object, such as a favorite blanket each
night.
■ Put the baby to bed while still awake but drowsy rather than after falling
asleep, so the infant learns self-soothing skills.
■ Do not try to awaken the baby in non-rapid eye movement (NREM or quiet)
sleep.

will assist in helping the infant get back to sleep. Suggestions helpful for the For the baby who has trouble going to sleep, remain in the room for a few
nursing care by providing
■

family are as follows: minutes but do not establish eye contact; place a hand on the abdomen or
approaches and teaching ■ Place the baby to sleep in a quiet and darkened room, a “sleep friendly” chest or gently hold flailing arms and legs.
environment.
in a format directly appli- ■ Establish a consistent sleep routine and time; the routine may involve some Source: Data from National Sleep Foundation. (2011). Sleep, infants, and parents. Retrieved from
cable when you work with cuddling and rocking time but should not be vigorous, stimulating play. http://www.sleepfoundation.org/articles/ask-the-expert/sleep-infants-and-parents

families.

and psychologic health are closely related to these factors. For many cues related to hunger or discomfort, the nurse plans interventions
parents, membership in a faith-based congregation provides spiritual to help prevent further problems. Teaching, demonstrations, and ac-
sustenance and an important sense of belonging. This group may also knowledging parent success are all health maintenance actions. An
provide food, clothing, and care for the new infant. Sometimes par- expected outcome for these activities is the reestablishment of ex-
ents who have not attended institutionalized services will choose to pected growth and development, and age-appropriate interactions of
do so to offer a significant spiritual home for their new child. Services the infant with others.
such as christening and blessing an infant welcome the child formally
into the family and provide meaning to parents and extended family
members. Having a baby often helps parents to feel that they have an RELATIONSHIPS
important meaning and purpose in life, regardless of a faith-based Family
membership. An atmosphere where the infant is valued and offers The infant’s social interactions, both within and outside the family,
meaning to the lives of the adults present is a positive atmosphere for display enormous growth in the first year. The family is the primary
emotional growth. Assess the family’s meaningful activities, practices, unit where the infant learns DESIGN
to interact with other
SERVICES OF people. Therefore,
# 108438   Cust: Pearson
and   Au: Ball  Pg. No. xiirituals. Ask about needs or desires for C/M/Y/K
Title: Child Health Nursing
engagement
  Server:
referrals
in faith-based
in the community such as to an organized religious group orShort
nurses should examine family dynamics during health supervision
/ Normal
visits. Strengths and needs of the family are
Publishing identified during psycho-
Services
S4carlisle
 American Indian and Alaska Native children have a very high rate of otitis media, the Clinical Manifestations table below.
perhaps due to culturally related bony structure of the ear, nose, and mouth. Black Infants and young children have characteristic behaviors that
children have a higher incidence of the condition than White children. However,
indicate otitis media may be present. Pulling at the ear is a sign
White children are more likely to have tympanostomy tube insertion for treatment
of otitis media. The major risk factor for frequent otitis media is low socioeconomic of ear pain (Figure 24–9 ■ ). Diarrhea, vomiting, and fever are
status, regardless of ethnicity ( Smith & Boss, 2010). Be alert for risk factors, plan typical of otitis media. Irritability and “acting out” may be signs
prevention programs, and ensure prompt care and teaching about treatments for of a related hearing impairment. The child with otitis media of-
families of children affected. What prevention measures would you emphasize for ten has night awakenings with crying due to increased pressure
families? See the nursing management section on otitis media for suggestions of
when prone or supine. See the Clinical Manifestations forUse This Book Successfully  xiii
tableYou
Features That Help
preventive approaches.
further detail.

Clinical Manifestations Acute Otitis Media and Otitis Media with Effusion
ETIOLOGY CLINICAL MANIFESTATIONS CLINICAL THERAPY
Acute otitis media—bacterial infec- Behavioral—ear pain, pulling at ear, rapid onset, irritability, mal- Treat ear pain with anesthetic eardrops, herbal pain
tion in the middle ear from pathogens aise, poor feeding. products instilled into the auditory canal, or systemic
transferred from the nasopharynx; most Examination—bulging tympanic membrane, air or fluid bubbles acetaminophen or ibuprofen. Clinical Manifes-
common infectious agents are S. pneu- present behind tympanic membrane; immobile or poorly mobile Verify that the tympanic membrane is intact before
moniae, H. influenzae, M. catarrhalis. tympanic membrane, red (or other color change such as white, inserting eardrops. tations boxes link
gray, or yellow as long as bulging is present) tympanic membrane, Observe the child’s condition for 48–72 hours and if etiology, clinical
reduced visibility of tympanic membrane landmarks with displaced not improved, treat with course of antibiotics.
light reflex. manifestations,
Otitis media with effusion— Behavioral—difficulty hearing or responding as expected to Provide symptomatic treatment of pain. and clinical ther-
collection of fluid in the middle ear behind sounds. Carefully assess hearing acuity over several months. apy for specific
the tympanic membrane which is not Examination—signs of acute inflammation are NOT present; tym- Assess speech if loss of hearing acuity occurs.
infected with bacteria. panic membrane is retracted or neutral; immobile or partly mobile Assess development. conditions.
tympanic membrane; yellow or gray tympanic membrane; opaque
or thickened tympanic membrane with visibility of landmarks
reduced.

Solid Tumors 967

Nursing Care Plans are present in every chapter dealing with health
conditions. They illustrate the conceptual approach that nurses need Health Promotion & Maintenance Overview The Child Receiving Cancer Treatment

in caring for children, including assessment, NANDA nursing diag- Cancer treatment often extends for several years, so the child
needs to continue health promotion and health mainte-
noses, goals, plans, interventions (with NIC), and evaluation (with nance visits.
GROWTH AND DEVELOPMENT SURVEILLANCE
NOC). ■ The child is assessed for height, weight, and
body mass index. This provides information
about growth patterns which may be altered
by cancer treatment. If indicated, 24-hour diet
recalls and other nutritional assessments are
performed.
■ Teaching is provided about age-appropriate foods. Since ap-
petite may be impaired during periods of treatment, the child may be lack-
432 Unit IV | Chapter 16 | Nursing Care of the Child with a Chronic Condition ing fruits, vegetables, or other foods, as well as the nutrients they include.
Encourage parents to be sure the child has a well-balanced diet during
periods of remission.
the child to treatments, and having disturbed sleep at night.
Assess both the child’s sleep patterns and the family’s
experiences. Encourage plans for respite care to en-
able rest periods. Provide cots, rocking chairs, and
other comfortable settings for the child and fam-
ily members during treatments.
■ Both the child and parents may not expect or
understand the profound fatigue that occurs dur-
ing cancer treatment. They can be helped to plan
for providing quiet times, eliminating electronic media
at sleep time, and replenishing energy through naps, mas-
sage, relaxing baths, and spending time with family.
PHYSICAL ACTIVITY
■ Since the child has periods of fatigue, patterns of physical activity may
decrease. Emphasize the importance of integrating physical activity

Nursing Care Plan
INTERVENTION
1. Nursing Diagnosis: Knowledge, Deficient (Child) related to learning self-care skills
NIC Priority Intervention—Individual
Teaching: Planning, implementing, and
evaluating a teaching program designed to
address a patient’s particular need
GOAL: The child will acquire self-care skills for lifetime management.
Assess the child’s developmental level
■ ■
and select an educational approach and
self-care activities to match.
■ Review with the child all steps involved
in the self-care skill and how to perform
the skill.
■ Use demonstration/return demonstration
until the child is comfortable with
procedures.
■ Help parents develop a planned sequence
of self-care skills to teach the child.
■ Discuss a plan for increased responsibility
for self-care with the child and parents.
2. Nursing Diagnosis: Family Processes, Interrupted related to management of a chronic disease
NIC Priority Intervention—Normalization
Promotion: Assisting parents and other fam-
ily members of children with chronic illnesses
or disabilities in providing normal life experi-
ences for their children and families
GOAL: The child and family will manage the required treatments, monitoring, and medication regimen for the child’s condition while maintaining family routines
and functioning.
■ Assess the child’s and family’s lifestyle and
attempt to fit the child’s care needs into
those schedules.
■ Discuss the family’s routines for special
occasions and vacations and any activities
important to the child. Identify ways to
modify the child’s management for these
occasions and activities.
3. Nursing Diagnosis: Coping, Readiness for Enhanced related to self-care management of a chronic condition
NIC Priority Intervention—Resiliency
Promotion: Assisting individuals, families, and
communities in development, use, and strength-
ening of protective factors to be used in coping
with environmental and societal stressors
GOAL: The child will develop a support system network.
■ Talk with the child about how to tell
friends, teachers, and other important
The Child with a Chronic Condition
RATIONALE
Learning goals for the child must match
knowledge and skill expectations appropriate
for the developmental stage.
■ The child may have watched the routine used by
parents many times, and asking the child to list
each step helps the nurse identify extra training
needed.
■ Evaluation permits positive reinforcement and
guidance for modification of techniques.
■ Parents need guidance to identify appropriate
self-care skills that the child is developmentally
ready to learn.
■ Parents often need encouragement to transition
responsibility to the child, becoming a supervisor
rather than the person controlling care.
■ Fitting the child’s care to the child’s and family’s
lifestyle promotes adherence to the regimen and
healthier family processes.
■ It is important for the child to participate in special
events with the family and peers to promote
psychologic development.
■ These important persons can assist the child in an
emergency if they have enough information to
EXPECTED OUTCOME
NOC Suggested Outcome—Knowledge: Extent of understanding
conveyed about treatment regimen
The child demonstrates the proper technique in the self-care
■ with infections when the child’s immune system is compromised and neu-
skill and is able to assume responsibility for that skill with su-
pervision by the parent. Responsibility for self-care increases as
new skills are learned.
NOC Suggested Outcome—Family Health Status: Overall health
status and social competence of family unit
■ The child and family maintain important family routines and
successfully manage the child’s condition.
NOC Suggested Outcome—Health-Seeking Behavior:
Personal actions to manage stressors that tax an individual’s
resources.
Health Promotion & Maintenance Overviews summarize the
needs of children with specific chronic conditions, such as asthma
■ The child identifies the friends, teachers, and other important
persons informed about the chronic condition who can provide
■ Perform developmental screening of young children. Provide suggestions
for parents about the stimulation that is appropriate for the child’s age.
Include quiet activities that can be used when the child is fatigued or
receiving therapy. These might include reading books, listening to music,
and working on a computer. Have the parent plan for these activities on
days that the child goes for chemotherapy or other treatment.
■ Ask about the school-age child’s progress in school. Performance may be
altered due to neurologic effects of treatment as well as missing school.
Plan for the family to partner with the school personnel for provision of
tutors, computer programs, or other needed assistance.
■ Encourage continued social contact with peers when blood counts are
adequate to prevent infection.
PHYSICAL ASSESSMENT AND SCREENING
■ Careful physical assessments are performed to identify any abnormali-
ties that may result from cancer or its treatment. Be alert for signs of
anemia, neutropenia, and thrombocytopenia; refer for treatment and
suggest preventive measures such as infection control for neutropenia.
Cardiopulmonary and neuromuscular assessments are particularly im-
portant. Vision and hearing should be assessed prior to treatment and
periodically throughout. Include measurements of fine and gross motor
activity.
ELIMINATION
■ Toddlers may have an interruption in toilet training during periods when
they do not feel well. Help parents to understand this regression, and en-
courage them to start again when the child is feeling better.
■ Some medications cause diarrhea or constipation, so evaluate bowel
patterns and provide guidance as needed. Skin care instruction may be
needed if the child has diarrhea and is relatively immobile. Increasing flu-
ids and fiber foods may be needed for constipation.
■ Evaluate urinary output since many medications have effects on kidney
function. Encourage adequate fluids for age to ensure elimination of
medications.
SLEEP AND FATIGUE
■ Children undergoing treatment often have disturbed sleep patterns. Par-
ents of young children may become exhausted working all day, getting
when the child feels well, since it is needed for learning gross motor
skills, facilitating blood flow, improving mental status, and setting pat-
terns for the future.
DISEASE AND INJURY PREVENTION STRATEGIES
■ The child with cancer has the same safety hazards as other children of
the same age, and such topics as car safety seats, fire prevention, water
safety, and violence prevention should be addressed.
■ An important hazard for children with cancer is infection due to decreased
immune response and neutropenic episodes. Keep records of immuniza-
tion status. Follow the recommendations of the CDC and AAP for other
immunizations. Teach the hazards of exposure to large groups and those
tropenia is present. Teach care of central lines and other potential sources
of infection. Have families report signs of infection and exposure to known
illnesses promptly.
MENTAL AND SPIRITUAL HEALTH
■ Evaluate the child and family for signs of anxiety and depression. Ask
how they are managing the cancer treatment and what poses the great-
est challenges. Refer to other families with similar circumstances for
support.
■ Ensure that the child has contact with friends through childcare or school,
or via phone, letters, and computer.
■ Find out the impact of the child’s cancer on the parents’ jobs. Ask how the
siblings have been coping, what changes there are in school performance,
and whether teachers and others are aware of the stress the sibling may
be experiencing.
TRANSITIONAL CARE
■ As the child’s treatment ends, instruct them about needed periodic
follow-up with the oncologist. Continue to perform neurologic examina-
tions and ascertain school performance. Be alert for signs of secondary
tumors.
■ Ask about worries regarding the future. As teens grow older, have them
take over more responsibility for informing care providers of their cancer
history and assist them to transition to adult healthcare providers.

■
persons about the chronic condition.
Discuss ways to explain the condition to
important persons and how to answer
questions.
Role-play ways to talk about the condition
■ ■
with friends and teachers.
■ Encourage the child to attend peer support
groups or camps specific to the child’s
condition.
■
assess the problem.
Having an opportunity to plan and role-play the
support when needed. or diabetes. These overviews teach you to look at the child who has
conversation will reduce the child’s anxiety about
condition disclosure. a chronic illness like any other child, with health maintenance needs
Sharing information about the condition helps oth-
for prevention, education, and basic care.
ers understand changes in lifestyle needed by the
child.
■ Learning and support networks developed at camp
can promote development of problem-solving skills
that increase coping abilities.

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xiii C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle Publishing Services
 sema (air leakage in the tissue). The child with a closed pneumo-
thorax may have breath sounds decreased or absent on the injured
side, and the child may be in respiratory distress. A tension pneu-
mothorax with a mediastinal shift may be seen as the lung col-
lapses. Signs of tension pneumothorax include increasing tracheal
deviation, respiratory distress, decreased or absent breath sounds
on one side, decreased chest wall movement, and paradoxical
breathing.
Collaborative Care
Immediate treatment for an open pneumothorax is covering the
drainage system.
Nursing Management
Nursing care focuses on airway management and maintaining
lung inflation. The child usually arrives on the nursing unit with
a chest tube and drainage system in place. Continued close obser-
vation for respiratory distress is essential. Carefully monitor vital
signs and respiratory function. When the chest tube is removed,
the site is covered with an occlusive dressing and the child’s re-
spiratory status is carefully monitored for signs of respiratory
distress.

xiv  End-of-Chapter Review
wound with an airtight seal; however, a gloved hand can be used
until a bandage is prepared. This action prevents more air from en-
tering the chest. For a closed pneumothorax, a needle or tube tho-
racostomy is performed rapidly to relieve the pressure in the chest.
This is usually performed before a chest radiograph that often re-
Complications of chest tube placement include hemothorax (if
the thoracostomy and chest tube are improperly placed), lung tissue
injury, and scarring from poor tube placement (especially if the tube
is placed too near the breast in girls). If a hemothorax occurs, monitor
blood draining into the chest tube system and the child’s physiologic

End-of-Chapter Review veals air in the chest. A chest tube is inserted and a closed drain- status for hypovolemic shock. See Chapter 26 for the management

8
age system is attached to help remove the air and reinflate the lung of a child in hypovolemic shock.

Chapter Highlights summarize key points of

the chapter.
Chapter Highlights
Clinical Reasoning in Action refers back to
the chapter-opening scenario and asks criti- Respiratory conditions are the most common cause of hospitalization in chil-
■

dren between 1 and 9 years of age and a leading cause in children between
■ Sudden infant death syndrome (SIDS) is a leading cause of death in infants.

Onset of the fatal episode occurs during sleep and remains unexplained after

cal thinking questions to help students apply 10 and 19 years of age.

■ The child’s airway is shorter and narrower than an adult’s. These differences
a thorough investigation, including an autopsy, a review of the circumstances
of death, and the clinical history.

knowledge to real patient care. create a greater potential for obstruction. The lungs have no muscles of their
own, so respiration is powered by the diaphragm and intercostal muscles.
■ Laryngotracheobronchitis (LTB) is a viral croup syndrome with signs of an

upper respiratory illness, ®

hoarseness,
NCLEX-RN 799 inspiratory stridor, and a
Reviewtachypnea,
■ Foreign body aspiration is most often caused by small objects that make their seal-like barking cough. Fever may or may not be present.
■ way into the child’s mouth, such as
Children under 2 years have an increased risk of developing tuberculosis, and foods, small toy parts,
■ or household objects Epiglottitis is caused by bacterial
In cystic fibrosis, defective chloride-ion transport across the exocrine and epi-
■ invasion of the soft tissue of the larynx,
NCLEX-RN® Review prepares students for like beads,
if untreated have a greater chance safety pins,tocoins,
of progressing activeorTBbuttons. The increasing mobility
and spreading andwalls
thelial cell tendencyresults in ancausing
abnormal inflammation
accumulation andof edema
viscous,ofdehydrated
the epiglottis and surrounding tissues
to put small objects
beyond the lungs (e.g., meningitis and disseminated TB). in the mouth makes this a major health problem for infants that can result in life-threatening
mucus that affects the respiratory, gastrointestinal, and reproductive systems. airway obstruction. Classic signs of epi-
course exams on chapter content and gives ex- ■ Asthma is one of the most commonand toddlers.chronic respiratory disorders in child- ■ Signs of smoke inhalation injury glottitis include
in children dysphonia,
include burns ofdysphagia,
the face and drooling,
neck, and distressed respiratory
Signs of impending respiratory
hood. The respiratory difficulties of an acute asthma episode result from
■ failure in infants and children include worsen- effort.
singed nasal hairs, soot around the mouth or nose, and hoarseness with stridor
posure to all formats of NCLEX®-style questions. inflammation that causes theingnormalrespiratory distress,
protective irritability, lethargy,
mechanisms mottled color or
of the lungs or voice
cyanosis, diapho-
change. ■ Neonatal respiratory distress syndrome is the most common cause of respi-

(mucous formation, mucosalresis, and increased

swelling, and airway respiratory
muscle effort such astodyspnea
contraction) ■ (difficulty
Pulmonarybreathing),
contusion occursratory distress in with
in association pretermbluntinfants,
chest and the incidence
trauma. The increases to 60% of all
tachypnea
overreact in response to a stimulus and (increased
cause airway respiratory rate), nasal flaring, grunting,
obstruction. energy andfrom
retractions.
the injury oftenpreterm
bruises infants
the lung withtissue
a gestational age of less
in the absence than 28 weeks.
of rib

Detailed References provide the basis for ■ Apnea is cessation of respiration

Bronchopulmonary dysplasia (BPD) usually develops in neonates with a birth
■

weight of 1000 g or less and respiration

a gestationalassociated
lasting
withofcyanosis,
age at birth
longer
less thanmarked
28 weeks
than 20 seconds, or any pause in A higher risk for meconium
fractures. Although the child may appear initially asymptomatic, respiratory
pallor, hypotonia,
distressor bradycardia.
■

often develops withinvanced

aspiration syndrome occurs
gestational age, greater than 40 weeks. The meconium causes a
a few hours.
in neonates of ad-

­evidence-based nursing care and support the Three types of apnea are noted in
who are treated with oxygen and positive-pressure ventilation for respiratory
■

failure or respiratory distress complete

syndrome.cessation
Treatmentof leads
breathing;
neonates:
obstructiveand
to inflammation
central apnea,
■ in which there is chemical inflammation of the
A pneumothorax may become life threatening if internal pressure from a closed
apnea, in which there is an
pneumothorax is not airway
ab- vented. Air obstruction,
leaking and persistent
into the chest
airway
cavity during
that
pulmonary
can lead to pulmonary
hypertension.
inspiration
edema, small

currency and accuracy of the textbook. sence of nasal airflow when respiratory
damage to the bronchioles, resulting in fibrosis, edema of the bronchioles,
and smooth muscle hypertrophy.
efforts are
which a central respiratory pause either precedes or follows
present; and mixed apnea, in Respiratory syncytial virus (RSV)
cannot escape during expiration, increasing compression. Venous blood return
to airway
the heartobstruction.
■

is impaired as theamediastinum
lower respiratoryshiftstract
towardillness
is the most
that occurslung.
the unaffected
common cause of bronchiolitis,
when an infecting agent (virus or
■ Obstructive sleep apnea syndrome is a disorder of breathing during sleep that bacterium) causes inflammation and obstruction of the bronchioles.
in children is commonly caused by enlarged tonsils and adenoids. Children ■ Symptoms of pneumonia in infants and children include elevated tempera-

Clinical Reasoning in Action have symptoms of sleep deprivation such as daytime sleepiness, poor atten-
tion, increased activity, aggression or acting-out behavior, and poor school
ture, crackles, wheezes, cough, dyspnea, tachypnea, restlessness, and de-
creased breath sounds if consolidation occurs.
performance.
INTRODUCTION DISCUSSION
Return to the scenario at the beginning of the chapter. Hannah and her mother 1. Describe the signs and symptoms that would indicate that Hannah’s asthma
are learning more about asthma management during a health center visit with is progressing in severity. Develop an asthma action plan that provides guid-
the nurse practitioner. She has no asthma symptoms during today’s visit, and ance for daily management as well as managing asthma symptoms to avoid
has taken all medications prescribed since her recent hospitalization. an emergency department visit.
DESCRIPTION 2. Identify information about the family’s lifestyle and home environment that
Prior to the acute asthma episode that occurred at school, Hannah had used could be potential triggers for Hannah’s asthma.
only short-acting beta2-agonists for symptoms, about once a week. During her 3. Develop an asthma education plan that corresponds to Hannah’s stage
hospitalization she needed systemic corticosteroids and was sent home with oral of development, and identify appropriate self-care responsibilities to begin
corticosteroids that were tapered and discontinued 3 days ago. Because of the teaching her.
severity of her asthma episode, Hannah’s daily treatment will be changed from 4. Describe the essential elements of an individualized health plan for Hannah
step 1 for intermittent asthma to step 2 for mild persistent asthma. and the actions that must be taken to have one developed in collaboration
with the school nurse.

800 Unit VI | Chapter 25 | Alterations in Respiratory Function
References
Adams, S. M., Good, M. W., & Defranco, G. M. (2009).
Sudden infant death syndrome. American Family
Physician, 79(10), 870–874.
Ajao, T. I., Oden, R. P., Joyner, B. L., & Moon, R. Y. (2011).
Decisions of black parents about infant bedding and
sleep surfaces: A qualitative study. Pediatrics, 128(3),
494–502.
Akinbami, L. J., Moorman, J. E., & Liu, X. (2011, January
12). Asthma prevalence, health care use, and mortality:
United States, 2005–2009. National Health Statistics
Reports, 32, 1–16.
Allergy and Asthma Network. (2010). Medications at
school. Retrieved from http://aanma.org/advocacy/meds-
at-school/
Al-Saif, S., Alvard, R., Manfreda, J., Kwatkowsky, K.,
Cates, D., Qurashi, M., & Rigato, H. (2008). A ran-
domized controlled trial of theophylline versus CO2
inhalation for treating apnea of prematurity. Journal of
Pediatrics, 153(4), 513–518.
Alverson, B., & Ralston, S. L. (2011). Management of
bronchiolitis: Focus on hypertonic saline. Contemporary
Behm, I., Kabir, Z., Connolly, G. N., & Alpert, H. R.
(2012). Increasing prevalence of smoke-free homes and
decreasing rates of sudden infant death syndrome in the
United States: An ecological association study. Tobacco
Control, 21, 6–11.
Bonkowsky, J. L., & Tieder, J. S. (2009). A pragmatic ap-
proach to ALTEs. Contemporary Pediatrics, 26(11),
54–63.
Brashers, V. L. (2010a). Alterations in pulmonary func-
tion. In K. L. McCance, S. E. Huether, V. L. Brashers, &
N. S. Rote, Pathophysiology: The biologic basis for dis-
ease in adults and children (6th ed., pp. 1266–1309).
St. Louis, MO: Mosby Elsevier.
Brashers, V. L. (2010b). Structure and function of the
pulmonary system. In K. L. McCance, S. E. Huether,
V. L. Brashers, & N. R. Rote, Pathophysiology: The bio-
logic basis for disease in adults and children (6th ed.,
pp. 1242–1265). St. Louis, MO: Mosby Elsevier.
Busse, W. W., Morgan, W. J., Gergen, P. J., Mitchell, H. E.,
Gern, J. E., Liu, A. H., . . . Sorkness, C. A. (2011). Ran-
domized trial of omalizumab (Anti-IgE) for asthma in
NCLEX-RN® Review
1. The nurse is caring for an infant who was admitted to the hospital for the 3. An 8-year-old child is diagnosed with viral pneumonia and sent home from the
treatment of RSV bronchiolitis. What assessment item would the nurse clinic without an antibiotic prescription. The symptoms worsen, and the child
report immediately to the healthcare provider?
1. Increased temperature
returns to the clinic a week later with signs of a higher fever, listlessness, and a
harsh, productive cough. The child’s mother states, “I knew a prescription for an-
2. Increased heart rate tibiotics was needed.” Which indicates the nurse’s most appropriate response?
Coleman-Phox, K., Odouli, R., & De-Jun, L. (2008). Use
of a fan during sleep and risk of3.sudden
Decreased pulsesyn-
infant death oximeter saturations 1. “It is better to wait to make sure so we don’t use antibiotics unnecessarily. This
drome. Archives of Pediatrics 4. and
Decreased bowel
Adolescent sounds
Medi- approach also saves healthcare dollars.”
cine, 162(10), 963–968.
2. The neonatal nurse is giving discharge instructions to parents of an infant 2. “Sometimes we just do not know. I’m glad you came back in.”
Cruz, A. T., & Starke, J. R. (2010). Pediatric tuberculosis.
diagnosed with bronchopulmonary dysplasia (BPD). Teaching was ineffec-
Pediatrics in Review, 31(1), 13–25.
3. “You do not want to expose your child to medication unnecessarily. Now it is
tive if which statement necessary, because it is bacterial pneumonia.”
Cuff, S., & Loud, K. (2008). Exercise-induced broncho- is made by one of the parents?
spasm. Contemporary Pediatrics, 4. “Antibiotics are not effective for viral pneumonia. Bacteria can grow later in the
1. “I25can
(9),expect
88–95.my baby to require diuretic therapy.”
Cystic Fibrosis Foundation.2.(2011a). About my
“I can expect cystic
baby to be on oxygen therapy for the rest of his life.” duration of the illness, making antibiotics necessary later.”
fibrosis: What you need to3. know . Retrieved
“I can expect myfrom
baby to receive respiratory treatments at least once daily.” 4. The nurse is caring for a pediatric patient who may be experiencing ob-
http://www.cff.org/AboutCF/
4. “I can expect to come to the office monthly during winter months for at least structive sleep apnea syndrome. What questions are appropriate to include
Cystic Fibrosis Foundation. (2011b). About cystic fibro-
1 year.” from http://
sis: Frequently asked questions. Retrieved in the history assessment for this child? (Select all that apply)
www.cff. org/AboutCF/Faqs/
1. “Does your child sleep on his/her back?”
Cystic Fibrosis Foundation. (2011c). Screening for
2. “Does your child complain of evening headaches?”
cystic fibrosis. Retrieved from http://www.cff.org/
AboutCF/Testing/NewbornScreening/ScreeningforCF/
3. “Does your child have any signs of hyperactivity?”
4. “Does your child have difficulty with schoolwork?”
Cystic Fibrosis Foundation. (2011d). Airway clear-
ance techniques. Retrieved fromhttp://www.cff.org/ 5. “Does your child wet the bed?”
treatments/Therapies/Respiratory/AirwayClearance/
See Appendix I for answers.
8

Pediatrics, 28(2), 30–38.
American Academy of Allergy, Asthma, and Immunol-
ogy (AAAAI). (2013). What is a peak flow meter? Re-
trieved from http://www.aaaai.org/
American Academy of Pediatrics (AAP). (2012). Red
book: 2012 Report of the Committee on Infectious
Diseases (29th ed.). Elk Grove Village, IL: Author.
American Academy of Pediatrics (AAP) Committee on
Infectious Disease. (2009). Policy statement—Modified
recommendations for use of palivizumab for prevention
of respiratory syncytial virus infections.
Amirav, I. (2010). To inhale or not to inhale: Is that the
question? A simple method of DPI instruction. Journal
of Pediatrics, 156(2), 339–339e1.
Antoon, A. Y., & Donovan, M. K. (2007). Burn injuries.
In R. M. Kliegman, R. E. Behrman, H. B. Jenson, &
B. F. Stanton, Nelson textbook of pediatrics (18th ed.,
pp. 450–458). Philadelphia, PA: Elsevier Saunders.
Askin, D. F., & Diehl-Jones, W. (2009). Pathogenesis
and prevention of chronic lung disease in the neonate.
Critical Care Nursing Clinics of North America, 21,
11–25.
Asthma Initiative of Michigan for Healthy Lungs.
(2011). How to use a metered-dose inhaler the right
way. Retrieved from http://www.getasthmahelp.org/
inhalers_main.asp
Ayad, O., Dietrich, A., & Mihalov, L. (2008). Extracorpo-
real membrane oxygenation. Emergency Medical Clin-
ics of North America, 26, 953–959.
Baker, L. K., & Denyes, M. J. (2008). Predictors of self-care
in adolescents with cystic fibrosis: A test of Orem’s theo-
ries of self-care and self-care deficit. Journal of Pediatric
Nursing, 23(1), 37–48.
Banasiak, N. C. (2007). Childhood asthma: Part two:
Management update. Journal of Pediatric Health Care,
21(3), 184–191.
Baraldi, E., & Filippone, M. (2007). Chronic lung disease
after premature birth. New England Journal of Medicine,
357(19), 1946–1955.
Baum, C. R. (2008). What’s new in pediatric carbon
monoxide poisoning? Clinical Pediatric Emergency
Medicine, 9, 43–46.
inner-city children. New England Journal of Medicine,
364(11), 1005–1015.
Callahan, K. A., Panter, T. M., Hall, T. M., & Slemmons,
M. (2010). Peak flow monitoring in pediatric asthma
management: A clinical practice column submission.
Journal of Pediatric Nursing, 25, 12–17.
Camargo, C. A., Rachelefsky, G., & Schatz, M. (2009).
Managing asthma exacerbations in the emergency de-
partment: Summary of the National Asthma Education
and Prevention Program Expert Panel Report 3: Guide-
lines for the management of asthma exacerbations. Jour-
nal of Allergy and Clinical Immunology, 124, S5–S14.
Carbajal, R., Biran, V., Lenclen, R., Epaud, R., Cimerman,
P., Thibault, P., . . . Fauroux, B. (2008). EMLA cream and
nitrous oxide to alleviate pain induced by palivizumab
(Synagis) intramuscular injections in infants and young
children. Pediatrics, 121(6), e1591–e1598.
Carrier, C. T. (2009). Back to sleep: A culture change to
improve practice. Newborn & Infant Nursing Reviews,
9(3), 163–168.
Centers for Disease Control and Prevention (CDC).
(2008). Initiating change: Creating an asthma-
friendly school. Retrieved from http://www.cdc.gov/
HealthyYouth/asthma/creatingafs/index.htm
Centers for Disease Control and Prevention (CDC).
(2011a). Trends in tuberculosis—United States, 2010.
Morbidity and Mortality Weekly Report, 60(11),
333–337.
Centers for Disease Control and Prevention (CDC).
(2011b). Vital signs: Asthma prevalence, disease charac-
teristics, and self-management education—United States,
2001–2009. Morbidity and Mortality Weekly Report,
60(17), 547–552.
Chipps, B., Zeiger, R. S., Murphy, K., Mellon, M., Schatz,
M., Kosinski, M., . . . Ramachandran, S. (2011). Longi-
tudinal validation of the Test for Respiratory Asthma
Control in Kids in pediatric practices. Pediatrics, 127(3),
e737–e747.
Clark, A. P., Giuliano, K., & Chen, H. (2006). Pulse oxim-
etry revisited: “But his O2 was normal!” Clinical Nurse
Specialist, 20(6), 268–272.
Coffman, S. (2009). Late preterm infants and risk for
RSV. Maternal and Child Nursing, 34(6), 378–384.
D’Agustino, J. (2010). Pediatric airway nightmares.
Emergency Medical Clinics of North America, 28,
119–126.
Davis, P. G., Schmidt, B., Roberts, R. S., Doyle, L. W., Asz-
talos, E., Haslam, R., . . . Tin, W. (2010). Caffeine for ap-
nea of prematurity trial: Benefits may vary in subgroups.
Journal of Pediatrics, 156(3), 382–387.
Dukhovny, D., Lorch, S. A., Schmidt, B., Doyle, L. W.,
Kok, J. H., Roberts, R. S., . . . Zupancic, J. A. F. (2011).
Economic evaluation of caffeine for apnea of prematu-
rity. Pediatrics, 127(1), e146–e155.
Duncan, J. R., Paterson, D. S., Hoffman, J. M., Mokler,
D. J., Borenstein, N. S., Belliveau, R. A., . . . Kinney, H. C.
(2010). Brainstem serotonergic deficiency in sudden in-
fant death syndrome.Journal of the American Medical
Association, 303(5), 430–437.
Durbin, W. J., & Stille, C. (2008). Pneumonia. Pediatrics
in Review, 29(5), 147–158.
Everard, M. L. (2006). Aerosol delivery to children. Pedi-
atric Annals, 35(9), 630–636.
Fakhoury, K. F., Sellers, C., Smith, E. O., Rama, J. A., &
Fan, L. L. (2010). Serial measurements of lung function
in a cohort of young children with bronchopulmonary
dysplasia. Pediatrics, 125(6), e1441–e1447.
Flume, P. A., O’Sullivan, B. P., Robinson, K. A., Goss,
C. H., Mogayzel, P. J., Willey-Courand, D. B., . . . Cystic
Fibrosis Foundation, Pulmonary Therapies Committee
(2007). Cystic fibrosis pulmonary guidelines: Chronic
medications for maintenance of lung health. American
Journal of Respiratory and Critical Care Medicine,
176, 957–969.
Fong, E. W., & Levin, R. H. (2007). Inhaled corticoste-
roids for asthma. Pediatrics in Review, 28(6), e30–e35.
Fu, L. Y., Colson, E. R., Corwin, M. J., & Moon, R. Y.
(2008). Infant sleep location: Associated maternal and
infant characteristics with sudden infant death syn-
drome prevention recommendations. Journal of Pedi-
atrics, 153(4), 503–508.
Geary, C., Caskey, M., Fonseca, R., & Malloy, M. (2008).
Decreased incidence of bronchopulmonary dysplasia
after early management changes, including surfactant
and nasal continuous positive airway pressure treatment
at delivery, lowered oxygen saturation goals, and early

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xiv C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle Publishing Services

Acknowledgments
It is both challenging and a significant responsibility to write a pedi-
atric textbook. Pediatric nursing is constantly changing due to new
knowledge and technologies. It is inspiring to observe this evolution
of pediatric nursing practice and to have the opportunity to share
with nursing students much of our enthusiasm for working with
children and their families. We appreciate the opportunity to con-
tribute to the education of a new generation of nurses.
This edition of the textbook used the strong foundation of the
first edition and integrated some new features. The production of a
textbook requires a team that is fully committed to the vision from
the beginning of the revision through the final production process.
We were fortunate to have a close collaborative relationship with
our publishing company, Pearson. Kim Norbuta, our nursing edi-
tor, infused new ideas and approaches into the textbook and accom-
panying learning aids. We are excited about the coming application
of simulations as methods of expanding understanding of pediatric
nursing for the student. Julie Alexander, vice president and pub-
lisher, has once again enthusiastically supported this venture on be-
half of Pearson.
Our developmental editor, Kim Wyatt, has worked with us for
several books; she is a cheerleader and a friend, and she has an exqui-
site eye for detail. She worked side by side with a new editor, Mary
Cook, to ensure the quality and timeliness of the present edition.
Mary was essential in cultivating our relationship with reviewers—
her pleasant and competent manner was outstanding. We thank
­Maria Reyes, production editor; Patrick Walsh, production manag-
ing editor; and editorial assistant Erin Rafferty, for their expertise
and valuable contributions. Our thanks also go to Mary Siener for
# 108438   Cust: Pearson   Au: Ball  Pg. No. xv
Title: Child Health Nursing   Server:
Acknowledgments  xv
the textbook design. At S4Carlisle Publishing Services, we thank
Lynn Steines for coordinating production, and Joan Lyon for her
copyediting skills.
George Dodson took many of the photos in this book. We sin-
cerely thank the children, families, and nurses who allowed us to il-
lustrate development, pediatric healthcare conditions, and nursing
care of children in hospital, home, and community settings.
One chapter in the book was written by an expert in a specialized
field. We particularly thank Linda Ward for her contributions on ge-
netics and genomics. She is a participant in the National Institutes
of Health Summer Genetics Institute and a researcher in education
of nurses on these important topics, and we could have no better
contributor. We would also like to acknowledge the academic- and
clinical-based pediatric nurses who served as reviewers and con-
sultants. Their valuable feedback enabled us to more appropriately
focus our chapters for today’s student nurses and the practice of pe-
diatric nursing.
This book emphasizes partnering with families to provide com-
prehensive care for children. Our own families are also critically
important to our lives. Without them we could not reach our own
personal and professional goals, and we depend on them every day
for support, love, and caring. We thank them for their enduring part-
nerships and contributions that made this book a reality.
Jane W. Ball
Ruth C. Bindler
Kay J. Cowen
DESIGN SERVICES OF
C/M/Y/K
Short / Normal
S4carlisle
Publishing Services
Contents
Chapter 2
UNIT I Family-Centered Care:
Nurses, Children, and Families 1 Theory and Application 28
Family Roles 29
Chapter 1 Family-Centered Care 29
Child Health Nursing: History of Family-Centered Care 29
Concepts, Roles, and Issues 2 Promoting Family-Centered Care 30
Overview of Pediatric Health Care 3 Family Composition 32
Nuclear Family 32
Role of the Nurse in the Care of Children 3 Blended or Reconstituted Family 32
Direct Care Provider 3 Extended Family 33
Patient Educator 5 Single-Parent Family 33
Patient Advocacy 6 Binuclear Family 33
Case Manager 6 Heterosexual Cohabiting Family 34
Research 6 Gay and Lesbian Family 34
History of Child Health Care 7 Family Functioning 34
The Beginnings of Child Health Nursing 7 Transition to Parenthood 34
Historic Legislation 8 Parental Influences on the Child 35
Other Advances in Child Health Care 8 Family Size 35
Nursing Process in Pediatric Care 9 Sibling Relationships 35
Clinical Reasoning 9 Parenting 35
Evidence-Based Practice 9 Authoritarian Parents 36
Assessing Quality of Health Care 10 Authoritative Parents 36
Contemporary Climate for Pediatric Permissive Parents 36
Nursing Care 11 Indifferent Parents 36
Partnering with Families: Parent Adaptability 36
Family-Centered Care 11 Assessing Parenting Styles 37
Culturally Competent Care 11 Discipline and Limit Setting 38
Pediatric Health Statistics 12 Special Family Considerations 39
Infant Mortality 12, Child Mortality 13 Divorce and Its Effects
Healthy People 2020 14 on Children 39
Morbidity and Hospitalization 14 Stepparenting 39
Healthcare Financing 14
Health Benefits 15 Foster Care 40
Healthcare Technology 16 Foster Parenting 41
Health Status of Foster Children 41
Legal and Ethical Concepts and
Transition to Permanent Placement 41
Responsibilities 16
Regulation of Nursing Practice 16 Adoption 42
Accountability and Risk Management 16 Legal Aspects of Adoption 42
Accountability 16, Patient Safety 16, Preparation for Adoption 42
Risk Management 18 International Adoptions 43
Legal and Ethical Issues in Pediatric Care 19 Family Theories 43
Informed Consent 19, Child Participation in Family Development Theory 44
Healthcare Decisions 20, Child’s Rights Versus Family Systems Theory 44
Parents’ Rights 20, Confidentiality 21, Patient Family Stress Theory 45
Self-Determination Act 21
Ethical Concepts and Issues 22 Family Assessment 45
Withholding or Withdrawing Medical Treatment 22, Family Stressors 45
Genetic Testing of Children 23, Organ Family Strengths 45
Transplantation Issues 23 Collecting Data for Family
Partnering with Children and Their Families 24 Assessment 46

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xvi C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
 Contents  xvii

Family Assessment Tools 46 Principles of Inheritance 88

Genogram 47, Family Ecomap 47, Family Mendelian Pattern of Inheritance 88
APGAR 47, Home Observation for Measurement Dominant Versus Recessive Disorders 88,
of the Environment 47, Friedman Family Autosomal Dominant 88, Autosomal Recessive 89,
Assessment Model 48, Calgary Family X-Linked 89, X Inactivation 91, Y-Linked
Assessment Model 48 Disorders 91
Family Support Services 50 Variability in Classic Mendelian Patterns
Nursing Management 50 of Inheritance 91
Penetrance 92, New Mutation 92, Anticipation 92,
Variable Expressivity 92, Sex-Limited Traits 92,
Chapter 3 Sex-Influenced Traits 92
Cultural Influences 55 Other Variations in Monogenic Inheritance 92
Culture—Definitions and Basic Concepts 56 Imprinting 92
Culture and Nurse Theorists 56 Uniparental Disomy 93
Application of Cultural Theories 58 Polygenic and Multifactorial Inheritance 93
Definitions Related to Culture 58 Neural Tube Defects 93
Demographics and Cultural Diversity Congenital Heart Defects 93
Cleft Lip and Palate 93
in the United States 59
Autism Spectrum Disorder 93
Cultural Competence in Nursing 59 Collaborative Care 93
Health Care and Culture 60 Diagnostic Procedures 93
Disparities in Health and Barriers to Nursing Management 96
Health Care 60 The Role of the Nurse in Genetic Testing 98
Access and Barriers 60, Biological Differences 62, Visions for the Future 104
Environmental Differences 63
Cultural Practices That Influence Health Care 63 Chapter 5
Family Roles and Organization 63, Concepts of Growth and Development 107
Communication 64, Time Orientation 65,
Nutrition 66 Principles of Growth and Development 108
Health Beliefs, Approaches, and Practices 66 Major Theories of Development 108
Health Beliefs 66, Health Approaches Freud’s Theory of Psychosexual
and Practices 67
Development 109
Nursing Management 71 Theoretic Framework 109, Stages 109, Nursing
Application 109
Erikson’s Theory of Psychosocial
Development 109
UNIT II Theoretic Framework 109, Stages 110, Nursing
Application 113
Child Concepts and Application 77 Piaget’s Theory of Cognitive Development 113
Theoretic Framework 113, Stages 113, Nursing
Chapter 4 Application 115
Genetic and Genomic Influences 78 Kohlberg’s Theory of Moral Development 115
Theoretic Framework 115, Stages 116, Nursing
Partnering with Families: Meeting the Standard Application 116
of Genetic Nursing Care Delivery 79 Social Learning Theory 116
Impact of Genetic Advances on Health Promotion Theoretic Framework 116, Nursing Application 116
and Health Maintenance 80 Behaviorism 116
Theoretic Framework 116, Nursing Application 117
Genetic Basics 82 Ecologic Theory 117
Cell Division 82 Theoretic Framework 117, Levels or Systems 117,
Chromosomal Alterations 83 Nursing Application 119
Alterations in Chromosome Number 84, Structural Temperament Theory 119
Chromosomal Alterations 84 Theoretic Framework 119, Nursing
Genes 85 Application 120
Distribution and Function of Genes 86, Mitochondrial Resiliency Theory 120
Genes 86, Gene Alterations and Disease 86, Gene Theoretic Framework 120, Nursing Application 121
Alterations That Decrease Risk of Disease 87,
Genetic Variation: Single Nucleotide Polymorphisms Influences on Development 121
and Copy Number Variants 88 Growth and Development by Age Group 122

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xvii C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
xviii  Contents

Newborn (Up to 1 Month) 122 Newborn 152

Physical Growth and Development and Prenatal Infant 152
Influences 122 Toddler and Preschooler 153
Cognitive Development 124 School-Age Child 154
Psychosocial Development 124 Adolescent 154
Infant (1 Month to 1 Year) 126 The Child with Special Needs 154
Video Understanding Growth and Communicating with the Child with an Alteration
in Visual Perception 154, Communicating with the
Development 126
Child with an Alteration in Hearing Perception 155,
Cognitive Development 126 Communicating with the Child Who Does Not Speak
Psychosocial Development 130 English 155
Video Stages of Play 130, Personality and
Nursing Management 155
Temperament 130, Communication 130
Toddler (1 to 3 Years) 131
Physical Growth and Development 131 Chapter 7
Cognitive Development 131 Pediatric and Newborn Assessment 163
Psychosocial Development 132
Play 132, Personality and Temperament 133, Obtaining the Child’s History 164
Communication 133 Communication Strategies 164
Preschool Child (3 to 6 Years) 134 Strategies to Build Rapport with the Family
Physical Growth and Development 134 and Child 164
Cognitive Development 135 Data to Be Collected 165
Psychosocial Development 135 Patient Information 165, Physiologic Data 165,
Play 135, Personality and Temperament 135, Psychosocial Data 167, Developmental Data 168
Communication 137 Developmental Approach to the Examination 168
School-Age Child (6 to 12 Years) 137 Newborns and Infants Under 6 Months
Physical Growth and Development 138 of Age 169
Cognitive Development 139 Infants over 6 Months of Age 169
Psychosocial Development 139 Toddlers 169
Play 139, Personality and Temperament 140, Preschoolers 169
Communication 140, Sexuality 140 School-Age Children 169
Adolescent (12 to 18 Years) 140 Adolescents 169
Physical Growth and Development 140 Anatomic and Physiologic Characteristics
Cognitive Development 140 of Infants and Children 169
Psychosocial Development 141 General Appraisal 171
Activities 141, Personality and Temperament 142, Anthropometric Measurements 171
Communication 142, Sexuality 142 Infants and Toddlers 171, Preschoolers and
School-Age Children 172, Older Children and
Chapter 6 Adolescents 173
Child and Family Communication 146 Assessing Skin and Hair 173
Inspection of the Skin 173
Communication and the Nurse–Child–Family
Skin Color 173
Relationship 147 Palpation of the Skin 174
Forms of Communication 147 Temperature 174, Texture 174, Moistness 174,
Verbal Communication 147 Resilience (Turgor) 174
Nonverbal Communication 147 Capillary Refill Time 174
Facial Expressions 149, Body Language 149, Skin Lesions 175
Eye Contact 149, Touch 150, Physical Inspection of the Hair 175
Appearance 150 Palpation of the Hair 175
Factors Influencing Communication with Children Assessing the Head and Face 175
and Their Families 150 Inspection of the Head and Face 175
Medical Jargon 150 Palpation of the Skull 176
Gender 151 Sutures 176, Fontanels 176
Child’s Health Status 151
Assessing Eyes and Vision 177
Nursing Attitudes 151
Inspection of the External Eye Structures 177
Developmental and Cognitive Considerations for Eye Size and Spacing 177, Eyelids and
Communication with Children 152 Eyelashes 178, Eye Color 178, Pupils 178

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xviii C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
 Contents  xix

Inspection of the Eye Muscles 178 Third Heart Sound 196, Murmurs 196, Venous
Extraocular Movements 179, Corneal Light Hum 196
Reflex 179, Cover–Uncover Test 179 Completing the Heart Examination 196
Inspection of the Internal Eye Structures 179 Palpation of the Pulses 196, Blood Pressure 196,
Red Reflex 180 Other Signs 197
Vision Assessment 180 Assessing the Abdomen 197
Infants and Toddlers 180, Visual Fields 180, Topographic Landmarks of the
Standardized Vision Charts 180
Abdomen 197
Assessing the Ears and Hearing 181 Inspection of the Abdomen 198
Inspection of the External Ear Structures 181 Shape 198, Umbilicus 198, Rectus Muscle 198,
Inspection of the Tympanic Membrane 181 Abdominal Movement 198
Hearing Assessment 182 Auscultation of the Abdomen 198
Infants and Toddlers 183, Preschool and Older Percussion of the Abdomen 198
Children 183, Bone and Air Conduction of Palpation of the Abdomen 198
Sound 183 Light Palpation 198, Deep Palpation 199,
Assessing the Nose and Sinuses 184 Other Masses 199
Inspection of the External Nose 184 Assessment of the Inguinal Area 199
Palpation of the External Nose 184 Inspection 199, Palpation 199
Nasal Patency 184 Assessing the Genitalia and Perineum 199
Assessment of Smell 184 Preparation of Children for the
Inspection of the Internal Nose 184 Examination 199
Mucous Membranes 184, Nasal Septum 184, Females 199
Discharge 185 Inspection of the External Genitalia 199,
Inspection of the Sinuses 185 Palpation 200
Assessing the Mouth and Throat 185 Males 200
Inspection of the Mouth 185 Inspection of the External Genitalia 200,
Lips 185, Teeth 185, Mouth Odors 186, Gums Palpation 201
and Buccal Mucosa 186, Tongue 187, Palate 187 Inspection of the Anus and Rectum 201
Palpation of the Mouth Structures 187 Palpation of the Anus and Rectum 201
Inspection of the Throat 187 Assessment of Pubertal Development
Assessing the Neck 187 and Sexual Maturation 201
Inspection of the Neck 187 Females 201
Palpation of the Neck 188 Males 202
Lymph Nodes 188, Trachea 188, Thyroid 188 Sexual Maturity Rating 202
Range of Motion Assessment 188 Assessing the Musculoskeletal
Assessing the Chest 188 System 202
Topographic Landmarks of the Chest 188 Inspection of the Bones, Muscles,
Inspection of the Chest 190 and Joints 204
Shape of the Chest 190, Chest Palpation of the Bones, Muscles,
Circumference 190, Chest Movement and and Joints 204
Respiratory Effort 190, Respiratory Rate 191 Range of Motion and Muscle Strength 204
Palpation of the Chest 191 Active Range of Motion 204,
Chest Wall 191, Tactile Fremitus 191 Passive Range of Motion 204,
Auscultation of the Chest 191 Muscle Strength 204
Breath Sounds 192, Vocal Resonance 192, Posture and Spinal Alignment 204
Abnormal Breath Sounds 193, Abnormal Voice Inspection of the Upper Extremities 204
Sounds 193
Inspection of the Lower Extremities 205
Percussion of the Chest 193 Hips 205, Legs 206
Assessing the Breasts 193 Assessing the Nervous System 206
Inspection 193 Cognitive Function 206
Palpation 193 Behavior 206, Communication Skills 207,
Assessing the Heart 193 Memory 207, Level of Consciousness 207
Inspection of the Precordium 193 Cerebellar Function 207
Palpation of the Precordium 194 Balance 207, Coordination 207, Gait 208
Apical Impulse 194, Abnormal Sensations 194 Sensory Function 208
Percussion of the Heart Borders 194 Superficial Tactile Sensation 208, Superficial Pain
Auscultation of the Heart 194 Sensation 208
Heart Rate and Rhythm 194, Differentiation of Heart Cranial Nerve Function 208
Sounds 195, Splitting of the Heart Sounds 195, Infant Primitive Reflexes 210

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xix C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
xx  Contents

Superficial and Deep Tendon Reflexes 210 At Birth 254

Superficial Reflexes 212, Deep Tendon Assessment of Risk and Protective
Reflexes 212 Factors 255
Analyzing Data from the Physical Newborn Visit Following Hospital
Examination 213 Discharge 257
Routine Health Supervision
Newborn Assessment 214 Visits 257
Newborn Transition 214
Assessment at Birth 214 General Observations 257
Assessment of the Newborn 214 Growth and Developmental
Gestational Age Assessment 215, Size for Surveillance 258
Gestational Age 219, General Appearance 220, At Birth 258
Vital Signs 220, Skin 220, Head 221, Assessing Growth and Development
Eyes 222, Ears 223, Nose 223, Mouth 223, in the Outpatient Setting 259
Neck 223, Chest and Lungs 223, Heart 223,
Abdomen 224, Genitalia and Anus 224, Nutrition 260
Extremities 224, Neurologic System 225 Breastfeeding 260
Formula Feeding 262
Physical Activity 263
UNIT III Oral Health 263
Mental and Spiritual Health 263
Health Promotion and Maintenance Promoting Maternal Mental Health 264
Through Childhood 228 Promoting Newborn Mental Health 264
Relationships 267
Chapter 8 Disease Prevention Strategies 269
Concepts of Health Promotion Injury Prevention Strategies 270
and Maintenance 229 Nursing Management 270
Definitions of Health Promotion
Chapter 10
and Maintenance 230
Health Promotion and Maintenance
Application of Resilience and Ecologic
of the Infant 275
Theories 231
Health Supervision in the Pediatric Early Contacts with the Family 276
Healthcare Home 234 General Observations 276
Components of Health Promotion Growth and Developmental
and Maintenance Visits 236 Surveillance 277
Contacts with the Family 237 Nutrition 279
General Observations 237 Physical Activity 280
Growth and Developmental
Surveillance 237 Oral Health 281
Nutrition 239 Mental and Spiritual Health 282
Physical Activity 240 Relationships 284
Oral Health 241 Family 284
Mental and Spiritual Health 241 Social Interactions 286
Relationships 244 Disease Prevention Strategies 286
Disease Prevention Strategies 244
Injury Prevention (Safety) Strategies 246 Injury Prevention Strategies 288
Additional Topics 247 Nursing Management 288
Nursing Management 247
Chapter 11
Chapter 9 Health Promotion and Maintenance
Health Promotion and Maintenance of the Toddler and Preschooler 295
of the Newborn 252
General Observations 296
Early Contacts with the Family 253 Growth and Developmental
Prenatal 253
Surveillance 297
Prenatal Assessment of Risk and Protective
Factors 253 Nutrition 299

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xx C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
 Contents  xxi

Physical Activity 301

Oral Health 302
UNIT IV
Mental and Spiritual Health 304 Child Healthcare Settings
Relationships 307 and Considerations 358
Disease Prevention Strategies 309
Injury Prevention Strategies 311 Chapter 14
Nursing Management 314 Nursing Care of the Child in the Community 359
Chapter 12 Community-Based Health Care 360
Characteristics of Community-Based Health
Health Promotion and Maintenance
Care 360
of the School-Age Child 319
Roles of Nurses in Community Settings 361
General Observations 320 Role of the Pediatric Nurse in an Office or Health
Growth and Developmental Center Setting 361
Surveillance 321 Identifying Severely Ill and Injured Children 361,
Telephone Advice 362, Educating the Child and
Nutrition 322 Family 362, Identifying Community Resources 363,
Physical Activity 324 Ensuring a Safe Environment for Children 363
Oral Health 326 Role of the Pediatric Nurse in a Hospital
Outpatient Setting 363
Mental and Spiritual Health 326 Specialty Care Ambulatory Clinics 363, Urgent Care
Self-Concept 326 or Emergency Department Settings 364
Sexuality 328 Role of the Nurse in a School Setting 364
Sleep 328 Community Health Focus 367, School-Based Health
School 328 Centers 367, Preparation for Emergencies 367,
Mental Health Disorders 329 Children with Special Healthcare Needs 368,
Spiritual Health 329 Facilitating the Child’s Return to School 369
Nursing Role 329 Nursing in Childcare Settings 369
Reducing Disease Transmission 370, Health
Relationships 329
Promotion 370, Environmental Safety 370,
Disease Prevention Strategies 330 Care for Children with Illnesses 370, Emergency
Injury Prevention Strategies 332 Care Planning 370
Nursing Management 334 Other Community Settings 371
Role of the Nurse in Camp Settings 371
Chapter 13 Home Healthcare Nursing 371
Characteristics of Children in Home Care
Health Promotion and Maintenance Services 372, Role of the Pediatric Nurse in Home
of the Adolescent 340 Care 372
General Observations 341 Nursing Management 372
Community Health Nursing 374
Growth and Developmental
Emergency Care Planning 377
Surveillance 342
Emergency Medical Services for Children 377
Nutrition 343 Important Pediatric Physiologic Differences 377
Physical Activity 346 Disaster Preparedness 378
Oral Health 347 Clinical Manifestations 379, Clinical Therapy 379
Nursing Management 380
Mental and Spiritual Health 347
Self-Concept 347
Sexuality 348 Chapter 15
Sleep 348 Nursing Care of the Hospitalized Child 385
School 349
Mental Health Disorders 349 Effects of Hospitalization on Children and Their
Spiritual Health 349 Families 386
Nursing Role 349 Children’s Understanding of Health and
Relationships 349 Illness 386
Newborn 386, Infant 387, Toddler 389,
Disease Prevention Strategies 351 Preschooler 390, School-Age Child 390,
Injury Prevention Strategies 352 Adolescent 390
Nursing Management 354 Family Responses to Hospitalization 391

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xxi C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
xxii  Contents

Siblings’ Experience 391 Parental Reaction 421

Family Assessment 392 Siblings’ Reactions 421
Nurse’s Role in the Child’s Adaptation to Stressors on the Family 421
Hospitalization 393 Caregiver Burden 422
Planned Hospitalization 393 Maltreatment of the Child with a Chronic
Unexpected Hospitalization 394 Condition 422
Nursing Care of the Hospitalized Child 394 Family Financial Issues 422
Special Units and Types of Care 394 Promoting Healthy Family
General Pediatric Care Unit 395, Short-Stay, Coping 423
Outpatient, and Ambulatory Surgical Units 395, The Child with a Chronic Condition 424
Emergency Care 395, Intensive Care Unit 396, Developmental Considerations 424
Isolation 396, Rehabilitation 396 Newborn and Infant 424, Toddler 424,
Parental Involvement and Parental Presence 397 Preschooler 425, School-Age Child 425,
Preparation for Procedures 397 Adolescent 425
Psychologic Preparation 397, Physical Education and Schooling 426
Preparation 397 Educational System Planning 426, The Child’s
Performing the Procedure 399 Response to Entering School 427, Education
Preparation for Surgery 400 for Children Who Are Medically Fragile 427,
Preoperative Care 404 Homeschooling 428
Psychosocial Preparation 404, Parental Presence Transition to Adulthood 428
During Anesthesia Induction 404, Physical Collaborative Care 429
Preparation 404 Hospitalization 429, Ethical Issues 429,
Postoperative Care 405 Transition Between Hospital and
Postoperative Home Care Instructions 406 Home 429, Health Promotion and Health
Maintenance of Children with Chronic
Strategies to Promote Coping and Normal Conditions 430
Development of the Hospitalized Child 406 Nursing Management 430
Rooming In 406
Nurse’s Reactions to Care of Children
Child Life Programs 406
Therapeutic Play 407 with a Chronic Condition 436
Newborn and Infant 408, Toddler 408,
Preschooler 408, School-Age Child 409, Chapter 17
Adolescent 409 Nursing Care of the Child with a Life-
Strategies to Meet Educational Threatening Illness or Injury 440
Needs 410
Child and Family Teaching 411, Teaching Life-Threatening Illness or Injury 441
Plans 411, Teaching for Children with Special Settings Encountered by Children
Healthcare Needs 412
with a Life-Threatening Condition 441
Preparation for Home Care 412 Emergency Department 441
Assessing the Child and Family in Preparation Pediatric Intensive Care Unit 442
for Discharge 412 Neonatal Intensive Care Unit 442
Preparing the Child and Family for Discharge 413
Child’s Experience of a Life-Threatening Illness
Preparing the Child and Family for Home Health
or Injury 443
Care 413
Coping Mechanisms 443
Preparing the Child and Family for Long-Term
Nursing Management 444
Care or Rehabilitation 413
Parents’ Experience of a Child’s
Life-Threatening Illness or
Chapter 16
Injury 446
Nursing Care of the Child with a Chronic The Family in Crisis 446
Condition 417 Parental Reactions to Life-Threatening Illness
or Injury 447
General Concepts in the Care of a Child
Shock and Disbelief 447, Anger and
with a Chronic Condition 418 Guilt 448, Deprivation and Loss 448,
Overview of Chronic Conditions 418 Anticipatory Waiting 448, Readjustment or
The Family of a Child with a Chronic Mourning 448
Condition 419 Nursing Management 448
Informing the Parents 419 The Siblings’ Experience 453
Informing the Child 421 Nursing Management 453

DESIGN SERVICES OF
# 108438   Cust: Pearson   Au: Ball  Pg. No. xxii C/M/Y/K
Title: Child Health Nursing   Server: Short / Normal
S4carlisle
Publishing Services
Another random document with
no related content on Scribd:
Urban II, Pope, 305
Usury, 155

Veracity, fostered by science, 353

Vergil, 235
Vicarious suffering, doctrine of, 160

Wager of battle, 304;

disuse of, 331, 332
War, abolition of, a moral issue, 376;
abrogation of the ordinary moral code by, 377;
obsolescence of, as school of morals, 380
War ethics, as group morality, 20;
as survival from barbarism, 20;
beginning of rules of, 25–29;
Egyptian, 42;
Assyrian, 51;
Chinese, 65;
Brahmanic, 104;
Greek, 193–195;
Roman, 245 n. 1;
Mohammedan, 290, 294;
syncretism of pagan war ethics and Christian peace ethics,
300–306;
influence of martial ethics of Islam upon Christian ethics, 305;
progress in, in Middle Ages, 314–316;
progress in, in modern times, 375, 376;
atavistic character of war code, 378;
unfavorable reaction of, upon peace code, 378–380
Wealth, moral effects of unequal distribution of, 228
Wedgwood, Julia, 9
Wellhausen, 3
Wisdom, Greek virtue of, 176
World state, ethical basis of, 220
Wundt, Wilhelm, 5
Zarathustra, 126
Zeno, 206
Zoroaster, see Zarathustra
 Transcriber’s Notes
Punctuation, hyphenation, and spelling were made
consistent when a predominant preference was found in the
original book; otherwise they were not changed.
Simple typographical errors were corrected; unbalanced
quotation marks were remedied when the change was
obvious, and otherwise left unbalanced.
Footnotes, originally at the bottoms of the pages that
referenced them, have been collected, sequentially
renumbered, and placed at the end of the main text, just
before the Index.
The Index was not checked for proper alphabetization or
correct page references.
Page 159: “the good Osiris” was printed that way, but may
be a misprint for “the god Osiris”.
*** END OF THE PROJECT GUTENBERG EBOOK HISTORY AS
PAST ETHICS; AN INTRODUCTION TO THE HISTORY OF
MORALS ***

Updated editions will replace the previous one—the old editions

will be renamed.

Creating the works from print editions not protected by U.S.

copyright law means that no one owns a United States copyright
in these works, so the Foundation (and you!) can copy and
distribute it in the United States without permission and without
paying copyright royalties. Special rules, set forth in the General
Terms of Use part of this license, apply to copying and
distributing Project Gutenberg™ electronic works to protect the
PROJECT GUTENBERG™ concept and trademark. Project
Gutenberg is a registered trademark, and may not be used if
you charge for an eBook, except by following the terms of the
trademark license, including paying royalties for use of the
Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is
very easy. You may use this eBook for nearly any purpose such
as creation of derivative works, reports, performances and
research. Project Gutenberg eBooks may be modified and
printed and given away—you may do practically ANYTHING in
the United States with eBooks not protected by U.S. copyright
law. Redistribution is subject to the trademark license, especially
commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE
 PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the

free distribution of electronic works, by using or distributing this
work (or any other work associated in any way with the phrase
“Project Gutenberg”), you agree to comply with all the terms of
the Full Project Gutenberg™ License available with this file or
online at www.gutenberg.org/license.

Section 1. General Terms of Use and

Redistributing Project Gutenberg™
electronic works
1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand,
agree to and accept all the terms of this license and intellectual
property (trademark/copyright) agreement. If you do not agree to
abide by all the terms of this agreement, you must cease using
and return or destroy all copies of Project Gutenberg™
electronic works in your possession. If you paid a fee for
obtaining a copy of or access to a Project Gutenberg™
electronic work and you do not agree to be bound by the terms
of this agreement, you may obtain a refund from the person or
entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only

be used on or associated in any way with an electronic work by
people who agree to be bound by the terms of this agreement.
There are a few things that you can do with most Project
Gutenberg™ electronic works even without complying with the
full terms of this agreement. See paragraph 1.C below. There
are a lot of things you can do with Project Gutenberg™
electronic works if you follow the terms of this agreement and
help preserve free future access to Project Gutenberg™
electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the
collection of Project Gutenberg™ electronic works. Nearly all the
individual works in the collection are in the public domain in the
United States. If an individual work is unprotected by copyright
law in the United States and you are located in the United
States, we do not claim a right to prevent you from copying,
distributing, performing, displaying or creating derivative works
based on the work as long as all references to Project
Gutenberg are removed. Of course, we hope that you will
support the Project Gutenberg™ mission of promoting free
access to electronic works by freely sharing Project
Gutenberg™ works in compliance with the terms of this
agreement for keeping the Project Gutenberg™ name
associated with the work. You can easily comply with the terms
of this agreement by keeping this work in the same format with
its attached full Project Gutenberg™ License when you share it
without charge with others.

1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside
the United States, check the laws of your country in addition to
the terms of this agreement before downloading, copying,
displaying, performing, distributing or creating derivative works
based on this work or any other Project Gutenberg™ work. The
Foundation makes no representations concerning the copyright
status of any work in any country other than the United States.

1.E. Unless you have removed all references to Project

Gutenberg:

1.E.1. The following sentence, with active links to, or other

immediate access to, the full Project Gutenberg™ License must
appear prominently whenever any copy of a Project
Gutenberg™ work (any work on which the phrase “Project
Gutenberg” appears, or with which the phrase “Project
Gutenberg” is associated) is accessed, displayed, performed,
viewed, copied or distributed:

This eBook is for the use of anyone anywhere in the United

States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it
away or re-use it under the terms of the Project Gutenberg
License included with this eBook or online at
www.gutenberg.org. If you are not located in the United
States, you will have to check the laws of the country where
you are located before using this eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is

derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of the
copyright holder), the work can be copied and distributed to
anyone in the United States without paying any fees or charges.
If you are redistributing or providing access to a work with the
phrase “Project Gutenberg” associated with or appearing on the
work, you must comply either with the requirements of
paragraphs 1.E.1 through 1.E.7 or obtain permission for the use
of the work and the Project Gutenberg™ trademark as set forth
in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is

posted with the permission of the copyright holder, your use and
distribution must comply with both paragraphs 1.E.1 through
1.E.7 and any additional terms imposed by the copyright holder.
Additional terms will be linked to the Project Gutenberg™
License for all works posted with the permission of the copyright
holder found at the beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project

Gutenberg™ License terms from this work, or any files
containing a part of this work or any other work associated with
Project Gutenberg™.
 1.E.5. Do not copy, display, perform, distribute or redistribute
this electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1
with active links or immediate access to the full terms of the
Project Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if
you provide access to or distribute copies of a Project
Gutenberg™ work in a format other than “Plain Vanilla ASCII” or
other format used in the official version posted on the official
Project Gutenberg™ website (www.gutenberg.org), you must, at
no additional cost, fee or expense to the user, provide a copy, a
means of exporting a copy, or a means of obtaining a copy upon
request, of the work in its original “Plain Vanilla ASCII” or other
form. Any alternate format must include the full Project
Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,

performing, copying or distributing any Project Gutenberg™
works unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or

providing access to or distributing Project Gutenberg™
electronic works provided that:

• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
 about donations to the Project Gutenberg Literary Archive
Foundation.”

• You provide a full refund of any money paid by a user who

notifies you in writing (or by e-mail) within 30 days of receipt that
s/he does not agree to the terms of the full Project Gutenberg™
License. You must require such a user to return or destroy all
copies of the works possessed in a physical medium and
discontinue all use of and all access to other copies of Project
Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of

any money paid for a work or a replacement copy, if a defect in
the electronic work is discovered and reported to you within 90
days of receipt of the work.

• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project

Gutenberg™ electronic work or group of works on different
terms than are set forth in this agreement, you must obtain
permission in writing from the Project Gutenberg Literary
Archive Foundation, the manager of the Project Gutenberg™
trademark. Contact the Foundation as set forth in Section 3
below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend

considerable effort to identify, do copyright research on,
transcribe and proofread works not protected by U.S. copyright
law in creating the Project Gutenberg™ collection. Despite
these efforts, Project Gutenberg™ electronic works, and the
medium on which they may be stored, may contain “Defects,”
such as, but not limited to, incomplete, inaccurate or corrupt
data, transcription errors, a copyright or other intellectual
property infringement, a defective or damaged disk or other
medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES -

Except for the “Right of Replacement or Refund” described in
paragraph 1.F.3, the Project Gutenberg Literary Archive
Foundation, the owner of the Project Gutenberg™ trademark,
and any other party distributing a Project Gutenberg™ electronic
work under this agreement, disclaim all liability to you for
damages, costs and expenses, including legal fees. YOU
AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE,
STRICT LIABILITY, BREACH OF WARRANTY OR BREACH
OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH
1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER
THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR
ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE
OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF
THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If

you discover a defect in this electronic work within 90 days of
receiving it, you can receive a refund of the money (if any) you
paid for it by sending a written explanation to the person you
received the work from. If you received the work on a physical
medium, you must return the medium with your written
explanation. The person or entity that provided you with the
defective work may elect to provide a replacement copy in lieu
of a refund. If you received the work electronically, the person or
entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund.
If the second copy is also defective, you may demand a refund
in writing without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set

forth in paragraph 1.F.3, this work is provided to you ‘AS-IS’,
WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS
OR IMPLIED, INCLUDING BUT NOT LIMITED TO
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR
ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied

warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this
agreement violates the law of the state applicable to this
agreement, the agreement shall be interpreted to make the
maximum disclaimer or limitation permitted by the applicable
state law. The invalidity or unenforceability of any provision of
this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the

Foundation, the trademark owner, any agent or employee of the
Foundation, anyone providing copies of Project Gutenberg™
electronic works in accordance with this agreement, and any
volunteers associated with the production, promotion and
distribution of Project Gutenberg™ electronic works, harmless
from all liability, costs and expenses, including legal fees, that
arise directly or indirectly from any of the following which you do
or cause to occur: (a) distribution of this or any Project
Gutenberg™ work, (b) alteration, modification, or additions or
deletions to any Project Gutenberg™ work, and (c) any Defect
you cause.

Section 2. Information about the Mission of

Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new
computers. It exists because of the efforts of hundreds of
volunteers and donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the

assistance they need are critical to reaching Project
Gutenberg™’s goals and ensuring that the Project Gutenberg™
collection will remain freely available for generations to come. In
2001, the Project Gutenberg Literary Archive Foundation was
created to provide a secure and permanent future for Project
Gutenberg™ and future generations. To learn more about the
Project Gutenberg Literary Archive Foundation and how your
efforts and donations can help, see Sections 3 and 4 and the
Foundation information page at www.gutenberg.org.

Section 3. Information about the Project

Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-
profit 501(c)(3) educational corporation organized under the
laws of the state of Mississippi and granted tax exempt status by
the Internal Revenue Service. The Foundation’s EIN or federal
tax identification number is 64-6221541. Contributions to the
Project Gutenberg Literary Archive Foundation are tax
deductible to the full extent permitted by U.S. federal laws and
your state’s laws.

The Foundation’s business office is located at 809 North 1500

West, Salt Lake City, UT 84116, (801) 596-1887. Email contact
links and up to date contact information can be found at the
Foundation’s website and official page at
www.gutenberg.org/contact

Section 4. Information about Donations to

the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission
of increasing the number of public domain and licensed works
that can be freely distributed in machine-readable form
accessible by the widest array of equipment including outdated
equipment. Many small donations ($1 to $5,000) are particularly
important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws

regulating charities and charitable donations in all 50 states of
the United States. Compliance requirements are not uniform
and it takes a considerable effort, much paperwork and many
fees to meet and keep up with these requirements. We do not
solicit donations in locations where we have not received written
confirmation of compliance. To SEND DONATIONS or
determine the status of compliance for any particular state visit
www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states

where we have not met the solicitation requirements, we know
of no prohibition against accepting unsolicited donations from
donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot

make any statements concerning tax treatment of donations
received from outside the United States. U.S. laws alone swamp
our small staff.

Please check the Project Gutenberg web pages for current

donation methods and addresses. Donations are accepted in a
number of other ways including checks, online payments and
credit card donations. To donate, please visit:
www.gutenberg.org/donate.

Section 5. General Information About Project

Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could
be freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose
network of volunteer support.

Project Gutenberg™ eBooks are often created from several

printed editions, all of which are confirmed as not protected by
copyright in the U.S. unless a copyright notice is included. Thus,
we do not necessarily keep eBooks in compliance with any
particular paper edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg
Literary Archive Foundation, how to help produce our new
eBooks, and how to subscribe to our email newsletter to hear
about new eBooks.