PEDS Practice: Chapter 1 Introduction to Child Health and Pediatric Nursing

In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries?

Low birth weight Many factors may be associated with high infant mortality rates and poor health. Low birth weight and late or nonexistent prenatal care are the main factors in the poor rankings in infant mortality.

The parents of a child receiving chemotherapy for leukemia notice "certified pediatric hematology/oncology nurse" on the nurse's name badge. The parents ask the nurse about this. What is the best response by the nurse?

"This certifies that I have specialized in the field of oncology/hematology care of children." While all statements may be accurate, the statement that best defines the certification, "This certification represents specialized learning that I have in the field of oncology/hematology care of children," also ensures the parents that the nurse is not just obtaining this certification for job requirements or a pay increase, but that the nurse is best prepared to care for their child.

The school nurse is calculating the morbidity rate of an elementary school's absenteeism related to a highly communicable infection that has been present in the school over the last two weeks. Today the school has 127 of its 300 students absent. What is the morbidity rate that the nurse will report?

42.3

The nurse is caring for a child who underwent an appendectomy 12 hours ago. The child has reported incisional pain. When the nurse attempts to administer the prescribed analgesic the child's mother declines the medication. What initial action by the nurse is most appropriate?

Ask the child's mother to elaborate on her concerns about the medication. Some people may not approve of the administration of narcotics or medications containing alcohol. The nurse must first determine the cause of the concern. Then action can be taken to best provide care to the child. Continuing observation of the child does not address the needs related to pain management. Although the client's physician or the nursing supervisor may be contacted, it is not the initial action in this scenario.

The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained?

Determining the mother cannot read the form It would not be legal for this mother to give consent. A mother younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The physician or nurse could read the consent form to a mother who cannot read plus carefully explain the medical information in terms she understood.

Morbidity rates among children are most highly associated with which cause?

Environmental factors The factors most commonly associated with child morbidity are environmental and socioeconomic problems. The more difficult the societal issues and the more marked the environmental poverty, the higher the illness rates and childhood morbidity. Firearms, violence in schools, homicide, and suicide are all factors in morbidity, but they are not strictly related to children.

What is a current trend in child health care?

Health promotion rather than health restoration is stressed. It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.

The nurse is assessing a 9-year-old boy with pneumonia. Which finding is a factor for this child's morbidity?

Medical records reveal a history of asthma Asthma is a morbidity factor for additional childhood illness, particularly respiratory illness. The child's height and weight are appropriate and not associated with increased risk. The normal WBC count may help to determine if the pneumonia is bacterial or viral. Being in a Boy Scout troop may increase the risk of exposure, but would not be as closely associated with morbidity as is asthma.

The nurse is reviewing documentation on a client's chart. The physician has referred to parens patriae. When considering this notation, what should be included in the client's plan of care?

Recognize the child's care has been ordered by the state. Generally the parents of a minor child have the right to make care decisions. In the event the parents have decided on a course of nontreatment, the state may intervene and overrule the parents. In this case an order for treatment to continue can be made by the courts. This is referred to as parens patriae (the state has a right and a duty to protect children).

The nurse is focusing on health promotion for a 6-year-old girl. Which intervention best supports Healthy People goals?

Recommending a helmet for biking Recommending that the child wear a protective helmet best supports the goals of Healthy People because unintentional injury remains a leading cause of mortality and morbidity for children. Proper diet, adequate sleep, and after-school child care are important but do not affect child health status as much as injury prevention does.

The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which teaching subject best supports the emphasis on preventive care?

Showing the mother how to teach hand washing to her child. Teaching hand washing helps to prevent infection, emphasizes preventive care, and is basic to avoiding many common illnesses. Reminding the mother that the child will imitate her may promote safe parental role-modeling but does not reach the level of prevention that hand washing does. Knowing about developmental milestones and typical physical changes in toddlers does not directly promote preventive care.

The nurse is advised in the change of shift report that a child on the unit is considered a "mature minor". What criteria must this child meet to be considered in this role?

The child must have the maturity to understand the information provided related to his condition and planned course of treatment. In some states, a mature minor may give consent to certain medical treatment. The physician must determine that the adolescent (usually older than 14 years of age) is sufficiently mature and intelligent to make the decision for treatment. The provider also considers the complexity of the treatment, its risks and benefits, and whether the treatment is necessary or elective before obtaining consent from a mature minor.

The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group?

The importance of crossing streets safely Motor-vehicle accidents are a leading cause of death in this age group. p 10

What was the primary goal for the establishment of the Children's Bureau?

To improve the standards of health care he establishment of the Children's Bureau in 1912 began a period of studying economic and social factors related to infant mortality, infant care in rural areas, and other factors related to children's health. The goal of these legislative efforts was to improve the standards of health care.

The nurse provides soy milk and fresh vegetables to a pregnant woman who is single, and the mother of a toddler. Which federal program is the nurse implementing?

WIC Food Package Revised WIC Food Package Revised was designed to improve nutritional intake of the original WIC program (1966/1974) by supporting and promoting long-term breastfeeding and adding fruits and vegetables, whole grains, soy-based foods and a variety of culturally appropriate foods to recipients. In 1921 the Maternity & Infancy (Sheppard-Towner) Act provided grants to states to establish maternal and child health divisions in state health departments. Expansion of Lunch & Nutrition Act provides food for low income school age children year round along with low income children in daycare and Head Start programs. The No Child Left Behind Act of 2002 was enacted to ensure that all children in all classrooms have a research-based curriculum, well-prepared teachers, and a safe learning environment.

A nurse is considering employment in a practice that promotes family-centered care. When considering this position, the nurse recognizes that this philosophy will:

promote the involvement of the child and parents as members of the health care team. Family-centered care involves a mutually beneficial partnership between the child, the family, and health care professionals. It applies to the planning, delivery, and evaluation of health care for children of all ages in any setting.

In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the:

family. The family is the basic system in which health behavior and care are organized, secured, and performed. In most families, the parents or guardians, as advocates for their child, provide health promotion and health prevention care, as well as primary management of care when the child is sick. Parents and guardians have the prime responsibility for initiating and coordinating services rendered by health professionals.

The nurse is caring for a 16-year-old female who has been brought to the clinic by her mother seeking information about contraceptives. What action by the nurse will best promote the client's autonomy?

After a review of suitable contraceptive options, ask the client which is of the greatest interest. Autonomy refers to self determination and inclusion in decision making. Sharing information and allowing the teen to participate will promote autonomy. Encouraging the decision to be made by the teen does not embrace the decision making abilities of the teen. A discussion on abstinence is appropriate for inclusion but does not promote autonomy or address the reason for seeking health care.

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because:

increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Advances in health care have led to more children living with chronic illness or disability. The statements about genetic disease and older women may contain some truth but have only added a few people to the chronic illness total. Acute care pediatric nursing positions are decreasing in community hospitals but are more available in medical centers. Uninsured families may or may not be able to access nonhospital care. pg 6

A 17-year-old has been diagnosed with HIV. When developing the plan of care, which initial action should be included?

Notify the local health department of the individual's HIV status. The legal notification the local health department is mandated for certain communicable diseases. HIV is included in this category. Listing the sexual contacts and notifying them is the responsibility of the health authorities, not the individual clinic or office. Contacting the CDC will rest with the local health department.

A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating health care?

Parents Parents and guardians have the primary responsibility for initiating and coordinating services rendered by health professionals. A social worker or case manager may be involved but are not primarily responsible for the child's care. The community provides programs to promote and support children's health. pg 17

The nurse is caring for a 5-year-old girl with meningitis. What action by the nurse may be considered ethical behavior?

Starting intravenous fluids even though the child protests Ignoring the child's dissent regarding proposed therapy is ethically sound. The treatment will benefit the child, and at 5 years of age the decision maker is nearly always the parent or legal guardian. However, the nurse must use developmentally appropriate techniques to inform the child about the therapy and to carry it out. Telling her an intramuscular injection won't hurt lacks veracity. Referring to the girl as "her" when she is present shows disrespect. Scheduling a laboratory procedure at lunchtime is unfair to the child and lacks justice.

A student nurse shares an interest in pediatric nursing. When discussing her thoughts about pediatric nursing, which statements are consistent with the philosophies of pediatric nursing care? Select all that apply.

"I believe the family should be included in all aspects of the plan of care and treatment." "Since health care can be scary for a child, it's important to make them feel secure." "The child should be included as much as possible in the plan of care." The three general concepts that form the philosophy of pediatric nursing care are family-centered care, atraumatic care, and evidence-based care. Pediatric nurses use these three concepts to provide quality, cost-effective care that is continuous, comprehensive, and compassionate.

A newly hired nurse is receiving education about the role of the facility's ethics committee during the orientation period. Which statements indicate an understanding of the role of this group? Select all that apply.

"This group will review each case presented and formulate a decision for the facility." "Education concerning ethics is a role of the committee." "The role of the ethics committee has increased over the years." Ethics committees are formulated to assist a facility in making ethical decisions. These committees not only provide case-by-case review and resolution of ethical dilemmas but also review existing institutional policies and provide education to staff, physicians, children, and families on ethical issues. As technology has advanced, ethical dilemmas have increased and made the role of the committees more important over time.

A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking?

"We had to sign the form right away so the surgery could get scheduled." The statement about signing the form right away suggests that the family was coerced into agreeing to the surgery without being fully informed about the risks and benefits. The key ethical issues related to informed consent for treatment have similarities to those required for research participation: Consent must be voluntary and based upon shared information about the risks and benefits of the treatment. Furthermore, the parent must understand the information and be cognitively and mentally competent to make the decision. The statements about risks, activity limitations, and postoperative care indicate that information was shared with them and that they understood it.

The parents of a child on a pediatric unit are concerned with the plan of care the physician has provided. The parents ask the nurse if they may seek a second opinion if they are not in agreement with the plan of care. How should the nurse respond?

"You can always seek a second opinion if not in agreement with the current plan of care." As a child and family advocate, the nurse safeguards and advances the interests of children and their families by knowing their needs and resources, informing them of their rights and options, and assisting them to make informed decisions. The nurse in this situation has listened to the concerns of the parents and provided information to help assist them to make an informed decision about seeking a second opinion.

Which child represents an increasingly common pediatric medical scenario currently present in the United States?

9-year-old girl diagnosed with type 2 diabetes The incidence of diabetes is rising in the United States. This is not noted to be the case with congenital anomalies, trauma or lymphoma.

The nurse is providing care to a 6-year-old child following surgery. The nurse asks the child to rate the pain using the Faces of Pain scale. Which phase of the nursing process is the nurse demonstrating?

Assessment

A nurse is providing care to a child on an oncology unit. The nurse is both administering chemotherapy to the child and teaching the parents about the actions, side effects, and complications of the drug. These actions best describe which nursing role?

Clinical nurse specialist The clinical nurse specialist has a master's degree and provides expertise as an educator, clinician, or researcher, meeting the needs of staff, children, and families, as demonstrated in this scenario by both administering and providing information regarding the chemotherapy. The clinical coordinator typically holds a baccalaureate degree and fills a leadership role in a variety of settings. The case manager, also usually a baccalaureate-prepared nurse, is responsible for integrating care from before admission to after discharge. The pediatric nurse practitioner provides health maintenance care for children (such as well-child examinations and developmental screenings) and diagnoses and treats common childhood illnesses. He or she manages children's health in primary, acute, or intensive care settings or provides long-term management of the child with a chronic illness.

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

Facilitating return to school by working with the school nurse Much of an adolescent's life revolves around school and peers. In helping the teen return to school and friends, the nurse and the school nurse are achieving continuity of care and a supportive environment for healing. Teaching the mother cast care addresses the mother's learning needs and the teaching role of the nurse. Discussing driving safety with the teen is important and a factor in many adolescent injuries and deaths but is not a management activity. Changing dressings is a direct care activity of the nurse. pg 14

Following the discharge of a child who has a chronic health condition from the hospital, the nurse case manager follows up with a visit to the home and meets with the family and child. This visit best represents which philosophy of pediatric nursing?

Family-centered care The home visit by the case manager to some degree meets principles of each type of care, but is most representative of family-centered care because family-centered care is described as a mutually beneficial partnership between the child, the family, and health care professionals.

The school nurse is caring for several children who witnessed an 8-year-old girl get hit by car on the way to school. Which intervention is least important to the nursing plan of care for these children?

Making phone calls to the parents of the children counseled Making phone calls to the parents of the children who were determined to need counseling is least important to the nursing plan of care. It is, no doubt, mandatory for the nurse to inform and support the parents. However, this intervention is the least important based on the nursing diagnosis of the children's need for counseling, the intervention to arrange for a counselor, and the adaptation of the intervention by providing counseling for the friends of the injured child.

The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct. pg 18

The nurse is caring for a child who is scheduled to begin chemotherapy. When planning education for the parents what action by the nurse is most correct?

Obtain a small conference room and arrange the chairs in a circle for both the nurse and family members to sit. Teaching is an important function of the nurse. When providing the education, it is important to offer the information in an environment that is conducive to learning. A circular set of chairs will allow the nurse to face the parents during the exchange. A large class that has the nurse standing and the parents sitting does not provide the ability for a personal interaction needed for this session. Giving the parents information in writing should be done in conjunction with a face-to-face teaching session. Video information may be beneficial but does not replace the the face-to-face teaching session.

To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?

Teach injury prevention and proper safety practices. The leading cause of death throughout childhood is unintentional injury. pg 15

The public health nurse is conducting a clinic to help identify those children who are most at risk of becoming obese due to poor nutrition. Which children does the nurse correctly identify as being at a high risk? Select all that apply.

The child whose guardians are elderly grandparents living in senior government housing The child whose father and mother earn minimum wage at their jobs and have 3 younger siblings The child with 2 younger siblings whose father is single and has been out of work for 6 month Certain health concerns, such as poor nutrition, obesity, infections, lead poisoning, and asthma, affect poor children at higher rates and with greater severity than affluent and middle-class children. The child with elderly grandparents living in government housing, parents working for minimum wage, and a father unemployed for 6 months pose a high risk of obesity due to the likelihood of poor nutrition from the financial situation. pg 14

During the weekly team meetings, the physician and case manager discuss the client's planned assent. What activity should the nurse most anticipate?

The client will have a conference with the physician about the planned course of care and treatment. Assent means agreeing to something. In pediatric health care, the term assent refers to the child's participation in the decision-making process about health care. As a child gets older assent or dissent should be given more serious consideration. The pediatric client needs to be empowered by physicians to the extent of his or her capabilities, and as the child matures and develops over time the client should become the primary decision maker regarding his or her health care.

A group of students are reviewing information about Medicaid. Which statement shows inadequate knowledge of the topic?

The federal government is responsible for administering it. Medicaid is a form of health insurance for low-income and disabled individuals. It is financed by federal and state funds and administered by the states. Medicaid is not a direct provider of service, but rather provides compensation for health care services. Federal guidelines define the scope of basic services, the extent of coverage, and certain administrative requirements. The states administer the program and determine income eligibility criteria, specific services to be covered, and payment levels and methods. pg 8

According to the pediatric patient's Bill of Rights, the nurse manager should privately counsel a staff nurse to change their behavior in which of these situations? Select all that apply.

The nurse manager hears the staff nurse call the patient "kiddo." The nurse manager hears the parents ask the name of the surgeon that has been consulted and the staff nurse responding, "I'm not sure, it's best if you ask your doctor." A patient's Bill of Rights helps to ensure that the patient's needs are being met in an ethical and legal manner. The staff nurse calling the child "kiddo" and not informing the parents of a child the name of the care provider consulted violates the bill of rights, requiring counseling my the nurse manager.

The quality assurance nurse in a hospital is evaluating the care provided on a pediatric surgical unit. When evaluating if the nurses on the unit are using best evidence-based practice guidelines, the nurse questions which actions by the nursing staff on the pediatric surgical unit? Select all that apply

The nurse performs hand hygiene using alcohol-based hand gel before and after performing a physical assessment on a child. The nurse performs hand hygiene using soap and water prior to charting in the electronic medical record. The nurse takes the child to the sink to perform hand hygiene using soap and water prior to the child eating lunch. The nurse teaches the family to perform hand hygiene before and after changing their child's surgical dressing at home. The nurse asks the family to perform hand hygiene prior to entering the room of the child receiving chemotherapy for cancer treatment. Based on evidence-based practice guidelines for infection control, the nurse demonstrates evidence-based practice interventions in each scenario.

The nurse is working in a pediatric facility whose mission statement strongly emphasizes providing family-centered care. What nursing intervention best exemplifies this facility's belief?

The nurse plans a meeting with the parents, child, and case worker to discuss care alternatives for the child Providing care with an emphasis on a family-centered approach leads to better client outcomes as well as satisfaction with the facility and staff in care provided. Family-centered care involves a mutually beneficial partnership between the child, the family, and health care professionals.

The parents of a 9-year-old agree to allow their child to participate in a research project involving drug trials for a new drug for attention deficit hyperactivity disorder. Which rights of the child are related to beneficence? Select all that apply.

The parents and child are told of the physical and nonphysical risks associated with the research. The parents and child are informed of the possible adverse effects of the research. The parents and child are told of the direct and indirect benefits of participation. For issues related to beneficence, the parents and child should know the risks, adverse effects, and expected benefits of the research. Being fully informed of strategies to safeguard identity is an issue of confidentiality. Knowing they can withdraw at any time is a right of refusal, and knowing whom to contact for information is a basic right.

A child with a serious health condition has been hospitalized to undergo treatments. After a week of treatment the physicians have determined that the child has only weeks to live. What is the most likely initial course of action the nurse can anticipate?

The physician will confer with the parents to outline the severity of the child's condition. When a child is not expected to recover, steps will be taken to review the care being provided. The parents will be told of the expected outlook for the child followed by likely recommendations to discontinue treatment and focus on comfort measures. Although orders may be received to withhold resuscitation, a conference with the parents is indicated first. There is no need at this time to notify the facility's ethics committee

The nurse providing care to the fifth-grade child and his family reviews the nursing care plan, noting that teaching about pubertal changes is one of the individualized interventions. The nurse chooses not to address this. How should the nurse's action be evaluated?

This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. The nurse is not meeting professional role expectations. Implementing the interventions identified in the plan of care is expected. Nurses include families in developing the care plan. This is part of family-centered care. Nurses make clinical decisions but would omit teaching only if data indicated it a wise choice. Sexuality education falls to the school, family, and nurse. pg 14

The client is a 1-year-old girl from a low-income family presenting with a vitamin D deficiency and anemia. What assistance program would you recommend to the child's young mother?

WIC The special supplemental nutrition program for women, infants, and children (WIC) provides services to supply nutritional food to low-income women and their children. SCHIP or CHIP provides health insurance to newborns and children in low-income families who do not otherwise qualify for Medicaid and are uninsured. The Early Childhood Intervention (ECI) program, sponsored by Easter Seals, is available for the child with disabilities or developmental delays. pg 8

Which nursing activity requires the pediatric nurse to implement the ethical principle of nonmaleficence?

Weighing the potential harm caused by a child's chemotherapy with its potential benefits Questions of risks versus benefits often require the care team to examine options in the light of nonmaleficence; that is, the responsibility to avoid undue harm. Encouraging an adolescent to take ownership of her health will likely involve the principle of autonomy. Mediating in a family dispute or providing empathic care is less likely to involve the principle of nonmaleficence. pg 16