CH 1: Introduction to Child Heath and Pediatric Nursing
atraumatic care
The delivery of therapeutic care through the implementation of interventions that eliminate or minimize the psychological and physical distress experienced by children and their families in the health care system.
Definition of nursing
"the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations,"
Childhood mortality:
# of deaths per 1,000 between the ages of 1 & 14
family centered care
A partnership between families, the nurse, and other health professionals in which the priorities and needs of the family are addressed when the family seeks health care; a dynamic, deliberate approach to building collaborative relationships between health professionals and families that are respectful of diversity and beliefs about the nature of the child's condition and ways to manage it.
A single, 18-year-old woman in her second trimester presents at the clinic with vaginal bleeding. She confides to the nurse in confidence that she has been using cocaine to "calm her nerves" and hopes it didn't harm her baby. What would be the nurse's best response to this situation? A) Consult with the health care facility's institutional ethics committee for an appropriate response. B) Tell the doctor about the mother's drug use and ask him to intervene in the situation. C) Refer the mother to a drug and alcohol rehabilitation program and follow up with her recovery. D) Explain the effects of cocaine on the fetus and tell the mother that she must quit for her baby's sake.
A) Consult with the health care facility's institutional ethics committee for an appropriate response. Ethical issues of fetal well-being and treatments arise with debate about the appropriate balance between the maternal and fetal interests. Issues related to problematic behaviors generally revolve around use of illicit drugs and alcohol and their harmful effect on the fetus. These cases are very difficult to resolve successfully, whether the course of action is inside or outside the legal system, and may require consultation with the IEC.
The 5-year-old in the emergency room is having glass removed from a wound. Which action constitutes ethical behavior by the nurse? A) Holding the child's hand in order to facilitate removal of the glass B) Telling the child, "Stop screaming! You are scaring the other kids here!" C) Discussing with the physician the merits of sutures versus staples for wound closure D) Asking the parent to leave the emergency room cubicle due to crowding
A) Holding the child's hand in order to facilitate removal of the glass Restraining the child only as much as is needed in order to provide needed care is practicing ethically while being sensitive to the sanctity and quality of human life. It is practicing nonmaleficence means avoiding causing harm, intentionally or unintentionally. Removing the parent is not just. The child needs the support. Discussing sutures and staples while the child listens harms through fear. Developmentally, the child will misinterpret and not understand. Telling the child not to scream and promoting guilt ("scare others") does not benefit the child. At 5 years of age, he does not have emotional control when hurt. Promoting guilt is inappropriate for the developmental stage (initiative vs. guilt).
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? A) Learning the mother is not the custodial parent B) Finding out the mother is younger than 18 years of age C) Determining the mother cannot read the form D) Establishing the mother was never married
A) Learning the mother is not the custodial parent 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.
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? A) Low birth weight B) Early prenatal care C) Low adolescent delivery rates D) Home deliveries
A) 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 nurse is focusing on health promotion for a 6-year-old girl. Which intervention best supports Healthy People goals? A) Recommending a helmet for biking B) Explaining proper diet in the child's terms C) Discussing needed amount of sleep D) Providing information about after-school child care
A) Recommending a helmet for biking
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? A) Showing the mother how to teach hand washing to her child B) Reminding the mother that the child will imitate her C) Discussing with the mother anticipated developmental milestones D) Describing physical changes taking place in her child
A) 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.
Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because: A) increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. B) uninsured families can access these services. C) there are fewer positions for nurses in institutions providing acute care. D) disability and chronic illness have increased with the appearance of more genetic abnormalities. E) more disabilities are occurring in children because many women are delaying pregnancy and giving birth to babies later in life.
A) 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.
A client care conference is being conducted to discuss withholding life-sustaining care from a terminally ill child. What care can be considered in this category? Select all that apply. Oral hydration Intravenous hydration Chemotherapy Analgesics CPR
ALL but analgesics
When providing care to a child and family, a nurse provides them with information about their rights and options, assists them in making informed decisions, identifies their needs, and makes sure that they have the necessary resources. The nurse is fulfilling which role? A) Educator B) Advocate C) Collaborator D) Consultant
B) Advocate In the role of an 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. In the role of educator, the nurse instructs and counsels children and their families about all aspects of health and illness. In the role of collaborator, the nurse collaborates with the interdisciplinary health care team, the pediatric nurse integrates the child's and family's needs into a coordinated plan of care. In the role of consultant, the pediatric nurse ensures that the child's and family's needs are met through such activities as support group facilitation or working with the school nurse to plan the child's care.
After unintentional injuries, what is the leading cause of childhood mortality for children ages 1 to 4 years? A) Intentional injuries B) Pediatric cancer C) Congenital malformations D) Cardiac septal defects
C) Congenital malformations In 2010, the mortality rate for children between ages 1 and 4 years was 26.5 per 100,000, with the leading cause of death being unintentional injuries followed by congenital malformations.
The nurse is applying the nursing process to the care of a 5-year-old child who has been diagnosed with asthma. Which action should the nurse perform first? A) Identify the nursing diagnoses that are most commonly associated with childhood asthma B) Teach the child and the caregivers basic strategies for preventing and managing asthma symptoms C) Interview the child and the caregivers to determine the most common causes of the child's symptoms D) Collaborate with the child and the caregivers to determine their specific, desired outcomes for care
C) Interview the child and the caregivers to determine the most common causes of the child's symptoms The nursing process always begins with assessment, an activity that would include an interview focusing on precipitating factors. Each of the other listed activities would be performed subsequent to an assessment.
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? A) "Although there are risks involved, our son needs the surgery to cure the problem." B) "He might miss some school afterwards, but he'll be feeling much better." C) "We are amazed that he'll be up and walking around the day after surgery." D) "We had to sign the form right away so the surgery could get scheduled."
D) "We had to sign the form right away so the surgery could get scheduled."
A nurse is working as part of a research team evaluating children for participation in a research study. The nurse demonstrates respect when the nurse obtains assent from children over which age? A) 18 B) 16 C) 12 D) 7
D) 7 Respect for persons requires that the subject is able to independently and autonomously volunteer to participate in a study. Because infants and children do not have this ability, parents must consent on behalf of their children. Cognitively intact children over the age of seven years should always be asked to give their assent.
Beneficence
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.
what methods are used to aggregate the health of a child?
Mortality and morbidity rates
State Children's Health Insurance Program (SCHIP)
Program offering health insurance coverage for uninsured children under Medicaid.
neonate and infant mortality rate:
number of infant deaths occurring in the first 28 days of life per 1,000 live births.
The community health nurse is looking at measurements to capture information about general health status for a group of inner city children using recommendations of Healthy People 2020. Which factors are appropriate? Select all that apply. The number of days missed from school related to illness. How the individual child considers his health. Type and availability of health insurance for the family. History of chronic disease. Family health history.
The number of days missed from school related to illness. How the individual child considers his health. History of chronic disease.
Examples of Beneficence
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.
WHO's definition of health:
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Morbidity
measure of prevalence of a specific illness in a population at a specific time.
Reasons for mortality in children
unintentional injuries cancer suicide, homicide, diseases of the heart, influenza, and pneumonia.
