Pediatric Nursing Demystified

Pediatric Nursing Demystified

Pediatric Nursing Demystified

Joyce Y. Johnson, PhD, RN, CCRN

Dean and Professor

College of Sciences and Health Professions

Albany State University

Albany, Georgia

Jim Keogh, RN

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This book is dedicated to my mother Dorothy C. Young who has always been an inspiration to me, to my husband Larry and to Virginia and Larry Jr. who are the wind beneath my wings.

Joyce Y. Johnson

This book is dedicated to Anne, Sandy, Joanne, Amber-Leigh Christine, Shawn, and Eric, without whose help and support this book could not have been written.

James Keogh

We dedicate this book to our students who are the reason we teach and write. Much success in your nursing careers!

Authors

CONTENTS

Preface

Acknowledgments

PART I            ROLES AND RELATIONSHIPS

CHAPTER 1   Families and Communities

Overview

Types of Families

Nursing Implications

Social and Economic Factors

Nursing Implications

Diversity Issues

Nursing Implications

Conclusion

CHAPTER 2   Growth and Development

Overview

Newborn/Infant

Conditions and Concerns Common to Developmental Stage

Nursing Implications

Early Childhood (Preschool)

Conditions and Concerns Common to Developmental Stage

Nursing Implications

School-Aged Child

Conditions and Concerns Common to Developmental Stage

Nursing Implications

Preteen (Tweens)

Teen Years

Conditions and Concerns Common to Developmental Stage

Nursing Implications

Conclusions

CHAPTER 3   Pediatric Assessment

Overview

The Nursing Process

Health Assessment: Client History

Communication

Nursing History

Assessment

Nutritional Assessment

Family History and Review of Systems

Family Function

Physical Examination

Diagnostic Procedures

Laboratory Tests

Nursing Implications

Conclusion

PART II          SYSTEMATIC EXPLORATION OF PEDIATRIC CONDITIONS AND NURSING CARE

CHAPTER 4   Head and Neck: Eyes, Ears, Nose, and Throat

Overview

Eyes

Strabismus

Acute Conjunctivitis

Ears

Otitis Media

Nose

Mouth

Dental Caries

Stomatitis

Throat

Head

Pediculosis Capitis (Head Lice)

Conclusion

CHAPTER 5   Respiratory Conditions

Overview

Upper Respiratory Tract Infections

Acute Viral Nasopharyngitis

Tonsillitis and Pharyngitis

Croup Syndrome

Acute Laryngotracheobronchitis

Acute Epiglottitis

Acute Laryngitis

Infectious Mononucleosis

Lower Respiratory Tract Infections

Pneumonia

Asthma

Nursing Interventions

Bronchiolitis

Cystic Fibrosis

Respiratory Distress Syndrome

Sudden Infant Death Syndrome

Conclusion

CHAPTER 6   Cardiovascular Conditions

Overview

Congestive Heart Failure

Atrial Septal Defect

Ventricular Septal Defect

Patent Ductus Arteriosus

Coarctation of the Aorta

Aortic Stenosis

Tetralogy of Fallot

Transposition of Great Arteries

Bacterial Endocarditis

Rheumatic Fever

CHAPTER 7   The Hematologic System

Overview

Anemia

Aplastic or Hypoplastic Anemia

Iron Deficiency Anemia

Sickle Cell Anemia

Hemophilia

Idiopathic Thrombocytopenic Purpura

Beta-Thalassemia

Conclusion

CHAPTER 8   Oncology Conditions

Overview

Cancer Defined

Signs and Symptoms

Client History

Family Assessment

Symptoms

Physical Assessment

Test Results

Treatments

Nursing Interventions

Family and Child Support

Pediatric Oncology Conditions

Leukemia

Lymphomas

Sarcomas (Bone Tumors)

Neuroblastoma

Rhabdomyosarcoma

Retinoblastoma

Conclusion

CHAPTER 9   Endocrineand Metabolic Conditions

Overview

Thyroid Gland

Pituitary Glands

Adrenal Glands

Parathyroid Glands

Pancreas

Gonads

Congenital Hypothyroidism

Cushing Syndrome

Diabetes Mellitus

Galactosemia

Graves Disease (Hyperthyroidism)

Maple Syrup Urine Disease

Phenylketonuria

Conclusion

CHAPTER 10   Neurologic Conditions

Overview

Central Nervous System

Cerebral Spinal Fluid

Brain

Spinal Cord

Seizures

Meningitis

Encephalitis

Reye Syndrome

Neural Tube Defects

Brain Tumors

Cerebral Palsy

Down Syndrome

Duchenne Muscular Dystrophy

Guillain-Barré Syndrome

Hydrocephalus

Conclusion

CHAPTER 11   Gastrointestinal Conditions

Overview

The Esophagus

The Stomach

The Liver

The Pancreas

The Intestines

Appendicitis

Celiac Disease

Cleft Palate and Cleft Lip

Crohn Disease

Hepatitis

Hirschsprung Disease

Intussusception

Pyloric Stenosis

Tracheoesophageal Fistula/Esophageal Atresia

Ulcerative Colitis

Volvulus

Conclusion

CHAPTER 12   Genitourinary Conditions

Overview

Nephrons

The Urinary Tract

Regulator

Glomerulonephritis

Urinary Tract Congenital Anomalies

Hemolytic Uremic Syndrome

Nephrotic Syndrome

Renal Failure

Wilms Tumor

Pyelonephritis

Urinary Tract Infection

Conclusion

CHAPTER 13   Musculoskeletal Conditions

Overview

Bones

Joints

Skeletal Muscles

Soft Tissue Injury

Fracture

Hip Dysplasia

Osteogenesis Imperfecta

Torticollis

Scoliosis

Slipped Capital Femoral Epiphysis

Osteomyelitis

Juvenile Rheumatoid Arthritis

Ewing Sarcoma

Legg-Calvé-Perthes Disease

Talipes (Clubfoot)

Conclusion

CHAPTER 14   Infectious and Communicable Conditions

Overview

Chain of Infection

Stages of Infection

A Good Defense

The Defenders

Vaccinations

Bacteria

Viruses

Diphtheria

Haemophilus Influenzae Type B

Pertussis

Tetanus

Fifth Disease

Mumps

Poliomyelitis

Roseola Infantum

Rubella

Rubeola

Varicella

Anaphylaxis

Mononucleosis

Conclusion

CHAPTER 15   Integumentary Conditions

Overview

Skin Lesions/Dermatitis

Wounds

Psoriasis

Scabies

Lyme Disease (Tick Bite)

Burn Injury

Final Exam

Index

PREFACE

Pediatric Nursing Demystified offers a detailed overview of the essential concepts involved in the nursing care of the pediatric client. The major conditions seen in the pediatric population are highlighted along with the associated nursing care.

Because the client is a child or adolescent, nursing care involves a family-centered process. Chapter 1 discusses family dynamics and community resources. Chapter 2 focuses on growth and development stages from infancy through adolescence with an emphasis on the impact of developmental stage on the care being provided to a client. Concepts of growth and development related to the pediatric client that informs nursing care and communications with this population and their family members are discussed. Major theories are summarized, and the key aspects that relate to care of the pediatric client are highlighted. Chapter 3 follows with a review of health assessment with a focus on the pediatric client. Part II includes 12 chapters that address individual pediatric conditions with a systematic review of illnesses and conditions encountered in the pediatric population.

Pediatric Nursing Demystified is an easy-to-understand presentation of concepts and focuses on the information that students need most to deal with the common conditions that face pediatric clients. This review focuses on the most critical information in pediatric nursing by discussing the underlying factors involved in maintaining or restoring the health and well-being of the pediatric client and family and those factors that threaten that well-being. Pediatric Nursing Demystified contains clear language and helpful features to guide the student through application of concepts to real-life situations.

The features of the book are organized as follows:

Each detailed chapter contains learning objectives.

Key words are identified for the content area.

A brief overview of the topic is provided.

Content is divided into:

• A brief review of anatomy and physiology

• Discussion of what went wrong that resulted in the condition

• Signs and symptoms

• Test results

• Treatment

• Nursing intervention

Illustrations are provided to aid memory and understanding of the condition.

Diagrams and tables are provided to summarize important details.

Routine checkups are provided to briefly test understanding gained after a portion of the information is presented.

A conclusion summarizes the content presented.

A Final Checkup is provided with NCLEX-style questions to test the knowledge gained from the chapter.

A comprehensive exam that includes NCLEX-style questions that cover content presented throughout Pediatric Nursing Demystified appears at the end of the book.

Pediatric Nursing Demystified is a nursing student’s best friend in the study for course exams and the NCLEX.

ACKNOWLEDGMENTS

We would like to thank Joe Morita for his direction and tremendous support in the development of this project.

Thank you to Edna Boyd Davis for her contributions to this project.

Thank you to Clemmie Riggins for her assistance in the preparation of the manuscript.

PART I

Roles and Relationships

CHAPTER 1

Families and Communities

Learning Objectives

At the end of the chapter, the student will be able to

Describe the impact of family dynamics on the nursing care of the pediatric client.

Distinguish the types of families in a community.

Contrast the health-related concerns resulting from families and communities at varied socioeconomic levels.

Indicate appropriate nursing approaches to address family and community concerns related to care of the pediatric client.

Discuss ethnic-cultural influences on family and community dynamics.

Determine appropriate nursing implications of ethnic-cultural concepts.

KEY WORDS

OVERVIEW

The family and community provide the foundation for the growth and development of a pediatric client. Health promotion, maintenance, and restoration activities can be supported or hindered by family dynamics and the presence or absence of family and community support resources. Challenges presented by family or community distress can severely limit a child’s successful progression through the developmental stages of life. Understanding the basic concepts of family and community dynamics helps the nurse to provide comprehensive care to the pediatric client and family.

Foundational concepts

• Family-centered nursing recognizes family support as a needed constant in a child’s life.

• The family, in addition to the child, is supported throughout the health-care experience.

• Collaboration with family is facilitated throughout hospital, community, and home care.

• Family advocacy includes enabling families to build on current strengths and helping them maintain a sense of control over their lives.

• Separation of the child from the family should be kept at a minimum to reduce psychological distress.

• In the home setting, the nurse is a visitor and should respect the authority of the family.

• Community support resources are crucial for families with a child with special needs—developmental delay, sensory deficits (blindness, deafness, etc.).

Roles and relationships

• Family members often play more than one role in the family system. Family roles:

Include but are not restricted to parent (mother, father, stepmother, stepfather, foster parent), child, sibling, provider, homemaker, or caregiver.

Vary depending on type and structure of family, including number and age of members and ethnic-cultural background.

May change as a result of the illness or the changes in the needs of a child. Illness can cause stress in a family, and that stress can in turn increase the distress of the child.

TYPES OF FAMILIES

Types of families may be described in different ways, and needs may vary based on family composition and function. The type of family a child belongs to may include

Nuclear family: Husband (usually the provider), wife (usually homemaker although frequently works also), and child/children.

Reconstituted/binuclear/blended family: Child or children and one parent in one home and another parent in a different home. A stepparent and step-siblings may be present in one or both homes, reconstituting two families into one and resulting in two blended nuclear families.

Cohabitation family: A man and woman who live together with a child or children without being married.

Single-parent family: A man or woman living with one or more children.

Gay/lesbian family: Two men or two women who live together as parents to one or more biological or adopted children.

Extended family: Multigenerational groups consisting of parents and children with other relatives (i.e., grandparents, aunts, uncles, cousins, grandchildren).

NURSING IMPLICATIONS

Perform a family assessment to determine the presence or absence of support for the child during and after hospitalization.

Identify and collaborate with key individuals within the family unit to promote restoration and maintenance of health after the child is discharged home.

Plan activities to minimize separation of child from family.

Involve parents and family in care activities to promote learning for after-discharge care.

Assess the home environment and determine the presence of contributing factors to pediatric illness and risk factors for additional physical or psychological health problems.

Collaborate with family members to minimize risk factors and prepare the home environment to meet the needs of the pediatric client and ensure follow-up after discharge.

Develop an action plan that addresses the needs of the pediatric client and family from admission through discharge back into the community and home setting.

SOCIAL AND ECONOMIC FACTORS

Social factors such as living environment and community relationships, in addition to economic factors such as poverty, unemployment, or homelessness, can impact the health of a child and family because of limited access to clean water, food, shelter, or health. Some groups are considered high-risk populations, groups of people at higher risk for illness than the general population, due to social, economic, or cultural factors. Be aware of these key social factors:

Poverty may limit access to healthy food leading to nutritional deficits.

Lack of access to health care decreases health promotion and maintenance and contributes to late diagnosis of illness and delayed treatment.

Unemployment contributes to poverty and possible homelessness, increasing exposure to overcrowded shelters, dangerous situations, and illness.

High-risk behaviors such as unprotected sex, drugs, and reckless driving can lead to unwanted pregnancy, infections, addiction, and injury.

Teen pregnancy can result in poor prenatal care, premature birth, and birth defects as well as poor parenting, leading to physiologic and psychological damage to the pediatric client.

Family disruption due to factors such as drug or alcohol abuse, mental illness, domestic violence, or divorce can destabilize the child’s life, leading to distress.

Community instability because of gang activity, crime, violence, high unemployment, and poverty can result in decreased available health resources.

NURSING IMPLICATIONS

Perform community assessment to identify contributing factors to pediatric illness and risk factors for additional health problems.

Address community resource needs prior to discharge; follow up in community or home setting after discharge.

Work collaboratively with community agencies to provide comprehensive care to the pediatric client and family and facilitate follow-up assessment and evaluations.

DIVERSITY ISSUES

Diversity commonly relates to ethnic-cultural differences found in persons of varied races or religious beliefs. Knowledge of practices that are acceptable or preferred and those that are forbidden allows the nurse to plan care that is appropriate according to the client’s ethnic and cultural background. The most effective process for determining appropriate care is to ask the client, family, or significant other about preferences and taboos. Many cultural preferences and rituals do not conflict with medical care or pose harm to the client; however, some natural supplements may interact with medications or diet. Support of cultural norms can result in increased client and family comfort and decreased anxiety.

Consider these principles when providing care to clients of varied ethnic or cultural origin:

Cultural norms are communicated from generation to generation.

Clients from families that have first- or second-generation members who emigrated from a different culture are more likely to adhere to cultural rituals, whereas clients born in the United States or coming to the country early in childhood may be fully assimilated (acculturated) having adopted American customs, cultural norms, behaviors, and attitudes.

A subculture is a group within a culture that has different beliefs and values from that deemed typical for the culture; the nurse should note individualized preferences.

Stereotyping is categorizing a group of people together, usually by race, rather than respecting individual characteristics.

In some cultures, females should not be addressed directly but through the dominant male family member.

Some cultures are matriarchal with the oldest female family member accepted as the decision maker.

Older family members in some cultures are respected as the decision makers for the family.

Children in some cultures are not allowed to communicate directly with nonfamily members without family presence and permission.

It is unacceptable to touch a child without permission, and some parts of the body, such as the head, should not be touched, if avoidable.

Photographs should not be taken without first consulting with client and family.

Ethnocentric behavior (belief that one’s own culture is best) can block communication with client and family by decreasing trust and comfort.

Communication in the native tongue may be needed for full understanding of client concerns.

NURSING IMPLICATIONS

Consider the following concepts when providing care to clients from different ethnic-cultural groups.

Communication

Assess the family dynamics and consult with family member (or the client if older child or adolescent) to determine preferences relative to communication and the decision-making process between nurse and family members.

Monitor your own behavior and avoid imposing cultural preferences on the client.

Provide an interpreter or use technology to assist in translation of concerns voiced in native tongue.

Physical Touch

Determine taboos related to physical contact, and if possible avoid unacceptable touching by asking the client or family to move body part as you examine them.

When unacceptable touching is needed, explain the purpose and minimize contact as much as possible.

If cross-gender touch is forbidden and you are the nurse of the opposite gender assigned to provide care, enlist a same-gender assistant to provide physical care as you manage the care.

Diet and Rituals

Ask the client and family about preferences because not all individuals from a cultural group practice the same rituals.

Determine food preferences and relay information to dietician to promote offering of appropriate meal choices.

Instruct family regarding dietary restrictions secondary to medical condition and if desired allow them to supply desired foods if otherwise unavailable.

Instruct family to notify you regarding any foods or supplements provided to the client to avoid harmful drug-substance interaction.

Consult family prior to removal of jewelry, bedside structures, or ointments from the client or the room to avoid disruption of religious or cultural ritual for luck or well-being.

CONCLUSION

Factors related to family and community can positively or negatively impact the care of the pediatric client. You should deliver family-centered care to ensure that support systems are maximized and not disrupted so the client receives needed support throughout the illness and the return to the home and community. Note these key points:

Assessment of family and community provides the nurse with a full picture of risks that threaten and benefits that are available to promote the health of the pediatric client.

Collaboration with community resources is key to a successful transition from hospital to the home or community setting, particularly for children with special needs.

Cultural and ethnic preferences should be considered and accommodated when possible.

The nurse should not impose cultural norms and preferences on the clients.

CHAPTER 2

Growth and Development

Learning Objectives

At the end of the chapter, the reader will be able to

Discuss types of growth and development.

Recognize the characteristics common to each developmental stage.

Discuss categories of development cited by two theorists.

Discuss the common causes of pediatric injury and death for each developmental stage.

Explain appropriate adaptations to nursing measures to provide age-appropriate care.

KEY WORDS

FIGURE 2-1

FIGURE 2-2

OVERVIEW

Every developmental stage comes with a particular set of challenges and accomplishments. Care of the client in a particular stage of development requires an understanding of the particular physical and psychosocial reactions that typically takes place with the client in that stage. Although concepts are stated as being typical for an age group, the nurse should be flexible and expect that some clients may overlap developmental stages. The nurse must recognize the presence of expected developmental characteristics or signs of developmental delays that may result from prolonged or chronic illness when planning age-appropriate care for the client and family.

THEORETICAL FOUNDATIONS FOR GROWTH AND DEVELOPMENT

Growth and development can be categorized from various perspectives: physical, language, cognitive, social, and emotional. All areas must be assessed and progression in each area supported. Biological age refers to child’s age based on biological health and functional capabilities, whereas chronological age is the number of years that have elapsed since birth. Social age refers to the social roles and expectations related to the child’s age, and psychological age is the adaptive capacities compared to another child of the same chronological age. Developmental stages and ages may overlap depending on the reference used. Psychosocial theorists Freud, Erikson, and Piaget propose behaviors that may be anticipated as a child develops.

NEWBORN/INFANT

Age range: birth to 12 months (up to 24 months)

Physical Milestones

Makes jerky, quivering arm thrusts

Brings hands within range of eyes and mouth

Moves head from side to side while lying on stomach

Head flops backward if unsupported

Keeps hands in tight fists

Strong reflex movements

Progresses from five to eight feedings per day to three meals and two snacks by 12 months

Progresses from sleeping 20 hours per day to 12 hours and two naps by 12 months

Sensory Milestones

Focuses 8