Sickle cell anemia vaso occlusive crisis ati

Pediatric Health Promotion Project.

RN NURSING CARE OF CHILDREN I

RN Nursing Care of Children REVIEW MODULE EDITION 10.0

Contributors Norma Jean E. Henry, MSN/Ed, RN

Mendy McMichael, DNP, MSN

Janean Johnson, MSN, RN, CNE

Agnes DiStasi, DNP, RN, CNE

Carrie B. Elkins, DHSc, MSN

Honey C. Holman, MSN, RN

Pamela Roland, MSN, RN

Robin A. Hertel, EdS, MSN, RN, CMSRN

Kellie L. Wilford, MSN, RN

Marsha S. Barlow, MSN, RN

Consultants Judy Drumm, DNS, RN, CPN

Christi Glesmann, Ed.D, MSN, RN

Christi Blair, MSN, RN

Tomekia Earl, MSN, RN

Lakeisha Wheless, MSN, RN

INTELLECTUAL PROPERTY NOTICE ATI Nursing is a division of Assessment Technologies Institute®, LLC.

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property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by

third parties who have licensed their materials to Assessment Technologies Institute, LLC.

II CONTENT MASTERY SERIES

IMPORTANT NOTICE TO THE READER Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for

informational and educational purposes only and may be modified or updated by the publisher at any time. This

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RN NURSING CARE OF CHILDREN USER’S GUIDE III

User’s Guide Welcome to the Assessment Technologies Institute® RN Nursing Care of Children Review Module Edition 10.0. The mission of ATI’s Content Mastery Series® Review Modules is to provide user-friendly compendiums of nursing knowledge that will:

● Help you locate important information quickly. ● Assist in your learning efforts. ● Provide exercises for applying your nursing knowledge. ● Facilitate your entry into the nursing profession as a

newly licensed nurse.

This newest edition of the Review Modules has been redesigned to optimize your learning experience. We’ve fit more content into less space and have done so in a way that will make it even easier for you to find and understand the information you need.

ORGANIZATION This Review Module is organized into units covering the foundations of nursing care of children, nursing care of children who have systems disorders, and nursing care of children who have other specific needs. Chapters within these units conform to one of four organizing principles for presenting the content.

● Nursing concepts ● Growth and development ● Procedures ● System disorders

Nursing concepts chapters begin with an overview describing the central concept and its relevance to nursing. Subordinate themes are covered in outline form to demonstrate relationships and present the information in a clear, succinct manner.

Growth and development chapters cover expected growth and development, including physical and psychosocial development, age-appropriate activities, and health promotion, including immunizations, health screenings, nutrition, and injury prevention.

Procedures chapters include an overview describing the procedure(s) covered in the chapter. These chapters provide nursing knowledge relevant to each procedure, including indications, nursing considerations, interpretation of findings, and complications.

System disorders chapters include an overview describing the disorder(s) and/or disease process. These chapters address assessments, including risk factors, expected findings, laboratory tests, and diagnostic procedures. Next, you will focus on patient-centered care, including nursing care, medications, therapeutic procedures, interprofessional care, and client education. Finally, you will find complications related to the disorder, along with nursing actions in response to those complications.

ACTIVE LEARNING SCENARIOS AND APPLICATION EXERCISES

Each chapter includes opportunities for you to test your knowledge and to practice applying that knowledge. Active Learning Scenario exercises pose a nursing scenario and then direct you to use an ATI Active Learning Template (included at the back of this book) to record the important knowledge a nurse should apply to the scenario. An example is then provided to which you can compare your completed Active Learning Template. The Application Exercises include NCLEX-style questions, such as multiple-choice and multiple-select items, providing you with opportunities to practice answering the kinds of questions you might expect to see on ATI assessments or the NCLEX. After the Application Exercises, an answer key is provided, along with rationales.

NCLEX® CONNECTIONS To prepare for the NCLEX-RN, it is important to understand how the content in this Review Module is connected to the NCLEX-RN test plan. You can find information on the detailed test plan at the National Council of State Boards of Nursing’s website, www.ncsbn. org. When reviewing content in this Review Module, regularly ask yourself, “How does this content fit into the test plan, and what types of questions related to this content should I expect?”

To help you in this process, we’ve included NCLEX Connections at the beginning of each unit and with each question in the Application Exercises Answer Keys. The NCLEX Connections at the beginning of each unit point out areas of the detailed test plan that relate to the content within that unit. The NCLEX Connections attached to the Application Exercises Answer Keys demonstrate how each exercise fits within the detailed content outline. These NCLEX Connections will help you understand how the detailed content outline is organized, starting with major client needs categories and subcategories and followed by related content areas and tasks. The major client needs categories are:

● Safe and Effective Care Environment ◯ Management of Care ◯ Safety and Infection Control

● Health Promotion and Maintenance ● Psychosocial Integrity ● Physiological Integrity

◯ Basic Care and Comfort ◯ Pharmacological and Parenteral Therapies ◯ Reduction of Risk Potential ◯ Physiological Adaptation

An NCLEX Connection might, for example, alert you that content within a unit is related to:

● Physiological Adaptation ◯ Alterations in Body Systems

■ Identify clinical manifestations and incubation periods of infectious diseases.

IV USER’S GUIDE CONTENT MASTERY SERIES

QSEN COMPETENCIES As you use the Review Modules, you will note the integration of the Quality and Safety Education for Nurses (QSEN) competencies throughout the chapters. These competencies are integral components of the curriculum of many nursing programs in the United States and prepare you to provide safe, high-quality care as a newly licensed nurse. Icons appear to draw your attention to the six QSEN competencies.

Safety: The minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others.

Patient-Centered Care: The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.

Evidence-Based Practice: The use of current knowledge from research and other credible sources, on which to base clinical judgment and client care.

Informatics: The use of information technology as a communication and information-gathering tool that supports clinical decision-making and scientifically based nursing practice.

Quality Improvement: Care related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs.

Teamwork and Collaboration: The delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes.

ICONS Icons are used throughout the Review Module to draw your attention to particular areas. Keep an eye out for these icons.

This icon is used for NCLEX Connections.

This icon indicates gerontological considerations, or knowledge specific to the care of older adult clients.

This icon is used for content related to safety and is a QSEN competency. When you see this icon, take note of safety concerns or steps that nurses can take to ensure client safety and a safe environment.

This icon is a QSEN competency that indicates the importance of a holistic approach to providing care.

This icon, a QSEN competency, points out the integration of research into clinical practice.

This icon is a QSEN competency and highlights the use of information technology to support nursing practice.

This icon is used to focus on the QSEN competency of integrating planning processes to meet clients’ needs.

This icon highlights the QSEN competency of care delivery using an interprofessional approach.

This icon appears at the top-right of pages and indicates availability of an online media supplement, such as a graphic, animation, or video. If you have an electronic copy of the Review Module, this icon will appear alongside clickable links to media supplements. If you have a hard copy version of the Review Module, visit www.atitesting.com for details on how to access these features.

FEEDBACK ATI welcomes feedback regarding this Review Module. Please provide comments to comments@atitesting.com.

RN NURSING CARE OF CHILDREN TABLE OF CONTENTS V

Table of Contents

NCLEX® Connections 1

UNIT 1 Foundations of Nursing Care of Children SECTION: Perspectives of Nursing Care of Children

CHAPTER 1 Family-Centered Nursing Care 3

CHAPTER 2 Physical Assessment Findings 7

CHAPTER 3 Health Promotion of Infants (2 Days to 1 Year) 15

CHAPTER 4 Health Promotion of Toddlers (1 to 3 Years) 21

CHAPTER 5 Health Promotion of Preschoolers (3 to 6 Years) 25

CHAPTER 6 Health Promotion of School-Age Children (6 to 12 Years) 29

CHAPTER 7 Health Promotion of Adolescents (12 to 20 Years) 33

NCLEX® Connections 37

SECTION: Specific Considerations of Nursing Care of Children

CHAPTER 8 Safe Administration of Medication 39

CHAPTER 9 Pain Management 43

CHAPTER 10 Hospitalization, Illness, and Play 49

Hospitalization and illness 49

Play 50

CHAPTER 11 Death and Dying 53

VI TABLE OF CONTENTS CONTENT MASTERY SERIES

NCLEX® Connections 57

UNIT 2 Nursing Care of Children Who Have System Disorders SECTION: Neurosensory Disorders

CHAPTER 12 Acute Neurological Disorders 59

Meningitis 59

Reye syndrome 61

CHAPTER 13 Seizures 65

CHAPTER 14 Head Injury 71

CHAPTER 15 Cognitive and Sensory Impairments 75

Visual impairments 75

Hearing impairments 76

Down syndrome 77

NCLEX® Connections 81

SECTION: Respiratory Disorders

CHAPTER 16 Oxygen and Inhalation Therapy 83

Pulse oximetry 83

Nebulized aerosol therapy 84

Metered‑dose inhaler or dry powder inhaler 84

Chest physiotherapy 85

Oxygen therapy 86

Suctioning 87

Artificial airways 88

CHAPTER 17 Acute and Infectious Respiratory Illnesses 91

Tonsillitis and tonsillectomy 91

Common respiratory illnesses 92

Nasopharyngitis 93

Acute streptococcal pharyngitis 94

Bronchitis (tracheobronchitis) 94

Bronchiolitis 94

Allergic rhinitis 95

Bacterial pneumonia 95

Croup syndromes 96

Acute laryngotracheobronchitis and acute spasmodic laryngitis 96

Influenza A and B 96

RN NURSING CARE OF CHILDREN TABLE OF CONTENTS VII

CHAPTER 18 Asthma 99

CHAPTER 19 Cystic Fibrosis 105

NCLEX® Connections 109

SECTION: Cardiovascular and Hematologic Disorders

CHAPTER 20 Cardiovascular Disorders 111

Congenital heart disease 111

Pulmonary artery hypertension 114

Infective (bacterial) endocarditis 114

Cardiomyopathy 115

Shock 115

Rheumatic fever 118

Dyslipidemia 119

Kawasaki disease 120

CHAPTER 21 Hematologic Disorders 123

Epistaxis 123

Iron deficiency anemia 123

Sickle cell anemia 125

Hemophilia 127

NCLEX® Connections 131

SECTION: Gastrointestinal Disorders

CHAPTER 22 Acute Infectious Gastrointestinal Disorders 133

CHAPTER 23 Gastrointestinal Structural and Inflammatory Disorders 139

Cleft lip and palate 139

Gastrointestinal reflux disease 140

Hypertrophic pyloric stenosis 141

Hirschsprung’s disease 142

Intussusception 143

Appendicitis 143

Meckel’s diverticulum 144

VIII TABLE OF CONTENTS CONTENT MASTERY SERIES

NCLEX® Connections 147

SECTION: Genitourinary and Reproductive Disorders

CHAPTER 24 Enuresis and Urinary Tract Infections 149

Enuresis 149

Urinary tract infections 150

CHAPTER 25 Structural Disorders of the Genitourinary Tract and Reproductive System 153

CHAPTER 26 Renal Disorders 157

Acute glomerulonephritis 157

Nephrotic syndrome 158

Hemolytic uremic syndrome 160

Acute renal failure 161

Chronic renal failure 162

NCLEX® Connections 165

SECTION: Musculoskeletal Disorders

CHAPTER 27 Fractures 167

CHAPTER 28 Musculoskeletal Congenital Disorders 173

Clubfoot 173

Legg‑Calve‑Perthes disease 174

Developmental dysplasia of the hip (DDH) 174

Osteogenesis imperfecta 176

Scoliosis 177

CHAPTER 29 Chronic Neuromusculoskeletal Disorders 181

Cerebral palsy 181

Spina bifida 183

Juvenile idiopathic arthritis 185

Muscular dystrophy 187

RN NURSING CARE OF CHILDREN TABLE OF CONTENTS IX

NCLEX® Connections 191

SECTION: Integumentary Disorders

CHAPTER 30 Skin Infections and Infestations 193

Skin infections 193

Arthropod bites and stings 196

Skin infestations 197

CHAPTER 31 Dermatitis and Acne 201

Contact dermatitis 201

Atopic dermatitis 202

Acne 204

CHAPTER 32 Burns 207

NCLEX® Connections 213

SECTION: Endocrine Disorders

CHAPTER 33 Diabetes Mellitus 215

CHAPTER 34 Growth Hormone Deficiency 221

NCLEX® Connections 225

SECTION: Immune and Infectious Disorders

CHAPTER 35 Immunizations 227

CHAPTER 36 Communicable Diseases 235

CHAPTER 37 Acute Otitis Media 241

CHAPTER 38 HIV/AIDS 245

NCLEX® Connections 249

SECTION: Neoplastic Disorders

CHAPTER 39 Organ Neoplasms 251

CHAPTER 40 Blood Neoplasms 257

CHAPTER 41 Bone and Soft Tissue Cancers 263

Bone tumors 263

Rhabdomyosarcoma 265

X TABLE OF CONTENTS CONTENT MASTERY SERIES

NCLEX® Connections 269

UNIT 3 Nursing Care of Children Who Have Other Specific Needs

CHAPTER 42 Complications of Infants 271

Phenylketonuria 271

Meningocele/Myelomeningocele 272

Necrotizing enterocolitis 274

Respiratory distress syndrome 274

Congenital hypothyroidism 275

Substance‑exposed infants 276

Hyperbilirubinemia 277

Newborn sepsis 279

Failure to thrive 280

Plagiocephaly 280

Newborn seizures 281

Complications of the preterm infant 282

Chromosomal abnormalities 283

CHAPTER 43 Pediatric Emergencies 287

Respiratory emergencies 287

Drowning 288

Apparent life‑threatening event 288

Sudden infant death syndrome 289

Poisoning 289

CHAPTER 44 Psychosocial Issues of Infants, Children, and Adolescents 293

Depression 293

Posttraumatic stress disorder 293

Attention‑deficit/hyperactivity disorder 294

Autism spectrum disorder 295

Cognitive impairment 296

Failure to thrive 296

Maltreatment of infants and children 297

Bullying 299

RN NURSING CARE OF CHILDREN TABLE OF CONTENTS XI

References 301

Active Learning Templates A1 Basic Concept A1

Diagnostic Procedure A3

Growth and Development A5

Medication A7

Nursing Skill A9

System Disorder A11

Therapeutic Procedure A13

RN NURSING CARE OF CHILDREN NCLEX® CONNECTIONS 1

NCLEX® Connections

When reviewing the following chapters, keep in mind the relevant topics and tasks of the NCLEX outline, in particular:

Client Needs: Safety and Infection Control ACCIDENT/ERROR/INJURY PREVENTION Identify factors that influence accident/injury prevention (e.g., age, developmental stage, lifestyle, mental status).

Identify and facilitate correct use of infant and child car seats.

Client Needs: Health Promotion and Maintenance AGING PROCESS Provide care and education for the newborn less than 1 month old through the infant or toddler client through 2 years.

Provide care and education for the preschool, school age and adolescent client ages 3 through 17 years.

DEVELOPMENTAL STAGES AND TRANSITIONS: Provide education to clients/staff members about expected age-related changes and age-specific growth and development.

TECHNIQUES OF PHYSICAL ASSESSMENT: Choose physical assessment equipment and techniques appropriate for the client.

Client Needs: Pharmacological and Parenteral Therapies

MEDICATION ADMINISTRATION: Review pertinent data prior to medication administration.

RN NURSING CARE OF CHILDREN CHAPTER 1 Family-Centered nursing Care 3

UNIT 1 FOUNDATIONS OF NURSING CARE OF CHILDREN SECTION: PERSPECTIVES OF NURSING CARE OF CHILDREN

CHAPTER 1 Family-Centered Nursing Care

Families are groups that should remain constant in children’s lives. Family is defined as what an individual considers it to be.

Families often include individuals with a biological, marital, or adoptive relationship, but in the absence of these characteristics, families also consist of individuals who have a strong emotional bond and commitment to one another.

due to the expanding concepts of family, the term household is sometimes used.

Positive family relationships are characterized by parent-child interactions that show mutual warmth and respect.

COMPONENTS OF CARE Family-centered nursing care includes the following.

● Agreed-upon partnerships between families of children, nurses, and providers, in which the families and children benefit.

● Respecting cultural diversity, and incorporating cultural views in the plan of care.

● Understanding growth and developmental needs of children and their families.

● Treating children and their families as clients. ● Working with all types of families. ● Collaborating with families regarding hospitalization,

home, and community resources. ● Allowing families to serve as experts regarding their

children’s health conditions, usual behaviors in different situations, and routine needs.

PrOmOting Family-Centered Care Nurses should perform comprehensive family assessments to identify strengths and weaknesses.

Characteristics of healthy families ● Members communicate well and listen to each other. ● There is affirmation and support for all members. ● There is a clear set of family rules, beliefs, and values. ● Members teach respect for others. ● There is a sense of trust. ● Members play and share humor together. ● Members interact with one another. ● There is a shared sense of responsibility. ● There are traditions and rituals. ● There is adaptability and flexibility in roles. ● Members seek help for their problems.

NURSING CONSIDERATIONS ● Nurses should pay close attention when family

members state that a child “isn’t acting right” or has other concerns.

● Children’s opinions should be considered when providing care.

FAMILY THEORIES

Family systems The family is viewed as a whole system, instead of the individual members.

● A change to one member affects the entire system. ● The system can both initiate and react to change. ● Too much and too little change can lead to dysfunction.

Family stress Describes stress as inevitable.

● Stressors can be expected or unexpected. ● Explains the reaction of a family to stressful events. ● Offers guidance for adapting to stress.

deVelOPmental Views families as small groups that interact with the larger social system.

● Emphasizes similarities and consistencies in how families develop and change.

● Uses Duvall’s family life cycle stages to describe the changes a family goes through over time.

● How the family functions in one stage has a direct effect on how the family will function in the next stage.

CHAPTER 1

4 CHAPTER 1 Family-Centered nursing Care CONTENT MASTERY SERIES

FAMILY COMPOSITION Traditional nuclear family: Married couple and their biologic children (only full brothers and sisters)

Nuclear family: Two parents and their children (biologic, adoptive, step, foster)

Single-parent family: One parent and one or more children

Blended family (also called reconstituted): At least one stepparent, stepsibling, or half-sibling

Extended family: At least one parent, one or more children, and other individuals (might not be related)

Gay/lesbian family: Two members of the same sex who have children and a legal or common-law tie

Foster family: A child or children who have been placed in an approved living environment away from the family of origin, usually with one or two parents

Binuclear family: Parents who have terminated spousal roles but continue their parenting roles

Communal family: Individuals who share common ownership of property and goods, and exchange services without monetary consideration

Changes that occur with the birth (or adoption) of the first child

● Parents’ sense of self as they transition to the new parental role

● Division of labor and roles within the relationships of couples

● Relationships with grandparents ● Work relationships ● Increased financial responsibilities and possible loss

of income ● Necessary sleep habit changes

PARENTING STYLES

tyPes OF Parenting

Dictatorial or authoritarian

Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations.

the child is never allowed to watch television on school nights.

Permissive

Parents exert little or no control over the child’s behaviors, and consult the child when making decisions.

the child assists with deciding whether he will watch television.

Democratic or authoritative

Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting.

the child can watch television for 1 hr on school nights after completing all of his homework and chores.

Parents negatively reinforce deviations from the rules.

the privilege is taken away but later reinstated based on new guidelines.

Passive

Parents are uninvolved, indifferent, and emotionally removed.

the child may watch television whenever he wants.

guidelines FOr PrOmOting aCCePtaBle BeHaViOr in CHildren

● Set clear and realistic limits and expectations based on the developmental level of the child.

● Validate the child’s feelings, and offer sympathetic explanations.

● Provide role modeling and reinforcement for appropriate behavior.

● Focus on the child’s behavior when disciplining the child.

FAMILY ASSESSMENT History: Medical history for parents, siblings, and grandparents

Structure: Family members (mother, father, son)

Developmental tasks: Tasks a family works on as the child grows (parents with a school-age child helping her to develop peer relations)

Family characteristics: Cultural, religious, and economic influences on behavior, attitudes, and actions

Family stressors: Expected (birth of a child) and unexpected (illness, divorce, disability, or death of a family member) events that cause stress

Environment: Availability of and family interactions with community resources

Family support system: Availability of extended family, work and peer relationships, as well as social systems and community resources to assist the family in meeting needs or adapting to a stressor

RN NURSING CARE OF CHILDREN CHAPTER 1 Family-Centered nursing Care 5

Application Exercises 1. a nurse manager on a pediatric

floor is preparing an education program on working with families for a group of newly hired nurses. Which of the following should the nurse include when discussing the developmental theory?

a. describes that stress is inevitable

B. emphasizes that change with one member affects the entire family

C. Provides guidance to assist families adapting to stress

d. defines consistencies in how families change

2. a nurse is assisting a group of parents of adolescents to develop skills that will improve communication within the family. the nurse hears one parent state, “my son knows he better do what i say.” Which of the following parenting styles is the parent exhibiting?

a. authoritarian

B. Permissive

C. authoritative

d. Passive

3. a nurse is performing family assessment. Which of the following should the nurse include? (select all that apply.)

a. medical history

B. Parents’ education level

C. Child’s physical growth

d. support systems

e. stressors

PRACTICE Active Learning Scenario

a nurse is providing anticipatory guidance to the mother of a toddler. the nurse learns that the household includes the mother, toddler, an older brother, and a grandmother. use the ati active learning template: Basic Concept to complete this item.

RELATED CONTENT: describe the composition of this family.

UNDERLYING PRINCIPLES ● describe two methods the parent can use to positively influence the child. ● describe two ways the parent can promote acceptable behavior in the child.

NURSING INTERVENTIONS: include two additional family assessments the nurse should perform.

6 CHAPTER 1 Family-Centered nursing Care CONTENT MASTERY SERIES

Application Exercises Key 1. a. the family stress theory describes that stress is inevitable.

B. the family systems theory emphasizes that change with one member affects the entire family.

C. the family stress theory provides guidance to assist families adapting to stress.

d. CORRECT: the nurse should include that the developmental theory defines consistencies in how families change.

NCLEX® Connection: Health Promotion and Maintenance, Developmental Stages and Transitions

2. a. CORRECT: this parent is exhibiting an authoritarian parenting style. the parent controls the adolescent’s behaviors and attitudes through unquestioned rules and expectations.

B. this parent is not exhibiting a permissive parenting style. using this style, the parent exerts little or no control over the adolescent’s behaviors, and consults the adolescent when making decisions.

C. this parent is not exhibiting an authoritative parenting style. using this style, the parent directs the adolescent’s behavior by setting rules and explaining the reason for each rule setting.

d. this parent is not exhibiting a passive parenting style. using this style, the parent is uninvolved, indifferent, and emotionally removed.

NCLEX® Connection: Health Promotion and Maintenance, Developmental Stages and Transitions

3. a. CORRECT: the nurse should include a medical history on the parents, siblings, and grandparents when performing a family assessment.