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pediatric nursing
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1

children are not

little adults

2

models of care focus on?

all of them do focus their care on the family and infants core relationship; importance of the family

3

Which of the following is not a core concept of the family-centered care model?

  1. Dignity and respect for the child and family
  2. Referral from primary care to community services for additional non-medical needs
  3. Information sharing with the family
  4. Family participation in care, including collaboration in care planning and provision

“Referral from primary care to community services for additional non-medical needs” is a core concept of the pediatric medical home care model.

4

roles of the pediatric nurse

  • Incorporates knowledge of human growth and development when providing care to children
  • Recognizes the physiological differences between children and adults
  • Provides care in a developmentally appropriate manner to promote the optimal physical, psychological, and social well-being
  • Recognizes the integral role of family in a child’s health and incorporates the family in the plan of care
  • Provides culturally sensitive care by integrating knowledge of cultural and religious practices into the plan of care
  • Implements models of care that are specifically applicable to infants, children, and adolescents
5

assent

agree

6

dissent

disagree

7

at what age can a child make their own decision about being in a case study

ages 7-8

8

trends in pediatric nursing practice

  • Earlier onset of puberty and its ramifications for adolescent sexual health
  • Shift in the focus of medical/nursing care from disease treatment to health promotion and disease prevention
  • Provision of health education in the school system
  • Increased incorporation of families in the overall care of children
  • Increased numbers of children who require home care
  • Increased prevalence of autism spectrum disorders and childhood depression, requiring more education and research in these areas
9

Which of the following is not a trend in pediatric nursing practice?

  1. Increased usage of blood conservation techniques for hospitalized children
  2. Increased admissions based on lack of primary care access
  3. Increased incorporation of families in the overall care of children
  4. Decreased incidence of adolescent obesity as a result of school intervention programs

Correct Answer: D

The prevalence of obesity among adolescents has doubled since the 1990's, increasing from approximately 10 percent (in 1990) to 20 percent in 2014 (Federal Interagency Forum on Child and Family Statistics, 2016).

10

nursing process

ADPIE

11

Therapeutic relationship challenges

  • Abused and neglected
  • Terminally ill
  • Addicted to drugs
  • Chronically ill with a condition such as cystic fibrosis, cancer, or sickle cell anemia that leads to repeated hospital admissions
  • Tough, street-wise adolescents who challenge everything and everyone
  • Children or families who are perceived as noncompliant or nonadherent
  • Children of parents diagnosed with borderline personality disorder or other types of mental illness
12

medication safety precautions

  • Reconciliation of medications
  • Computer order entry
  • Labeling and storage
  • Banning of medication order abbreviations; decimal points
  • Special labeling and two-person verification of “high-risk”/”high alert” medications
  • Label all meds and med containers as they are drawn up/poured
  • Unit-dose dispensing
  • Use pumps with built-in, customizable software to prevent infusion errors
  • Label patient lines
13

veracity

A duty to tell the truth or not to tell a lie

14

advocacy

Speaking up for those who cannot speak for themselves

15

communication is a

two way process that includes

  • language
  • mannerisms
  • symbols
16

best option for finding out if a family has a cultural belief

ASK THEM

17

bidirectional process

needs both sender and receiver

18

denotation

the dictionary meaning of a word

19

connotation

the meanings and feelings associated with a word based on an individuals past experiences

20

BEST way to make sure teaching is effective

teach back, return demonstration

21

communication during emergency situations

  • Quiet environment
  • Communicate slowly
  • Avoid medical jargon
  • Sit down/face caregivers
  • Allow time for questions
  • Avoid false hope
  • Allow for repetition
  • Empathetic and sincere
  • let them know the physican will be in
  • call clergy or social worker for assistance
22

barriers to communication

  • unaddressed fears
  • insignificant information
  • Physical abnormalities
  • Physiological alterations
  • Cognitive barriers
  • Avoidance or distancing language
  • Environmental noise
  • Cultural differences
  • Language barriers
  • Psychological alterations
  • Sender and receiver biases
23

stressors in the family

  • Environmental factors
  • Reaction to a child’s illness
24

environmental factor stressors

  • Overwhelming concern for the child
  • Feelings of neglect of other children and family structure
  • Loss of income
  • Impact on social status
  • Employment constraints like unemployment or underemployment
  • Insurance issues, including being underinsured or uninsured
  • Poverty
  • Homelessness
  • Mental illness, chronic physical illness, or catastrophic illness or injury in the family unit
  • Addition of family members placing a strain on finances
  • Lack of support systems
  • Cultural and religious constraints
  • Inadequate coping skills
  • Societal pressures, HIV, suicide
  • Inadequate public education
  • Time at work necessitating the use of day care and nonfamily care providers
25

when does trust begin?

the first encounter

26

Which of the following describes Duvall’s family development theory?

  1. . The family is a target that should be assessed and to which nursing interventions should then be applied.
  2. B. A child receives the best quality care when healthcare providers work with the parents and family.
  3. The family’s life-cycle stages are based on changes in the structure, function, and roles within the unit.
  4. The family is a unit in which members are emotionally connected and interdependent.

c. Duvall’s theory states that the family’s life-cycle stages are based on changes in the structure, function, and roles within the unit. Understanding a family’s current stage of development can assist the nurse in identifying areas where education and anticipatory guidance may be needed.

27

parenting styles

  • Authoritatian-dictatorial
  • Permissive (laissez-faire)
  • Authoritative or democratic
28

authoritation- dictatorial parenting style

  • absolute rules, strict expectations
  • children have little decision making power
  • punishment by withdrawal of approval
  • children my become shy, sensitive, loyal and honest
29

permissive (laissez-faire) parenting style

  • children control their environment and make their own decisions
  • few rules to follow
  • children may have difficulty following rules that are expected in the public environment
  • children may grow to be irresponsible, disrespectful and aggressive
30

Authoritative or democratic parenting styes

  • Combination of authoritarian and permissive styles, drawing on the positive aspects of each
  • Firm rules that allow some freedom (rules with discussion)
  • Children are taught the correlation between actions and the consequences of those actions
  • Children may become self-reliant, assertive, and display high self-esteem
31

family APGAR five item questionnaire

  • A—Adaptation
  • P—Partnership
  • G—Growth
  • A—Affection
  • R—Resolve
32

Strategies for effective communication

  • Encourage parents to talk openly regarding their concerns.
  • Use open-ended questions.
  • Use careful, nonjudgmental statements.
  • Men may prefer a focus on cognitive, problem-solving talk
  • Women may prefer a focus on the process rather than the outcome
  • Be aware and considerate of generational, cultural, and other differences.
  • Incorporate active listening skills.
  • Use silence, empathy, respect, genuineness, and trust as nursing interventions.
  • Follow the established policies and procedures the hospital has in place for communication with nontraditional and noncustodial parents.
  • Remember to observe and record nonverbal communication factors, such as tone of voice, body language, and facial expression. Be aware of your own nonverbal communication factors, and make sure you are not communicating unintended messages.
  • Allow family members to voice their understanding of the current situation.
  • Clarify or provide teaching points to decrease misunderstandings.
33

Communicating with school-age children

  • 6-12 years
  • Curiosity
  • Hands-on experiences
  • Concreteness
34

Communicating with adolescent children

  • 13-18 years
  • Independence/maturity
  • Social networks/friends
  • Sexual development
  • Behavior fluctuates
  • Independent with ADL’s but need supervision/input
  • Trust
  • Own language/culture
  • Medical decision’s may be influenced by peer group
  • Nursing interventions
35

Which of the following is an appropriate method for communication with

  1. Label the patient’s emotions to validate feelings of fear and anxiety.
  2. Use music and sounds to assist in soothing the patient.
  3. Use statements such as “good job” instead of “good boy/girl.”
  4. Explain the limits of confidentiality.

B

36

Which of the following best practices is related to effective communication

  1. Know who is responsible for making health decisions for the patient.
  2. Respect differences of opinion.
  3. Recognize appropriate boundaries and maintain those boundaries.
  4. D. All of the above.

A. While all of the options are best practices a nurse should employ, knowing who is responsible for making health decisions for the patient relates specifically to effective communication. How might communication be hindered if the nurse doesn’t know who is responsible for making health decisions for the patient?

37

FICA Assessment Tool

  • F—faith and belief
  • I—importance
  • C—community
  • A—address in care
38

A cultural assessment should evaluate which of the following areas?

  1. Religious beliefs
  2. Food preferences
  3. Typical daily schedule
  4. All of the above

D. all of the above

39

trauma is

caused by an outside force

accidental or non-accidental

40

physiological is

disease

congenital defect

41

pediatric pain control

  • Massage therapy
  • Relaxation therapy
  • Play therapy
  • Pain assessments
    • NIPS
    • FLACC
    • Faces scale
    • Visual analog scale (VAS)
42

kuber Ross theory on grief

  • Anticipatory grief
  • Denial
  • Anger
  • Bargaining or negotiation
  • Depression
  • Acceptance
43

Which of the following stages of Kübler -Ross’ theory on grief is defined correctly?

  1. Bargaining: To receive or agree with what is offered, coming to terms with the event and the associated loss.
  2. Depression: A refusal to believe that an infant or child is dead or dying
  3. Anger: An attempt to create a change in the situation through an agreement for services exchanged.
  4. Anticipatory grief: The family of a patient with a terminal diagnosis prepares for death prior to the dying process.

Anticipatory grief occurs before the other stages of grief and is common in infant and pediatric death, when the family of a patient with a terminal diagnosis prepares for death prior to the dying process.

44

Which of the following is true about family presence during a code situation?

  1. Family should never be involved in pediatric code situations.
  2. Family presence can be positive since the family knows everything possible was done to save the patient.
  3. Family members are not likely to attempt to be at the bedside.
  4. The desired outcome is for the family to help as much as possible so they feel they’ve done all they can.

B, Family presence in pediatric code situations is handled differently in all hospitals. In situations in which the family is allowed to remain present, there are both positive and negative consequences. One of the positives is the family seeing that everything possible was done to save the patient.