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Table of Contents
NCLEX® Connections 1
UNIT 1 Foundations of Nursing Care of Children 3
SECTION: Perspectives of Nursing Care of Children 3
CHAPTER 1 Family-Centered Nursing Care 3
CHAPTER 2 Physical Data Collection 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 39
CHAPTER 8 Safe Administration of Medication 39
CHAPTER 9 Pain Management 43
CHAPTER 10 Hospitalization, Illness, and Play 49
CHAPTER 11 Death and Dying 53
PN NURSING CARE OF CHILDREN TABLE OF CONTENTS V
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NCLEX® Connections 57
UNIT 2 System Disorders 59
SECTION: Neurologic Disorders 59
CHAPTER 12 Acute Neurologic Disorders 59
CHAPTER 13 Seizures 65
CHAPTER 14 Cognitive and Sensory Impairments 71
NCLEX® Connections 77
SECTION: Respiratory Disorders 79
CHAPTER 15 Oxygen and Inhalation Therapy 79
CHAPTER 16 Acute and Infectious Respiratory Illnesses 87
CHAPTER 17 Asthma 95
CHAPTER 18 Cystic Fibrosis 101
NCLEX® Connections 105
SECTION: Cardiovascular and Hematologic Disorders 107
CHAPTER 19 Cardiovascular Disorders 107
CHAPTER 20 Hematologic Disorders 121
NCLEX® Connections 129
SECTION: Gastrointestinal Disorders 131
CHAPTER 21 Acute Infectious Gastrointestinal Disorders 131
CHAPTER 22 Gastrointestinal Structural and Inflammatory Disorders 137
VI TABLE OF CONTENTS CONTENT MASTERY SERIES
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NCLEX® Connections 145
SECTION: Genitourinary and Reproductive Disorders 147
CHAPTER 23 Enuresis and Urinary Tract Infections 147
CHAPTER 24 Structural Disorders of the Genitourinary Tract and Reproductive System 151
CHAPTER 25 Kidney Disorders 155
NCLEX® Connections 163
SECTION: Musculoskeletal Disorders 165
CHAPTER 26 Fractures 165
CHAPTER 27 Musculoskeletal Congenital Disorders 171
CHAPTER 28 Chronic Neuromusculoskeletal Disorders 179
NCLEX® Connections 189
SECTION: Integumentary Disorders 191
CHAPTER 29 Skin Infections and Infestations 191
CHAPTER 30 Dermatitis and Acne 197
CHAPTER 31 Burns 203
NCLEX® Connections 209
SECTION: Endocrine Disorders 211
CHAPTER 32 Diabetes Mellitus 211
CHAPTER 33 Growth Hormone Deficiency 217
PN NURSING CARE OF CHILDREN TABLE OF CONTENTS VII
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NCLEX® Connections 221
SECTION: Immune and Infectious Disorders 223
CHAPTER 34 Immunizations 223
CHAPTER 35 Communicable Diseases 231
CHAPTER 36 Acute Otitis Media 235
CHAPTER 37 HIV/AIDS 239
NCLEX® Connections 243
SECTION: Neoplastic Disorders 245
CHAPTER 38 Pediatric Cancers 245
NCLEX® Connections 255
UNIT 3 Other Specific Needs 257
CHAPTER 39 Complications of Infants 257
CHAPTER 40 Pediatric Emergencies 271
CHAPTER 41 Psychosocial Issues of Infants, Children, and Adolescents 277
References 287
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
Concept Analysis A15
VIII TABLE OF CONTENTS CONTENT MASTERY SERIES
, CHAPTER 1
UNIT 1 FOUNDATIONS OF NURSING CARE OF CHILDREN ● Members interact with one another.
SECTION: PERSPECTIVES OF NURSING CARE OF CHILDREN ● There is a shared sense of responsibility.
There are traditions and rituals.
Family-Centered
●
●
CHAPTER 1
Nursing Care
● Members seek help for their problems.
NURSING ACTIONS
● Nurses should pay close attention when family
members state that a child “isn’t acting right” or has
Families are groups that should remain constant other concerns.
Children’s opinions should be considered when
in children’s lives. Family is defined as what an
●
providing care.
individual considers it to be.
Families often include individuals with a FAMILY THEORIES
biological, marital, or adoptive relationship,
but in the absence of these characteristics, FAMILY SYSTEMS
The family is viewed as a whole system, instead of the
families also consist of individuals who have individual members.
a strong emotional bond and commitment to ●
The system can both initiate and react to change.
one another.
●
● Too much and too little change can lead to dysfunction.
Due to the expanding concepts of family, the
term household is sometimes used. FAMILY STRESS
Describes stress as inevitable.
Positive family relationships are characterized ● Stressors can be expected or unexpected.
Explains the reaction of a family to stressful events.
by parent-child interactions that show mutual
●
●
warmth and respect.
DEVELOPMENTAL
COMPONENTS OF CARE Views families as small groups that interact with the
larger social system.
Family-centered nursing care includes the following.
● Emphasizes similarities and consistencies in how
● Agreed-upon partnerships between families of children,
families develop and change.
nurses, and providers, in which the families and
● Uses Duvall’s family life cycle stages to describe the
changes a family goes through over time.
● Respecting cultural diversity and incorporating cultural ●
views in the plan of care.
on how the family will function in the next stage.
● Understanding growth and developmental needs of
children and their families.
Treating children and their families as clients.
FAMILY COMPOSITION
●
● Working with all types of families.
● Collaborating with families regarding hospitalization, Traditional nuclear family: Married couple and their
home, and community resources. biologic children (only full brothers and sisters)
● Allowing families to serve as experts regarding their
Nuclear family: Two parents and their children (biologic,
adoptive, step, foster)
situations, and routine needs.
Single-parent family: One parent and one or more
children
PROMOTING FAMILY-CENTERED CARE
Blended family (also called reconstituted): At least one
Nurses should perform comprehensive family data
stepparent, stepsibling, or half-sibling
collection to identify strengths and weaknesses.
Extended family: At least one parent, one or more
Characteristics of healthy families
children, and other individuals (might not be related)
● Members communicate well and listen to each other.
● Gay/lesbian family (LGBT): Two members of the same sex
● There is a clear set of family rules, beliefs, and values. who have children and a legal or common-law tie
● Members teach respect for others.
Foster family: A child or children who have been placed in
● There is a sense of trust.
an approved living environment away from the family of
● Members play and share humor together.
origin, usually with one or two parents
PN NURSING CARE OF CHILDREN CHAPTER 1 FAMILY-CENTERED NURSING CARE 3
, Binuclear family: Parents who have terminated spousal GUIDELINES FOR PROMOTING
roles but continue their parenting roles ACCEPTABLE BEHAVIOR IN CHILDREN
Communal family: Individuals who share common ● Set clear and realistic limits and expectations based on
ownership of property and goods, and exchange services the developmental level of the child.
without monetary consideration ●
sympathetic explanations.
Changes that occur with the birth (or adoption) of the ● Provide role modeling and reinforcement for
appropriate behavior.
● Parents’ sense of self as they transition to the new ● Focus on the child’s behavior when disciplining
parental role
the child.
● Division of labor and roles within the relationships
of couples
Relationships with grandparents
FAMILY DATA COLLECTION
●
● Work relationships
● History: Medical history for parents, siblings, and
loss of income grandparents
● Necessary sleep habit changes
Structure: Family members (mother, father, son)
Developmental tasks: Tasks a family works on as the
PARENTING STYLES child grows (parents with a school-age child helping her
to develop peer relations)
TYPES OF PARENTING Family characteristics: Cultural, religious, and economic
Authoritarian
Family stressors: Expected (birth of a child) and
Parents try to control the child’s behaviors and attitudes unexpected (illness, divorce, disability, or death of a
through unquestioned rules and expectations. family member) events that cause stress
The child is never allowed to watch Environment: Availability of and family interactions with
television on school nights. community resources
Family support system: Availability of extended family,
Permissive
work and peer relationships, as well as social systems
Parents exert little or no control over the child’s behaviors, and community resources to assist the family in meeting
and consult the child when making decisions. needs or adapting to a stressor
The child assists with deciding whether
they will watch television.
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 homework and chores.
Parents negatively reinforce deviations from the rules.
The privilege is taken away but later
reinstated based on new guidelines.
4 CHAPTER 1 FAMILY-CENTERED NURSING CARE CONTENT MASTERY SERIES
, Application Exercises Active Learning Scenario
1. A nurse on a pediatric unit is assisting the manager A nurse is assisting providing anticipatory guidance
with preparing an education program on working to the mother of a toddler. The nurse learns that the
with families for a group of newly hired nurses. household includes the mother, toddler, an older
Which of the following should the nurse include brother, and a grandmother. Use the ATI Active Learning
when discussing the developmental theory? Template: Basic Concept to complete this item.
A. Describes that stress is inevitable
RELATED CONTENT: Describe the composition of this family.
B. Emphasizes that change with one
member affects the entire family UNDERLYING PRINCIPLES: Describe two ways the
parent can promote acceptable behavior in the child.
C. Provides guidance to assist
families adapting to stress NURSING INTERVENTIONS: Include two additional
D. Defines consistencies in how families change family data collection the nurse should perform.
2. A nurse is assisting a group of guardians of adolescents
to develop skills that will improve communication
within the family. The nurse hears one guardian 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 assisting with performing family
data collection. 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
PN NURSING CARE OF CHILDREN CHAPTER 1 FAMILY-CENTERED NURSING CARE 5
, Application Exercises Key Active Learning Scenario Key
1. A. The family stress theory describes that
stress is inevitable. RELATED CONTENT: This is an extended family, which
B. The family systems theory emphasizes that change includes at least one parent, one or more children, and
with one member affects the entire family. other individuals who are either related or not related.
C. The family stress theory provides guidance
to assist families adapting to stress. UNDERLYING PRINCIPLES: Promoting acceptable behavior
D. CORRECT: Include that the developmental theory ●
Validate the child’s feelings, and offer sympathetic explanations.
defines consistencies in how families change. ●
Provide role modeling and reinforcement for acceptable behavior.
NCLEX® ●
Set clear and realistic limits and expectations
based on the child’s developmental level.
●
Focus on the behavior when implementing discipline.
2. A. CORRECT: This parent is exhibiting an authoritarian parenting NURSING INTERVENTIONS: Family data collection
style. The parent controls the adolescent’s behaviors and
●
Medical history on parents, siblings, and grandparents
attitudes through unquestioned rules and expectations. ●
Family structure for roles/position within the family, as
B. This parent is not exhibiting a permissive parenting well as occupation and education of family members
style. Using this style, the parent exerts little or no ●
Developmental tasks a family works on as the child grows
control over the adolescent’s behaviors, and consults ●
Family characteristics (cultural, religious, and economic
the adolescent when making decisions. influences on behavior, attitudes, and actions)
C. This parent is not exhibiting an authoritative ●
Family stressors, (expected [birth of a child] and
parenting style. Using this style, the parent directs unexpected [illness of a child, divorce, disability or death
the adolescent’s behavior by setting rules and of a family member] events that cause stress)
explaining the reason for each rule setting. ●
Availability of and family interactions with community resources
D. This parent is not exhibiting a passive parenting ●
Family support systems (availability of extended family; work and
style. Using this style, the parent is uninvolved,
peer relationships; and social systems and community resources
indifferent, and emotionally removed.
to assist the family in meeting needs or adapting to a stressor)
NCLEX®
NCLEX®
Aging Process
3. A. CORRECT: Include a medical history on the
parents, siblings, and grandparents when
performing family data collection.
B. CORRECT: Include the family structure, which includes
family members, family size, roles/position within
the family, and occupation and education of family
members when performing a family assessment.
C. Include the child’s physical growth when performing
an individual assessment on the child.
D. CORRECT: Include support systems to determine
the availability of extended family, work and peer
relationships, and social systems and community
resources to assist the family in meeting needs
when performing a family assessment.
E. CORRECT: Include stressors, both expected and
unexpected, when performing a family assessment.
NCLEX®
6 CHAPTER 1 FAMILY-CENTERED NURSING CARE CONTENT MASTERY SERIES
, CHAPTER 2
UNIT 1 FOUNDATIONS OF NURSING CARE OF CHILDREN PHYSIOLOGIC AND GROWTH
SECTION: PERSPECTIVES OF NURSING CARE OF CHILDREN MEASUREMENTS
CHAPTER 2 Physical Data TEMPERATURE
Collection Findings 2.1 Temperature by age
EXPECTED LEVEL RECOMMENDED ROUTES
3 months Axillary
37.5˚ C (99.5˚ F)
●
Alter exams to accommodate chronological age 6 months ●
Rectal (if exact
1 year 37.7˚ C (99.9˚ F) measurement necessary)
and developmental needs. Involve children and
family members in examinations. Praise children ●
Axillary
3 years 37.2˚ C (99.0˚ F)
●
Tympanic
for cooperation during exams. ●
Oral (if child cooperative)
5 years 37.0˚ C (98.6˚ F)
●
Rectal (if exact
Observe for behaviors (interacting with nurse, measurement necessary)
making eye contact, permitting physical touch, 7 years 36.8˚ C (98.2˚ F)
●
Oral
9 years
and willingly sitting on the examination table) to 36.7˚ C (98.1˚ F) ●
Axillary
11 years
Tympanic
determine the child’s readiness to cooperate.
●
13 years 36.6˚ C (97.9˚ F)
Language, cognition, physical, social, and PULSE RATE
emotional development can be screened using Newborn (birth to 4 weeks): 110 to 160/min
a variety of standardized tools. A combination Infant (1 to 12 months): 90 to 160/ min
of data collected from psychosocial and medical Toddler (1 to 2 years): 80 to 140/min
Preschooler (3 to 5 years): 70 to 120/min
histories and a physical examination is used
School aged (6 to 12 years): 60 to 110/min
to determine the need to initiate a referral for Adolescent (13 to 18 years): 50 to 100/min
further evaluation. Values listed are general guidelines and may vary according to
NURSING ACTIONS RESPIRATIONS
● Keep the room warm and well lit. Newborn (birth to 4 weeks): 30 to 60/min
● Perform examinations in nonthreatening environments. Infant (1 to 12 months): 25 to 30/min
Keep medical equipment out of sight.
Toddler (1 to 2 years): 25 to 30/min
● Provide privacy. Determine whether older school-age
children and adolescents prefer a caregiver to remain Preschooler (3 to 5 years): 20 to 25/min
during examination. School aged (6 to 12 years): 20 to 25/min
● Take time to play and develop rapport prior to Adolescent (13 to 18 years): 16 to 20/min
beginning an examination. Values listed are general guidelines and may vary according to
● Observe for behaviors that demonstrate child’s
readiness to cooperate (interacting with nurse, making
eye contact, permitting physical touch, and willingly
BLOOD PRESSURE
sitting on the examination table).
● Readings should be compared with standard
● Explain each step of the examination to the child.
measurements (National High Blood Pressure Education
◯ Use age-appropriate language.
Program Working Group on High Blood Pressure in
◯ Demonstrate what will happen using dolls, puppets,
Children and Adolescents).
or paper drawings. ●
◯ Allow the child manipulate and handle equipment.
readings. (2.3)
◯ Encourage the child to use equipment on others.
Examine the child in a secure, comfortable position. For
GROWTH
●
example, a toddler can sit on a parent’s lap if desired.
● Proceed to examine the child in an organized sequence Growth can be evaluated using weight, length/height,
when possible. body mass index (BMI), and head circumference. Growth
● If the child is uncooperative, determine reasons, be charts are tools that can be used to determine the overall
health of a child.
examination quickly, and use a calm voice.
● It is recommended to use the World Health
Organizations (WHO) growth standards for infants
● Encourage the child and family to ask questions during
and children ages 0 to 2 in the United States and CDC
growth charts for children 2 years and older.
examination. ● To see growth charts by age and sex, visit the website
for the Centers for Disease Control and Prevention.
PN NURSING CARE OF CHILDREN CHAPTER 2 PHYSICAL DATA COLLECTION FINDINGS 7
, EXPECTED PHYSICAL FINDINGS HEAD AND NECK
Head
GENERAL APPEARANCE ● The shape of the head should be symmetric.
● Appears undistressed, clean, well-kept, and without ●
body odors.
closes by 8 weeks of age, and the anterior fontanel
● Muscle tone: Erect head posture is expected in infants usually closes between 12 and 18 months of age.
after 4 months of age.
● Makes eye contact when addressed (except infants). Face
● Follows simple commands as age-appropriate. ● Symmetric appearance and movement
● Uses speech, language, and motor skills spontaneously. ● Proportional features
SKIN, HAIR, AND NAILS Neck
● Short in infants
Skin ● No palpable masses
● Variations in skin color are expected. ● Midline trachea
● Temperature should be warm or slightly cool to ● Full range of motion present whether elicited actively
the touch. or passively
● Skin texture should be smooth and slightly dry, not oily.
● Skin turgor exhibits brisk elasticity with EYES
adequate hydration.
●
Eyebrows should be symmetric and evenly distributed
from the inner to the outer canthus.
● Skin folds should be symmetric.
Eyelids should close completely and open to allow the lower
Hair and scalp border and most of the upper portion of the iris to be seen.
● Hair should be evenly distributed, smooth, and strong. Eyelashes should curve outward and be evenly distributed
◯
that is stringy, dull, brittle, and dry. Conjunctiva
◯ Hair loss or balding spots on infants can indicate the ●
child is spending too much time in the same position. ●
● Scalp should be clean and absent from any scaliness,
infestations, and trauma. Lacrimal apparatus is without excessive tearing, redness,
● Examine children approaching adolescence for the or discharge.
presence of secondary hair growth. Sclera should be white.
Nails Corneas should be clear.
● Pink over the nail bed and white at the tips
●
Pupils should be:
● Round
Equal in size
LYMPH NODES
●
● Reactive to light
Lymph nodes should be nonpalpable. Lymph nodes that ● Accommodating
are small, palpable, nontender, and mobile can be an
Irises should be round with the permanent color
manifesting around 6 to 12 months of age.
2.3 Expected blood pressure ranges by age and sex
Average (50th Percentile) Hypertension (95th Percentile)
SYSTOLIC DIASTOLIC
SYSTOLIC DIASTOLIC GREATER THAN GREATER THAN
(mm Hg) (mm Hg) (mm Hg) (mm Hg)
NEWBORN (FULL TERM: BIRTH TO 4 WEEKS) 64 41 n/a
INFANT (1 MONTH TO 12 MONTHS) 85 50 n/a
MALE 85 to 91 37 to 46 103 to 109 56 to 65
TODDLER (1 YEAR TO 2 YEARS)
FEMALE 86 to 89 40 to 49 104 to 107 58 to 67
MALE 91 to 98 46 to 53 109 to 112 65 to 72
PRESCHOOLER (3 TO 5 YEARS)
FEMALE 89 to 93 49 to 52 107 to 110 67 to 72
MALE 96 to 106 55 to 62 114 to 123 74 to 81
SCHOOL AGED (6 TO 12 YEARS)
FEMALE 94 to 105 56 to 62 111 to 123 74 to 80
ADOLESCENT (13 TO 18 YEARS) less than 120 less than 80 n/a
8 CHAPTER 2 PHYSICAL DATA COLLECTION FINDINGS CONTENT MASTERY SERIES
Table of Contents
NCLEX® Connections 1
UNIT 1 Foundations of Nursing Care of Children 3
SECTION: Perspectives of Nursing Care of Children 3
CHAPTER 1 Family-Centered Nursing Care 3
CHAPTER 2 Physical Data Collection 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 39
CHAPTER 8 Safe Administration of Medication 39
CHAPTER 9 Pain Management 43
CHAPTER 10 Hospitalization, Illness, and Play 49
CHAPTER 11 Death and Dying 53
PN NURSING CARE OF CHILDREN TABLE OF CONTENTS V
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NCLEX® Connections 57
UNIT 2 System Disorders 59
SECTION: Neurologic Disorders 59
CHAPTER 12 Acute Neurologic Disorders 59
CHAPTER 13 Seizures 65
CHAPTER 14 Cognitive and Sensory Impairments 71
NCLEX® Connections 77
SECTION: Respiratory Disorders 79
CHAPTER 15 Oxygen and Inhalation Therapy 79
CHAPTER 16 Acute and Infectious Respiratory Illnesses 87
CHAPTER 17 Asthma 95
CHAPTER 18 Cystic Fibrosis 101
NCLEX® Connections 105
SECTION: Cardiovascular and Hematologic Disorders 107
CHAPTER 19 Cardiovascular Disorders 107
CHAPTER 20 Hematologic Disorders 121
NCLEX® Connections 129
SECTION: Gastrointestinal Disorders 131
CHAPTER 21 Acute Infectious Gastrointestinal Disorders 131
CHAPTER 22 Gastrointestinal Structural and Inflammatory Disorders 137
VI TABLE OF CONTENTS CONTENT MASTERY SERIES
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NCLEX® Connections 145
SECTION: Genitourinary and Reproductive Disorders 147
CHAPTER 23 Enuresis and Urinary Tract Infections 147
CHAPTER 24 Structural Disorders of the Genitourinary Tract and Reproductive System 151
CHAPTER 25 Kidney Disorders 155
NCLEX® Connections 163
SECTION: Musculoskeletal Disorders 165
CHAPTER 26 Fractures 165
CHAPTER 27 Musculoskeletal Congenital Disorders 171
CHAPTER 28 Chronic Neuromusculoskeletal Disorders 179
NCLEX® Connections 189
SECTION: Integumentary Disorders 191
CHAPTER 29 Skin Infections and Infestations 191
CHAPTER 30 Dermatitis and Acne 197
CHAPTER 31 Burns 203
NCLEX® Connections 209
SECTION: Endocrine Disorders 211
CHAPTER 32 Diabetes Mellitus 211
CHAPTER 33 Growth Hormone Deficiency 217
PN NURSING CARE OF CHILDREN TABLE OF CONTENTS VII
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NCLEX® Connections 221
SECTION: Immune and Infectious Disorders 223
CHAPTER 34 Immunizations 223
CHAPTER 35 Communicable Diseases 231
CHAPTER 36 Acute Otitis Media 235
CHAPTER 37 HIV/AIDS 239
NCLEX® Connections 243
SECTION: Neoplastic Disorders 245
CHAPTER 38 Pediatric Cancers 245
NCLEX® Connections 255
UNIT 3 Other Specific Needs 257
CHAPTER 39 Complications of Infants 257
CHAPTER 40 Pediatric Emergencies 271
CHAPTER 41 Psychosocial Issues of Infants, Children, and Adolescents 277
References 287
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
Concept Analysis A15
VIII TABLE OF CONTENTS CONTENT MASTERY SERIES
, CHAPTER 1
UNIT 1 FOUNDATIONS OF NURSING CARE OF CHILDREN ● Members interact with one another.
SECTION: PERSPECTIVES OF NURSING CARE OF CHILDREN ● There is a shared sense of responsibility.
There are traditions and rituals.
Family-Centered
●
●
CHAPTER 1
Nursing Care
● Members seek help for their problems.
NURSING ACTIONS
● Nurses should pay close attention when family
members state that a child “isn’t acting right” or has
Families are groups that should remain constant other concerns.
Children’s opinions should be considered when
in children’s lives. Family is defined as what an
●
providing care.
individual considers it to be.
Families often include individuals with a FAMILY THEORIES
biological, marital, or adoptive relationship,
but in the absence of these characteristics, FAMILY SYSTEMS
The family is viewed as a whole system, instead of the
families also consist of individuals who have individual members.
a strong emotional bond and commitment to ●
The system can both initiate and react to change.
one another.
●
● Too much and too little change can lead to dysfunction.
Due to the expanding concepts of family, the
term household is sometimes used. FAMILY STRESS
Describes stress as inevitable.
Positive family relationships are characterized ● Stressors can be expected or unexpected.
Explains the reaction of a family to stressful events.
by parent-child interactions that show mutual
●
●
warmth and respect.
DEVELOPMENTAL
COMPONENTS OF CARE Views families as small groups that interact with the
larger social system.
Family-centered nursing care includes the following.
● Emphasizes similarities and consistencies in how
● Agreed-upon partnerships between families of children,
families develop and change.
nurses, and providers, in which the families and
● Uses Duvall’s family life cycle stages to describe the
changes a family goes through over time.
● Respecting cultural diversity and incorporating cultural ●
views in the plan of care.
on how the family will function in the next stage.
● Understanding growth and developmental needs of
children and their families.
Treating children and their families as clients.
FAMILY COMPOSITION
●
● Working with all types of families.
● Collaborating with families regarding hospitalization, Traditional nuclear family: Married couple and their
home, and community resources. biologic children (only full brothers and sisters)
● Allowing families to serve as experts regarding their
Nuclear family: Two parents and their children (biologic,
adoptive, step, foster)
situations, and routine needs.
Single-parent family: One parent and one or more
children
PROMOTING FAMILY-CENTERED CARE
Blended family (also called reconstituted): At least one
Nurses should perform comprehensive family data
stepparent, stepsibling, or half-sibling
collection to identify strengths and weaknesses.
Extended family: At least one parent, one or more
Characteristics of healthy families
children, and other individuals (might not be related)
● Members communicate well and listen to each other.
● Gay/lesbian family (LGBT): Two members of the same sex
● There is a clear set of family rules, beliefs, and values. who have children and a legal or common-law tie
● Members teach respect for others.
Foster family: A child or children who have been placed in
● There is a sense of trust.
an approved living environment away from the family of
● Members play and share humor together.
origin, usually with one or two parents
PN NURSING CARE OF CHILDREN CHAPTER 1 FAMILY-CENTERED NURSING CARE 3
, Binuclear family: Parents who have terminated spousal GUIDELINES FOR PROMOTING
roles but continue their parenting roles ACCEPTABLE BEHAVIOR IN CHILDREN
Communal family: Individuals who share common ● Set clear and realistic limits and expectations based on
ownership of property and goods, and exchange services the developmental level of the child.
without monetary consideration ●
sympathetic explanations.
Changes that occur with the birth (or adoption) of the ● Provide role modeling and reinforcement for
appropriate behavior.
● Parents’ sense of self as they transition to the new ● Focus on the child’s behavior when disciplining
parental role
the child.
● Division of labor and roles within the relationships
of couples
Relationships with grandparents
FAMILY DATA COLLECTION
●
● Work relationships
● History: Medical history for parents, siblings, and
loss of income grandparents
● Necessary sleep habit changes
Structure: Family members (mother, father, son)
Developmental tasks: Tasks a family works on as the
PARENTING STYLES child grows (parents with a school-age child helping her
to develop peer relations)
TYPES OF PARENTING Family characteristics: Cultural, religious, and economic
Authoritarian
Family stressors: Expected (birth of a child) and
Parents try to control the child’s behaviors and attitudes unexpected (illness, divorce, disability, or death of a
through unquestioned rules and expectations. family member) events that cause stress
The child is never allowed to watch Environment: Availability of and family interactions with
television on school nights. community resources
Family support system: Availability of extended family,
Permissive
work and peer relationships, as well as social systems
Parents exert little or no control over the child’s behaviors, and community resources to assist the family in meeting
and consult the child when making decisions. needs or adapting to a stressor
The child assists with deciding whether
they will watch television.
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 homework and chores.
Parents negatively reinforce deviations from the rules.
The privilege is taken away but later
reinstated based on new guidelines.
4 CHAPTER 1 FAMILY-CENTERED NURSING CARE CONTENT MASTERY SERIES
, Application Exercises Active Learning Scenario
1. A nurse on a pediatric unit is assisting the manager A nurse is assisting providing anticipatory guidance
with preparing an education program on working to the mother of a toddler. The nurse learns that the
with families for a group of newly hired nurses. household includes the mother, toddler, an older
Which of the following should the nurse include brother, and a grandmother. Use the ATI Active Learning
when discussing the developmental theory? Template: Basic Concept to complete this item.
A. Describes that stress is inevitable
RELATED CONTENT: Describe the composition of this family.
B. Emphasizes that change with one
member affects the entire family UNDERLYING PRINCIPLES: Describe two ways the
parent can promote acceptable behavior in the child.
C. Provides guidance to assist
families adapting to stress NURSING INTERVENTIONS: Include two additional
D. Defines consistencies in how families change family data collection the nurse should perform.
2. A nurse is assisting a group of guardians of adolescents
to develop skills that will improve communication
within the family. The nurse hears one guardian 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 assisting with performing family
data collection. 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
PN NURSING CARE OF CHILDREN CHAPTER 1 FAMILY-CENTERED NURSING CARE 5
, Application Exercises Key Active Learning Scenario Key
1. A. The family stress theory describes that
stress is inevitable. RELATED CONTENT: This is an extended family, which
B. The family systems theory emphasizes that change includes at least one parent, one or more children, and
with one member affects the entire family. other individuals who are either related or not related.
C. The family stress theory provides guidance
to assist families adapting to stress. UNDERLYING PRINCIPLES: Promoting acceptable behavior
D. CORRECT: Include that the developmental theory ●
Validate the child’s feelings, and offer sympathetic explanations.
defines consistencies in how families change. ●
Provide role modeling and reinforcement for acceptable behavior.
NCLEX® ●
Set clear and realistic limits and expectations
based on the child’s developmental level.
●
Focus on the behavior when implementing discipline.
2. A. CORRECT: This parent is exhibiting an authoritarian parenting NURSING INTERVENTIONS: Family data collection
style. The parent controls the adolescent’s behaviors and
●
Medical history on parents, siblings, and grandparents
attitudes through unquestioned rules and expectations. ●
Family structure for roles/position within the family, as
B. This parent is not exhibiting a permissive parenting well as occupation and education of family members
style. Using this style, the parent exerts little or no ●
Developmental tasks a family works on as the child grows
control over the adolescent’s behaviors, and consults ●
Family characteristics (cultural, religious, and economic
the adolescent when making decisions. influences on behavior, attitudes, and actions)
C. This parent is not exhibiting an authoritative ●
Family stressors, (expected [birth of a child] and
parenting style. Using this style, the parent directs unexpected [illness of a child, divorce, disability or death
the adolescent’s behavior by setting rules and of a family member] events that cause stress)
explaining the reason for each rule setting. ●
Availability of and family interactions with community resources
D. This parent is not exhibiting a passive parenting ●
Family support systems (availability of extended family; work and
style. Using this style, the parent is uninvolved,
peer relationships; and social systems and community resources
indifferent, and emotionally removed.
to assist the family in meeting needs or adapting to a stressor)
NCLEX®
NCLEX®
Aging Process
3. A. CORRECT: Include a medical history on the
parents, siblings, and grandparents when
performing family data collection.
B. CORRECT: Include the family structure, which includes
family members, family size, roles/position within
the family, and occupation and education of family
members when performing a family assessment.
C. Include the child’s physical growth when performing
an individual assessment on the child.
D. CORRECT: Include support systems to determine
the availability of extended family, work and peer
relationships, and social systems and community
resources to assist the family in meeting needs
when performing a family assessment.
E. CORRECT: Include stressors, both expected and
unexpected, when performing a family assessment.
NCLEX®
6 CHAPTER 1 FAMILY-CENTERED NURSING CARE CONTENT MASTERY SERIES
, CHAPTER 2
UNIT 1 FOUNDATIONS OF NURSING CARE OF CHILDREN PHYSIOLOGIC AND GROWTH
SECTION: PERSPECTIVES OF NURSING CARE OF CHILDREN MEASUREMENTS
CHAPTER 2 Physical Data TEMPERATURE
Collection Findings 2.1 Temperature by age
EXPECTED LEVEL RECOMMENDED ROUTES
3 months Axillary
37.5˚ C (99.5˚ F)
●
Alter exams to accommodate chronological age 6 months ●
Rectal (if exact
1 year 37.7˚ C (99.9˚ F) measurement necessary)
and developmental needs. Involve children and
family members in examinations. Praise children ●
Axillary
3 years 37.2˚ C (99.0˚ F)
●
Tympanic
for cooperation during exams. ●
Oral (if child cooperative)
5 years 37.0˚ C (98.6˚ F)
●
Rectal (if exact
Observe for behaviors (interacting with nurse, measurement necessary)
making eye contact, permitting physical touch, 7 years 36.8˚ C (98.2˚ F)
●
Oral
9 years
and willingly sitting on the examination table) to 36.7˚ C (98.1˚ F) ●
Axillary
11 years
Tympanic
determine the child’s readiness to cooperate.
●
13 years 36.6˚ C (97.9˚ F)
Language, cognition, physical, social, and PULSE RATE
emotional development can be screened using Newborn (birth to 4 weeks): 110 to 160/min
a variety of standardized tools. A combination Infant (1 to 12 months): 90 to 160/ min
of data collected from psychosocial and medical Toddler (1 to 2 years): 80 to 140/min
Preschooler (3 to 5 years): 70 to 120/min
histories and a physical examination is used
School aged (6 to 12 years): 60 to 110/min
to determine the need to initiate a referral for Adolescent (13 to 18 years): 50 to 100/min
further evaluation. Values listed are general guidelines and may vary according to
NURSING ACTIONS RESPIRATIONS
● Keep the room warm and well lit. Newborn (birth to 4 weeks): 30 to 60/min
● Perform examinations in nonthreatening environments. Infant (1 to 12 months): 25 to 30/min
Keep medical equipment out of sight.
Toddler (1 to 2 years): 25 to 30/min
● Provide privacy. Determine whether older school-age
children and adolescents prefer a caregiver to remain Preschooler (3 to 5 years): 20 to 25/min
during examination. School aged (6 to 12 years): 20 to 25/min
● Take time to play and develop rapport prior to Adolescent (13 to 18 years): 16 to 20/min
beginning an examination. Values listed are general guidelines and may vary according to
● Observe for behaviors that demonstrate child’s
readiness to cooperate (interacting with nurse, making
eye contact, permitting physical touch, and willingly
BLOOD PRESSURE
sitting on the examination table).
● Readings should be compared with standard
● Explain each step of the examination to the child.
measurements (National High Blood Pressure Education
◯ Use age-appropriate language.
Program Working Group on High Blood Pressure in
◯ Demonstrate what will happen using dolls, puppets,
Children and Adolescents).
or paper drawings. ●
◯ Allow the child manipulate and handle equipment.
readings. (2.3)
◯ Encourage the child to use equipment on others.
Examine the child in a secure, comfortable position. For
GROWTH
●
example, a toddler can sit on a parent’s lap if desired.
● Proceed to examine the child in an organized sequence Growth can be evaluated using weight, length/height,
when possible. body mass index (BMI), and head circumference. Growth
● If the child is uncooperative, determine reasons, be charts are tools that can be used to determine the overall
health of a child.
examination quickly, and use a calm voice.
● It is recommended to use the World Health
Organizations (WHO) growth standards for infants
● Encourage the child and family to ask questions during
and children ages 0 to 2 in the United States and CDC
growth charts for children 2 years and older.
examination. ● To see growth charts by age and sex, visit the website
for the Centers for Disease Control and Prevention.
PN NURSING CARE OF CHILDREN CHAPTER 2 PHYSICAL DATA COLLECTION FINDINGS 7
, EXPECTED PHYSICAL FINDINGS HEAD AND NECK
Head
GENERAL APPEARANCE ● The shape of the head should be symmetric.
● Appears undistressed, clean, well-kept, and without ●
body odors.
closes by 8 weeks of age, and the anterior fontanel
● Muscle tone: Erect head posture is expected in infants usually closes between 12 and 18 months of age.
after 4 months of age.
● Makes eye contact when addressed (except infants). Face
● Follows simple commands as age-appropriate. ● Symmetric appearance and movement
● Uses speech, language, and motor skills spontaneously. ● Proportional features
SKIN, HAIR, AND NAILS Neck
● Short in infants
Skin ● No palpable masses
● Variations in skin color are expected. ● Midline trachea
● Temperature should be warm or slightly cool to ● Full range of motion present whether elicited actively
the touch. or passively
● Skin texture should be smooth and slightly dry, not oily.
● Skin turgor exhibits brisk elasticity with EYES
adequate hydration.
●
Eyebrows should be symmetric and evenly distributed
from the inner to the outer canthus.
● Skin folds should be symmetric.
Eyelids should close completely and open to allow the lower
Hair and scalp border and most of the upper portion of the iris to be seen.
● Hair should be evenly distributed, smooth, and strong. Eyelashes should curve outward and be evenly distributed
◯
that is stringy, dull, brittle, and dry. Conjunctiva
◯ Hair loss or balding spots on infants can indicate the ●
child is spending too much time in the same position. ●
● Scalp should be clean and absent from any scaliness,
infestations, and trauma. Lacrimal apparatus is without excessive tearing, redness,
● Examine children approaching adolescence for the or discharge.
presence of secondary hair growth. Sclera should be white.
Nails Corneas should be clear.
● Pink over the nail bed and white at the tips
●
Pupils should be:
● Round
Equal in size
LYMPH NODES
●
● Reactive to light
Lymph nodes should be nonpalpable. Lymph nodes that ● Accommodating
are small, palpable, nontender, and mobile can be an
Irises should be round with the permanent color
manifesting around 6 to 12 months of age.
2.3 Expected blood pressure ranges by age and sex
Average (50th Percentile) Hypertension (95th Percentile)
SYSTOLIC DIASTOLIC
SYSTOLIC DIASTOLIC GREATER THAN GREATER THAN
(mm Hg) (mm Hg) (mm Hg) (mm Hg)
NEWBORN (FULL TERM: BIRTH TO 4 WEEKS) 64 41 n/a
INFANT (1 MONTH TO 12 MONTHS) 85 50 n/a
MALE 85 to 91 37 to 46 103 to 109 56 to 65
TODDLER (1 YEAR TO 2 YEARS)
FEMALE 86 to 89 40 to 49 104 to 107 58 to 67
MALE 91 to 98 46 to 53 109 to 112 65 to 72
PRESCHOOLER (3 TO 5 YEARS)
FEMALE 89 to 93 49 to 52 107 to 110 67 to 72
MALE 96 to 106 55 to 62 114 to 123 74 to 81
SCHOOL AGED (6 TO 12 YEARS)
FEMALE 94 to 105 56 to 62 111 to 123 74 to 80
ADOLESCENT (13 TO 18 YEARS) less than 120 less than 80 n/a
8 CHAPTER 2 PHYSICAL DATA COLLECTION FINDINGS CONTENT MASTERY SERIES
