This is completed downloadable of Maternal-Child Nursing McKinney 4th Edition Test Bank
Product Details:
- ISBN-10 : 1437727751
- ISBN-13 : 978-1437727753
- Author:
Ideal for accelerated maternity and pediatrics courses, Maternal-Child Nursing, 4th Edition is filled with user-friendly features to help you quickly master essential concepts and skills. It offers completely updated content that’s easy to read and understand. Plus, active learning tools give you the chance to practice applying your knowledge and make learning fun!
Table of Content:
- Front Matter
- Contributors
- Reviewers
- Preface
- Concepts
- Features
- Objectives
- Nursing Process
- Critical Thinking Exercises
- Evidence-Based Practice
- Critical Alerts
- Want to Know
- Health Promotion
- Clinical Reference Pages
- Pathophysiology
- Procedures
- Drug Guides
- Key Concepts
- Ancillaries
- For Students
- For Instructors
- Acknowledgments
- Interactive Review – Maternal-Child Nursing Care
- Introduction to Maternal-Child Health Nursing
- Interactive Review – Introduction to Maternal-Child Nursing
- Chapter 1 Foundations of Maternity, Women’s Health, and Child Health Nursing
- Learning Objectives
- Historical Perspectives
- Maternity Nursing
- “Granny” Midwives
- Emergence of Medical Management
- Government Involvement in Maternal-Infant Care
- TABLE 1-1 FEDERAL PROJECTS FOR MATERNAL-CHILD CARE
- Impact of Consumer Demands on Health Care
- Development of Family-Centered Maternity Care
- Current Settings for Childbirth
- Traditional Hospital Setting
- Labor, Delivery, and Recovery Rooms
- FIG 1-1 A typical labor, delivery, and recovery room. Home-like furnishings (A) can be adapted quickly to reveal needed technical equipment (B).
- Labor, Delivery, Recovery, and Postpartum Rooms
- Birth Centers
- Home Births
- Nursing of Children
- Historical Perspectives
- Societal Changes
- Hygiene and Hospitalization
- Development of Family-Centered Child Care
- Current Trends in Child Health Care
- Cost Containment
- Diagnosis-Related Groups
- Managed care ExemplarManaged care organizations ExemplarManaged Care
- Capitated Care
- Effects of Cost Containment
- Case management ExemplarNurse case management ExemplarCase Management
- Evidence-Based Nursing Care
- Outcomes Management
- Nurse Sensitive Indicators
- Variances
- Clinical Pathways
- Home care models ExemplarHome Care
- Community Care
- Access to Care
- Public Health Insurance Programs
- FIG 1-2 Uninsured Children by Poverty Status, Household Income, Age, Race and Hispanic Origin, and Nativity, 2009. Federal surveys now give respondents the option of reporting more than one race. This figure shows data using the race-alone concept. For example, Asian refers to people who reported Asian and no other race.
- Preventative health activities ExemplarPreventive Health
- Health Care Assistance Programs
- Statistics on Maternal, Infant, and Child Health
- Maternal and Infant Mortality
- Maternal Mortality
- FIG 1-3 Infant mortality rates, 1950-2007
- Infant Mortality
- Racial Disparity for Mortality
- TABLE 1-2 INFANT MORTALITY DATA FOR SELECTED COUNTRIES (BASED ON 2007 DATA)
- International Infant Mortality
- TABLE 1-3 LEADING CAUSES OF DEATH AMONG CHILDREN AGES 1 TO 14 YEARS: DEATH RATES PER 100,000
- Adolescent Births
- Childhood Mortality
- Morbidity
- Ethics ExemplarEthical Perspectives on Maternity, Women’s Health, and Child Nursing
- Ethics and Bioethics
- Ethical Dilemmas
- Ethical Principles
- BOX 1-1 ETHICAL PRINCIPLES
- Solving Ethical Dilemmas
- Ethical Concerns in Reproduction
- Elective Pregnancy Termination
- Belief that Induced Abortion is a Private Choice
- BOX 1-2 SUPREME COURT DECISIONS ON ABORTION SINCE ROE V. WADE
- Belief that Elective Pregnancy Termination is Taking a Life
- Implications for Nurses
- Fetal Injury
- Ethical Concerns in Child Health Nursing
- Cessation of Treatment
- Terminating Life Support
- Social Issues
- Poverty
- Homelessness
- FIG 1-4 The cycle of poverty.
- Prenatal Care in the United States
- Government Programs for Health Care: Medicaid
- Distribution of health care ExemplarAllocation of Health Care Resources
- Care versus Cure
- Health Care Rationing
- Violence
- Legal Issues
- Safeguards for Health Care
- Scope of practice education requirements ExemplarNurse Practice Acts
- Standards of Care
- Agency Policies
- Accountability
- Malpractice
- NURSING QUALITY ALERT: Elements of Negligence
- Prevention of Malpractice Claims
- Informed consent ExemplarInformed Consent
- NURSING QUALITY ALERT: Requirements of Informed Consent
- Competence
- Full Disclosure
- Understanding of Information
- Voluntary Consent
- Refusal of Care
- Adoption
- Documentation
- Discharge teaching ExemplarDocumenting Discharge Teaching
- Disclosure of medical errors ExemplarDocumenting Incidents
- The Nurse as an Advocate
- Maintaining Expertise
- Current Trends and Their Legal and Ethical Implications
- Use of Unlicensed Assistive Personnel
- Concerns about Early Discharge
- Dealing with Early Discharge
- KEY CONCEPTS
- References and Readings
- Chapter 2 The Nurse’s Role in Maternity, Women’s Health, and Pediatric Nursing
- Learning Objectives
- The Role of the Professional Nurse
- BOX 2-1 ANA CODE OF ETHICS FOR NURSES
- Care Provider
- FIG 2-1 In the prenatal clinic, the nurse teaches a woman one-on-one.
- Teacher
- Factors Influencing Learning
- Principles of Teaching and Learning
- Collaborator
- Researcher
- Advocate
- Manager of Care
- Advanced Preparation for Maternity and Pediatric Nurses
- Certified Nurse-Midwives
- Nurse Practitioners
- Clinical Nurse Specialists
- Clinical Nurse Leaders
- Implications of Changing Roles for Nurses
- Therapeutic Communication
- Guidelines for Therapeutic Communication
- Therapeutic Communication Techniques
- Critical Thinking
- The Purpose of Critical Thinking
- Steps in Critical Thinking
- A Recognizing Assumptions
- B Examining Biases
- C Analyzing the Need for Closure
- D Data management Exemplar Managing Data
- Collecting Data
- Validating Data
- Organizing and Analyzing Data
- E Evaluating Other Factors
- The Nursing Process in Maternity and Pediatric Care
- BOX 2-2 COMMUNICATION TECHNIQUES
- TABLE 2-1 BEHAVIORS THAT BLOCK COMMUNICATION
- Assessment
- Screening Assessment
- Focused Assessment
- Nursing Diagnosis
- BOX 2-3 DEVELOPING INDIVIDUALIZED NURSING CARE THROUGH THE NURSING PROCESS
- Assessment
- Analysis
- Planning
- Implementing Nursing Interventions
- Evaluation
- Planning
- Setting Priorities
- Establishing Goals and Expected Outcomes
- Implementation
- Evaluation
- Complementary and Alternative Medicine
- Research studies ExemplarNursing Research and Evidence-Based Practice
- KEY CONCEPTS
- References and Readings
- Chapter 3 The Childbearing and Child-Rearing Family
- Learning Objectives
- Family-Centered Care
- Family Structure
- FIG 3-1 Traditional, two-parent families typically have the resources to prepare for childbirth and the needs of infants.
- Types of Families
- Traditional Families
- Nontraditional Families
- Single-Parent Families
- Blended Families
- Adoptive Families
- Multigenerational Families
- FIG 3-2 A nurse caring for a child needs to know the child’s family structure and the identity of the child’s primary caregiver. This background becomes the context in which the nurse provides care. If family support is a concern, the nurse can provide information about local community resources. For example, in some communities, after-school programs and “warm lines” can help children with schoolwork and alleviate loneliness and fear.
- Same-Sex Parent Families
- Communal Families
- Characteristics of Healthy Families
- Factors that Interfere with Family Functioning
- High-Risk Families
- Marital Conflict and Divorce
- Adolescent Parenting
- Violence
- Substance Abuse
- Child with Special Needs
- Healthy Versus Dysfunctional Families
- Coping with Stress
- Coping Strategies
- BOX 3-1 COPING STRATEGIES OF FAMILIES
- Internal Coping Strategies
- Relationship Strategies
- Cognitive Strategies
- Communication Strategies
- External Coping Strategies
- Community Strategy: Maintaining Active Linkages with the Community
- Social Support Strategies
- Spiritual Strategies
- Cultural Influences on Maternity and Pediatric Nursing
- FIG 3-3 Visible and hidden layers of culture are like the visible and submerged parts of an iceberg. Many cultural differences are hidden below the surface.
- Implications of Cultural Diversity for Nurses
- Western Cultural Beliefs
- TABLE 3-1 RELIGIOUS BELIEFS AFFECTING HEALTH CARE
- Cultural Influences on the Care of People from Specific Groups
- Asians and Pacific Islanders
- Hispanics
- African-Americans
- American Indians and Alaska Natives
- Middle Easterners
- Cross-Cultural Health Beliefs
- Traditional Methods of Preventing Illness
- Traditional Practices to Maintain Health
- Traditional Practices to Restore Health
- Cultural Assessment
- Parenting
- Parenting Styles
- Parent-Child Relationship Factors
- Parental Characteristics
- Characteristics of the Child
- Temperament and Parental Expectations
- BOX 3-2 CHARACTERISTICS OF TEMPERAMENT IN CHILDREN
- Discipline
- BOX 3-3 EFFECTIVE DISCIPLINE FOR POSITIVE SOCIALIZATION AND SELF-ESTEEM
- Dealing with Misbehavior
- Redirection
- Reasoning
- Time-Out
- Consequences
- Behavior Modification
- SAFETY ALERT: Avoiding the Use of Corporal Punishment as Discipline
- Corporal Punishment
- Nursing Process and the Family
- Family Assessment
- Nursing Diagnosis and Planning
- Intervention and Evaluation
- CRITICAL THINKING EXERCISE 3-1
- KEY CONCEPTS
- References and Readings
- Chapter 4 Communicating with Children and Families
- Learning Objectives
- Components of Effective Communication
- Touch
- FIG 4-1 Communication with children is enhanced by direct eye contact and by body language that conveys attentiveness and openness.
- Physical Proximity and Environment
- FIG 4-2 For effective communication, the nurse needs to be at the child’s eye level.
- Listening
- Attentiveness
- Clarification through Reflection
- Empathy
- Impartiality
- Visual Communication
- NURSING QUALITY ALERT: Tips to Enhance Listening and Communication Skills
- Tone of Voice
- TABLE 4-1 OPEN AND CLOSED BODY POSTURES
- Body Language
- Timing
- Family-Centered Communication
- NURSING QUALITY ALERT: Communicating with Families
- Establishing Rapport
- Availability and Openness to Questions
- FIG 4-3 The child’s continuing health care, both preventive and during illness, is enhanced by participation of the family.
- Family Education and Empowerment
- Effective Management of Conflict
- BOX 4-1 STRATEGIES FOR MANAGING CONFLICT
- TABLE 4-2 CHOOSING WORDS CAREFULLY
- Feedback from Children and Families
- Spirituality
- Transcultural Communication: Bridging the Gap
- BOX 4-2 WARNING SIGNS OF OVERINVOLVEMENT
- BOX 4-3 WARNING SIGNS OF UNDERINVOLVEMENT
- Therapeutic Relationships: Developing and Maintaining Trust
- NURSING QUALITY ALERT: Maintaining a Therapeutic Relationship
- Nursing Care
- Communicating with Children and Families
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- CRITICAL THINKING EXERCISE 4-1
- Interventions
- TABLE 4-3 DEVELOPMENTAL MILESTONES AND THEIR RELATIONSHIP TO COMMUNICATION APPROACHES
- Play
- BOX 4-4 STORYTELLING STRATEGIES
- Storytelling
- Explaining Procedures and Treatments
- Strategies for Enhancing Self-Esteem
- TABLE 4-4 CONSIDERATIONS IN CHOOSING LANGUAGE
- TABLE 4-5 SELF-ESTEEM IN CHILDREN: COMMUNICATION PRACTICES
- Evaluation
- Communicating with Children with Special Needs
- The Child with a Visual Impairment
- NURSING QUALITY ALERT: Communicating with Children with Special Needs
- The Child with a Hearing Impairment
- The Child Who Speaks Another Language
- The Child with Other Communication Challenges
- The Child with a Profound Neurologic Impairment
- KEY CONCEPTS
- References and Readings
- Chapter 5 Health Promotion for the Developing Child
- Learning Objectives
- Overview of Growth and Development
- Definition of Terms
- TABLE 5-1 STAGES OF GROWTH AND DEVELOPMENT The Following Stages and Age-Groupings Refer to Stages of Childhood Growth and Development
- Stages of Growth and Development
- Parameters of Growth
- Principles of Growth and Development
- Patterns of Growth and Development
- FIG 5-1 Changes in body proportions with growth.
- BOX 5-1 PATTERNS OF GROWTH AND DEVELOPMENT
- BOX 5-2 DIRECTIONAL PATTERNS OF GROWTH AND DEVELOPMENT
- Cephalocaudal Pattern (Head to Toe)
- Examples
- Proximodistal Pattern (from the Center Outward)
- Examples
- Critical Periods
- Factors Influencing Growth and Development
- Genetics
- Environment
- Culture
- FIG 5-2 Pediatric environmental history (0 to 18 years of age).
- Nutrition
- Health Status
- Family
- Parental Attitudes
- Child-Rearing Philosophies
- Theories of Growth and Development
- Piaget’s Theory of Cognitive Development
- Nursing Implications of Piaget’s Theory
- Freud’s Theory of Psychosexual Development
- TABLE 5-2 THEORIES OF GROWTH AND DEVELOPMENT
- Nursing Implications of Freud’s Theory
- Erikson’s Psychosocial Theory
- Nursing Implications of Erikson’s Theory
- Kohlberg’s Theory of Moral Development
- Nursing Implications of Kohlberg’s Theory
- Theories of Language Development
- Assessment of Growth
- Assessment of Development
- Denver Developmental Screening Test II (DDST-II)
- Nurse’s Role in Promoting Optimal Growth and Development
- Developmental Assessment
- Interviewing ExemplarInterview
- Play
- Classifications of Play
- Social Aspects of Play
- Solitary Play
- Parallel Play
- Associative Play
- Cooperative Play
- Onlooker Play
- Types of Play
- Dramatic Play
- Familiarization Play
- FIG 5-3 Types of play.
- Functions of Play
- Physical Development and Play
- Cognitive Development
- Emotional Development
- Social Development
- Moral Development
- Health Promotion
- Vaccination ExemplarImmunizations
- Active and Passive Immunity
- SAFETY ALERT: Preventing Vaccine Reactions
- Obstacles to Immunizations
- Informed Consent
- BOX 5-3 BARRIERS TO IMMUNIZATION
- Immunization Schedule
- Children with an Uncertain History of Immunization
- Administration of Vaccines
- Precautions and Contraindications
- BOX 5-4 NURSING RESPONSIBILITY IN ADMINISTERING VACCINES
- SAFETY ALERT: Special Considerations Related to Immunizations
- BOX 5-5 COMMON MISCONCEPTIONS ABOUT ADMINISTRATION AND SAFETY OF VACCINES
- Immunocompromised Children
- Education
- Nutrition and Activity
- Carbohydrates
- Fats
- Proteins
- Water
- Vitamins and Minerals
- Dietary Guidelines
- BOX 5-6 KEY DIETARY RECOMMENDATIONS SPECIFIC TO CHILDREN AND ADOLESCENTS
- Energy, Calories, and Servings
- Physical Activity
- FIG 5-4 MyPlate.
- Cultural and Religious Influences on Diet
- Assessment of Nutritional Status
- Anthropometric Data
- Clinical Evaluation
- Dietary History
- Twenty-Four-Hour Recall
- Food Frequency Questionnaire
- Food Diary
- Safety
- Injury prevention ExemplarInjury Prevention
- Anticipatory Guidance
- BOX 5-7 WHAT NURSES CAN DO TO PREVENT CHILDHOOD INJURIES
- SAFETY ALERT: Relationship Between Safety and Childhood Development
- Teaching Strategies
- KEY CONCEPTS
- References and Readings
- Chapter 6 Health Promotion for the Infant
- Learning Objectives
- Growth and Development of the Infant
- TABLE 6-1 SUMMARY OF GROWTH AND DEVELOPMENT: THE INFANT
- HEALTH PROMOTION: Healthy People 2020 Objectives for Infants
- Physical Growth and Maturation of Body Systems
- Neurologic System
- Respiratory System
- Cardiovascular System
- Safety Alert: Risks Caused by the Infant’s Immature Body Systems
- Immune System
- Gastrointestinal System
- Renal System
- Motor Development
- PATIENT-CENTERED TEACHING: How to “Baby-Proof” the Home
- Cognitive Development
- NURSING QUALITY ALERT: Possible Signs of Developmental Delays
- Sensory Development
- Vision
- Hearing
- BOX 6-1 LANGUAGE DEVELOPMENT AND DEVELOPMENTAL MILESTONES IN INFANCY
- 1 to 3 Months
- 3 to 4 Months
- 4 to 6 Months
- 6 to 8 Months
- 8 to 9 Months
- 9 to 12 Months
- Language Development
- FIG 6-1 This 6-month-old infant responds delightedly to her mother with a true social smile. Such interactive responses between parent and child promote communication and emotional development.
- Psychosocial Development
- Parent-Infant Attachment
- Stranger Anxiety
- Health Promotion for the Infant and Family
- CRITICAL THINKING EXERCISE 6-1
- Immunization
- BOX 6-2 CONTINUING ASSESSMENT QUESTIONS
- Feeding and Nutrition
- NURSING QUALITY ALERT: Essential Information for Infant Nutrition
- Factors Influencing Choice of Feeding Method
- Breastfeeding
- Formula Feeding
- Types of Formula
- Cow’s Milk
- EVIDENCE-BASED PRACTICE
- Formula Feeding Techniques
- Weaning
- Juices
- Water
- Solid Foods
- BOX 6-3 READINESS FOR INTRODUCTION OF SOLIDS
- Finger Foods
- Health Promotion: 2-Week-Old to 1-Month-Old Infant
- Focused Assessment
- Developmental Milestones
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Snacks
- Food Allergies
- HEALTH PROMOTION: The 2-Month-Old Infant
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Play
- Dental Care
- Teething
- Assessment of Dental Risk
- Cleaning Teeth
- Fluoride Supplementation
- Bottle-Mouth Caries
- HEALTH PROMOTION: The 4-Month-Old Infant
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Play
- Sleep and Rest
- Safety
- Motor Vehicle Safety
- FIG 6-2 The infant rides facing the rear of the vehicle, ideally in the middle of the back seat. The infant seat is secured to the vehicle with the seatbelt, and straps on the car seat adjust to accommodate the growing baby.
- FIG 6-3 After the child reaches 2 years of age and has attained the manufacturer’s height and weight recommendations for a rear-facing car seat, the child uses a forward-facing upright car safety seat. The safety straps should be adjusted to provide a snug fit, and the seat should be placed in the back seat of the car, ideally in the middle.
- Providing a Safe Home Environment
- Burn Prevention
- Safe Baby Furnishings
- PATIENT-CENTERED TEACHING: Crib Safety
- Fall prevention ExemplarPreventing Falls
- FIG 6-4 Safety education for parents of infants should emphasize the need for constant supervision and the use of restraining devices to prevent falls.
- HEALTH PROMOTION: The 6-Month-Old Infant
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Play
- Preventing Asphyxiation
- BOX 6-4 LEAD EXPOSURE RISK ASSESSMENT
- Preventing Lead Exposure
- Concerns during Infancy
- Patterns of Crying
- HEALTH PROMOTION: The 9-Month-Old Infant
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Play
- The Infant with Colic
- Etiology
- Management
- Nursing Considerations
- HEALTH PROMOTION: The 12-Month-Old Infant
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Play
- KEY CONCEPTS
- References and Readings
- Chapter 7 Health Promotion During Early Childhood
- Learning Objectives
- Growth and Development During Early Childhood
- FIG 7-1 Growth and development of the toddler.
- Physical Growth and Development
- The Toddler
- The Preschooler
- FIG 7-2 Growth and development of the preschooler.
- HEALTH PROMOTION: Healthy People 2020 Objectives for Toddlers and Preschoolers
- Motor Development
- The Toddler
- The Preschooler
- Cognitive and Sensory Development
- The Toddler
- The Preschooler
- HEALTH PROMOTION: The 15- to 18-Month-Old Child
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Play
- TABLE 7-1 Characteristics of Preoperational Thinking
- HEALTH PROMOTION: The 2-Year-Old Child
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Self-Esteem and Competence
- Play
- Language Development
- The Toddler
- The Preschooler
- Psychosocial Development
- The Toddler
- Negativism
- Ritualism and the Importance of Routine
- Separation Anxiety
- Play
- Psychosexual Development
- FIG 7-3 Types of play.
- BOX 7-1 Age-Related Activities and Toys for Toddlers and Preschoolers
- General Activities
- Toddler
- Preschooler
- Toys and Specific Types of Play
- Toddler
- Preschooler
- NURSING QUALITY ALERT: Important Tasks of the Toddler Period
- The Preschooler
- Play
- Psychosexual Development
- Spiritual and Moral Development
- Health Promotion for the Toddler or Preschooler and Family
- Nutrition
- BOX 7-2 Nutritious Snacks
- Nutritional Requirements
- Solid Foods
- FIG 7-4 By age 1 year, most children are eating the same foods as the rest of the family. Toddlers should be offered three meals and two healthy snacks each day. Most 2-year-olds can drink from a cup and use a spoon well if given the opportunity to practice.
- Age-Related Nutritional Challenges
- Food Jags
- Physiologic Anorexia
- BOX 7-3 Increasing Nutritional Intake
- Obesity Risk
- Dental Care
- Sleep and Rest
- FIG 7-5 Care of the deciduous teeth promotes healthy development of the permanent teeth. Some toddlers and preschoolers enjoy brushing their own teeth, but because toddlers and preschoolers lack the manual dexterity to remove plaque adequately, parents must assume this responsibility.
- CRITICAL THINKING EXERCISE 7-1
- Discipline
- Toddler Safety
- Car Safety
- PARENTS WANT TO KNOW: Guidelines for Disciplining a Toddler
- PATIENT-CENTERED TEACHING: Childhood Poison Prevention
- SAFETY ALERT: Car Safety
- Airplane Safety
- Fire and Burn Safety
- Preventing Falls
- Water Safety
- Preventing Poisoning
- Preschooler Safety
- Car Safety
- FIG 7-6 A high-back booster seat designed to properly hold a car lap and shoulder belt is strongly recommended for children who have outgrown a child safety seat. Booster seats raise the young child high enough to allow the car seatbelts to be correctly positioned over the child’s chest and pelvis.
- Fire and Burn Safety
- Firearm Safety
- Personal Safety
- Sexual Abuse
- Selected Issues Related to the Toddler
- Toilet Training
- HEALTH PROMOTION: The 3-Year-Old Child
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Self-Esteem and Competence
- Play
- BOX 7-4 Signs of Readiness for Toilet Training
- Physical Readiness
- Psychological Readiness
- FIG 7-7 No set rules exist for toilet training. The nurse can help parents understand that both physical readiness and psychological readiness are necessary for success.
- Temper Tantrums
- Sibling Rivalry
- PARENTS WANT TO KNOW: Strategies to Decrease Sibling Rivalry
- Selected Issues Related to the Preschooler
- Stuttering
- PARENTS WANT TO KNOW: How to Help the Child Who Stutters
- Preschool and Daycare Programs
- HEALTH PROMOTION: The 4- and 5-Year-Old Child
- Focused Assessment
- Developmental Milestones
- Critical Milestones∗
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Safety
- Self-Esteem and Competence
- Play
- Preparing the Child for School
- BOX 7-5 Checklist for School Readiness
- KEY CONCEPTS
- References and Readings
- Chapter 8 Health Promotion for the School-Age Child
- Learning Objectives
- Growth and Development of the School-Age Child
- Physical Growth and Development
- HEALTH PROMOTION: Healthy People 2020 Objectives for School-Age Children
- Body Systems
- Dentition
- Sexual Development
- FIG 8-1 Growth and development of the school-age child.
- NURSING QUALITY ALERT: Components of Sex Education
- BOX 8-1 AGE-RELATED ACTIVITIES AND TOYS FOR THE SCHOOL-AGE CHILD
- General Activities
- Toys and Specific Types of Play
- Motor Development
- Development of Gross Motor Skills
- Importance of Active Play
- PATIENT-CENTERED TEACHING: Assessing an Organized Recreational Sports Program
- Preventing Fatigue and Dehydration
- Development of Fine Motor Skills
- Cognitive Development
- Intuitive Thought Stage
- Concrete Operations Stage
- Reversibility
- Conservation
- Classification and Logic
- Humor
- Sensory Development
- Vision
- Hearing
- Language Development
- Psychosocial Development
- Development of a Sense of Industry
- Fostering Self-Esteem
- PATIENT-CENTERED TEACHING: How to Promote Self-Esteem in School-Age Children
- Spiritual and Moral Development
- Piaget
- Kohlberg
- Family Influence
- Spirituality and Religion
- Health Promotion for the School-Age Child and Family
- Nutrition During Middle Childhood
- Nutritional Requirements
- Age-Related Nutritional Challenges
- Dental Care
- Malocclusion
- Preventing Dental Injuries
- Dental Health Education
- Sleep and Rest
- HEALTH PROMOTION: The 6- to 8-Year-Old Child
- Focused Assessment
- Developmental Milestones
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Safety
- Play
- Self-Esteem and Competence
- CRITICAL THINKING EXERCISE 8-1
- Discipline
- Safety
- Car Safety
- Fire and Burn Safety
- SAFETY ALERT: Fire Safety Rules
- Bicycle, In-line Skating, Scooter, and Skateboard Safety
- PATIENT-CENTERED TEACHING: Bicycle, In-line Skating, Scooter, and Skateboard Safety
- Rules of the Road
- Pedestrian Safety
- Water Safety
- HEALTH PROMOTION: The 9- to 11-Year-Old Child
- Focused Assessment
- Developmental Milestones
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep
- Hygiene
- Safety
- Play
- Self-Esteem and Competence
- Selected Issues Related to the School-Age Child
- Adjustment to School
- Peer Influence
- Influence of Teachers
- Parents’ Role
- School Refusal
- Helping a Child Overcome School Refusal
- Self-Care Children
- Obesity ExemplarObesity
- Assessing the Scope of the Problem
- Prevention
- Diet ExemplarInterventions and Anticipatory Guidance
- PARENTS WANT TO KNOW: How to Prevent and Manage Obesity
- EVIDENCE-BASED PRACTICE
- Stress
- Sources of Stress in Children
- BOX 8-2 MANIFESTATIONS OF STRESS IN CHILDREN
- School Pressures
- Physical Threats
- Competitive Sports
- Tight Schedules and Adaptation Overload
- Family Pressures
- Media Influence
- Interventions and Anticipatory Guidance
- FIG 8-2 Health promotion for the school-age child and family.
- NURSING QUALITY ALERT: Sources of Stress for School-Age Children
- Bullying ExemplarPeer Victimization
- KEY CONCEPTS
- References and Readings
- Chapter 9 Health Promotion for the Adolescent
- Learning Objectives
- Adolescent Growth and Development
- HEALTH PROMOTION: Selected Healthy People 2020 Objectives for Adolescents
- Physical Growth and Development
- Psychosexual Development, Hormonal Changes, and Sexual Maturation
- NURSING QUALITY ALERT: Understanding Tanner Staging
- Female Sexual Maturation
- TABLE 9-1 SEXUAL MATURITY RATING (SMR): TANNER STAGES OF ADOLESCENT SEXUAL DEVELOPMENT
- Male Sexual Maturation
- Motor Development
- SAFETY ALERT: The Adolescent Who Is Involved in Athletics
- BOX 9-1 NURSING GOALS FOR PREPARTICIPATION SPORTS PHYSICAL EXAMINATION
- Cognitive Development
- Sensory Development
- Language Development
- PARENTS WANT TO KNOW: Communicating with Adolescents
- Psychosocial Development
- FIG 9-1 Adolescent growth and development.
- BOX 9-2 AGE-RELATED ACTIVITIES AND GAMES FOR ADOLESCENTS
- General Activities
- Games and Special Types of Play
- NURSING QUALITY ALERT: The Adolescent and Erikson
- Early Adolescence
- Middle Adolescence
- BOX 9-3 SIGNS OF GANG INVOLVEMENT
- NURSING QUALITY ALERT: Elements of Adolescent Care
- Vocational Exploration
- Late Adolescence (18 to 21 Years)
- Moral and Spiritual Development
- Health Promotion for the Adolescent and Family
- CRITICAL THINKING EXERCISE 9-1
- Nutrition during Adolescence
- BOX 9-4 FACTORS INFLUENCING THE ADOLESCENT’S DIET
- Age-Related Nutritional Challenges
- Nutritional Guidance for the Adolescent
- Hygiene
- Dental Care
- PATIENT-CENTERED TEACHING: Caring for a Child with an Avulsed Tooth
- Sleep and Rest
- HEALTH PROMOTION: The Adolescent
- Focused Assessment
- Developmental Milestones
- Health Maintenance
- Physical Measurements
- Immunizations
- Health Screening
- Anticipatory Guidance
- Nutrition
- Elimination
- Dental
- Sleep and Activity
- Safety
- Emotional Health
- Exercise and Activity
- Safety
- Car Safety
- Water Safety
- Suicide
- Violence Toward Others
- BOX 9-5 FACTORS CONTRIBUTING TO ADOLESCENT VIOLENCE
- Selected Issues Related to the Adolescent
- Body Piercing
- Tattoos
- ADOLESCENTS WANT TO KNOW: Tattooing
- Tanning
- Sexual Activity
- Adolescent Sexuality
- NURSING QUALITY ALERT: Factors to Consider in Selecting Adolescent Contraception
- Contraception
- KEY CONCEPTS
- References and Readings
- Chapter 10 Hereditary and Environmental Influences on Development
- Learning Objectives
- Hereditary Influences
- Structure of Genes and Chromosomes
- DNA
- FIG 10-1 Diagrammatic representation of the deoxyribonucleic acid (DNA) helix, which is the building block of genes and chromosomes.
- Genes
- Chromosomes
- FIG 10-2 When viewed before karyotyping, chromosomes appear jumbled. This photo is a spectral karyotype (SKY) from a normal female.
- Transmission of Traits by Single Genes
- Alleles
- Dominance
- FIG 10-3 Karyotypes of chromosomes that were stained, creating bands to distinguish each chromosome and identify missing or duplicated chromosome material. A, Normal male karyotype: 46,XY. B, Normal female karyotype 46,XX.
- Chromosome Location
- Patterns of Single-Gene Inheritance
- CRITICAL TO REMEMBER: Single-Gene Abnormalities
- Autosomal Dominant Traits
- BOX 10-1 SINGLE-GENE TRAITS
- Genogram (Pedigree) Symbols
- Autosomal Recessive
- Characteristics
- Transmission of Trait from Parent to Child
- Examples
- Genogram
- Autosomal Dominant
- Characteristics
- Transmission of Trait from Parent to Child
- Examples
- Genogram
- X-Linked Recessive
- Characteristics
- Transmission of Trait from Parent to Child
- Examples
- Genogram
- Autosomal Recessive Traits
- X-Linked Traits
- X-Linked Recessive Disorders
- Chromosome Abnormalities
- FIG 10-4 Karyotype of a male with trisomy 21 (Down syndrome: 47, XY, +21).
- CRITICAL TO REMEMBER: Chromosome Abnormalities
- Numerical
- Structural
- Numerical Abnormalities
- Trisomy
- FIG 10-5 Karyotype of a female with monosomy X (Turner syndrome 45,X).
- Monosomy
- Polyploidy
- Structural Abnormalities
- FIG 10-6 Illustration of a translocation of chromosome material between chromosomes 4 and 20.
- Multifactorial Disorders
- CRITICAL TO REMEMBER: Multifactorial Birth Defects
- Characteristics of Multifactorial Disorders
- Risk for Occurrence
- Environmental Influences
- Teratogens
- BOX 10-2 SELECTED ENVIRONMENTAL SUBSTANCES KNOWN OR THOUGHT TO HARM THE FETUS∗
- Avoiding Fetal Exposure
- Infections
- Drugs and Other Substances
- Ionizing Radiation
- Maternal Hyperthermia
- Manipulating the Fetal Environment
- Mechanical Disruptions to Fetal Development
- Genetic testing ExemplarGenetic Counseling
- Availability
- Focus on the Family
- BOX 10-3 DIAGNOSTIC METHODS THAT MAY BE USED IN GENETIC COUNSELING
- Preconception Screening
- Prenatal Diagnosis for Fetal Abnormalities
- Postnatal Diagnosis for an Infant with a Birth Defect
- Process of Genetic Counseling
- Supplemental Services
- Nursing Care of Families Concerned About Birth Defects
- Nurses as Part of a Genetic Counseling Team
- PARENTS WANT TO KNOW: About Birth Defects
- Nurses in General Practice
- Women’s Health Nurses
- Antepartum Nurses
- Identifying Families for Referral
- Helping the Woman Decide About Genetic Counseling
- Teaching About Lifestyle
- BOX 10-4 REASONS FOR REFERRAL TO A GENETIC COUNSELOR OR OTHER HEALTH CARE SPECIALIST
- BOX 10-5 PROBLEMS ENCOUNTERED IN GENETIC COUNSELING AND PRENATAL DIAGNOSIS
- Providing Emotional Support
- Helping the Woman and Family Deal with Abnormal Results
- Intrapartum and Neonatal Nurses
- Pediatric Nurses
- KEY CONCEPTS
- References and Readings
- Maternity Nursing Care
- Interactive Review – Maternity Nursing Care
- Chapter 11 Reproductive Anatomy and Physiology
- Learning Objectives
- Sexual Development
- Prenatal Development
- Childhood
- Sexual Maturation
- Initiation of Sexual Maturation
- Female Puberty Changes
- Breast Changes
- Body Contours
- Body Hair
- Skeletal Growth
- Reproductive Organs
- Menarche
- Male Puberty Changes
- Growth of the Testes and Penis
- TABLE 11-1 Major Hormones in Reproduction
- TABLE 11-2 Comparison Of Secondary Sex Characteristics In Females And Males
- Nocturnal Emissions
- Body Hair
- Body Composition
- Skeletal Growth
- Voice Changes
- Decline in Fertility
- FIG 11-1 External female reproductive structures.
- Female Reproductive Anatomy
- External Female Reproductive Organs
- Mons Pubis
- Labia Majora and Labia Minora
- FIG 11-2 Internal female reproductive structures, anterior view.
- Clitoris
- Vestibule
- Perineum
- Internal Female Reproductive Organs
- Vagina
- Uterus
- Divisions of the Uterus
- Corpus
- FIG 11-3 Internal female reproductive structures, midsagittal view.
- Isthmus
- Cervix
- Layers of the Uterus
- Perimetrium
- Myometrium
- FIG 11-4 Layers of the myometrium, showing the three types of smooth muscle fiber.
- Endometrium
- FIG 11-5 Structures of the bony pelvis, shown in lateral, A, and anterior, B, views.
- Fallopian Tubes
- Ovaries
- Support Structures
- Pelvis
- Muscles
- FIG 11-6 Muscles of the female pelvic floor.
- Ligaments
- Lateral Support
- Anterior Support
- Posterior Support
- Blood Supply
- Nerve Supply
- Female Reproductive Cycle
- FIG 11-7 The female reproductive cycle, showing the changes in hormone secretion from the anterior pituitary and interrelated changes in the ovary and uterine endometrium.
- Ovarian Cycle
- Follicular Phase
- Ovulatory Phase
- Luteal Phase
- Endometrial Cycle
- Proliferative Phase
- Secretory Phase
- Menstrual Phase
- Changes in Cervical Mucus
- The Female Breast
- Structure
- FIG 11-8 Structures of the female breast.
- Function
- Male Reproductive Anatomy and Physiology
- External Male Reproductive Organs
- Penis
- Scrotum
- FIG 11-9 Structures of the male reproductive system, midsagittal view.
- Internal Male Reproductive Organs
- Testes
- FIG 11-10 Internal structures of the testis. Production of sperm begins within the tiny coiled seminiferous tubules. Immature sperm pass from the seminiferous tubules to the epididymis and then to the vas deferens. During their passage through these structures, the sperm mature and acquire the ability to propel themselves.
- Accessory Ducts and Glands
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 12 Conception and Prenatal Development
- Learning Objectives
- Gametogenesis
- Oogenesis
- FIG 12-1 Gametogenesis. A, Formation of the mature ovum. B, Formation of mature sperm.
- TABLE 12-1 COMPARISON OF FEMALE AND MALE GAMETOGENESIS
- Spermatogenesis
- Conception
- Preparation for Conception in the Female
- Release of the Ovum
- Ovum Transport
- Preparation for Conception in the Male
- FIG 12-2 Mature sperm.
- Ejaculation
- Transport of Sperm in the Female Reproductive Tract
- Preparation of Sperm for Fertilization
- Fertilization
- Entry of One Spermatozoon into the Ovum
- Fusion of the Nuclei of Sperm and Ovum
- FIG 12-3 Process of fertilization. A, A sperm enters the ovum. B, The 23 chromosomes from the sperm mingle with the 23 chromosomes from the ovum, restoring the diploid number to 46. C, The fertilized ovum, now called a zygote, is ready for the first mitotic cell division.
- Pre-Embryonic Period
- Initiation of Cell Division
- Entry of the Zygote into the Uterus
- Implantation in the Decidua
- Maintaining the Decidua
- Location of Implantation
- Mechanism of Implantation
- FIG 12-4 Prenatal development from fertilization through implantation of the blastocyst. Implantation gradually occurs from the 6th through the 10th days. Implantation is complete by the 10th day.
- Embryonic Period
- Differentiation of Cells
- Second Week
- Third Week
- Fourth Week
- FIG 12-5 Embryonic development from the 3rd week through the 8th week after fertilization. CRL, Crown-rump length.
- TABLE 12-2 TIMETABLE OF PRENATAL DEVELOPMENT BASED ON FERTILIZATION AGE∗
- TABLE 12-3 DERIVATIVES OF THE THREE GERM LAYERS: DEVELOPING STRUCTURES
- Fifth Week
- Sixth Week
- Seventh Week
- Eighth Week
- Fetal Period
- Weeks 9 Through 12
- Weeks 13 Through 16
- Weeks 17 Through 20
- Weeks 21 Through 24
- Weeks 25 Through 28
- Weeks 29 Through 32
- FIG 12-6 Fetal development from 9 weeks of fertilization age through 38 weeks of fertilization age. Gestational age, measured from the first day of the last menstrual period, is about 2 weeks longer than the fertilization age.
- Weeks 33 Through 38
- Auxiliary Structures
- Placenta
- Maternal Component
- Development
- Circulation in the Maternal Side
- Fetal Component
- Development
- Circulation in the Fetal Side
- Metabolic Functions
- Transfer Functions
- Gas Exchange
- FIG 12-7 A, Placental structure, showing relationship of placenta, fetal membranes, and uterus. Arrows indicate the direction of blood flow between the fetus and placenta through the umbilical arteries and vein. Blood from the woman bathes the fetal chorionic villi within the intervillous spaces to allow exchange of oxygen, nutrients, and waste products without gross mixing of maternal and fetal blood. B, Structure of a chorionic villus, showing its fetal capillary network.
- FIG 12-8 Placental variations. Normal placenta, with insertion of umbilical cord near center and branching of fetal umbilical vessels over the surface Placenta with cord inserted near margin of placenta Placenta with a small accessory lobe Velamentous insertion of umbilical cord. Cord vessels branch far out on membranes. When membranes rupture, fetal umbilical vessels may be torn, and the fetus can hemorrhage.
- TABLE 12-4 MECHANISMS OF PLACENTAL TRANSFER
- Nutrient Transfer
- Waste Removal
- Antibody Transfer
- Transfer of Maternal Hormones
- Endocrine Functions
- Fetal Membranes and Amniotic Fluid
- Fetal Circulation
- Umbilical Cord
- Fetal Circulatory Circuit
- FIG 12-9 A, Fetal circulation. Three shunts—the ductus venosus, the ductus arteriosus, and the foramen ovale—allow most blood from the placenta to bypass the fetal lungs and liver. B, Circulation after birth. Note that the fetal shunts have closed. The umbilical vessels, the ductus venosus, and the ductus arteriosus have been converted to ligaments.
- Changes in Blood Circulation After Birth
- FIG 12-10 A, Monozygotic twinning. The single inner cell mass divides into two inner cell masses during the blastocyst stage. These twins have a single placenta and chorion, but each twin develops in its own amnion. B, Dizygotic twinning. Two ova are released during ovulation, and each is fertilized by a separate spermatozoon. The ova may implant near each other in the uterus, or they may be far apart.
- Multifetal Pregnancy
- Monozygotic Twinning
- Dizygotic Twinning
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 13 Adaptations to Pregnancy
- Learning Objectives
- Physiologic Responses to Pregnancy
- Changes in Body Systems
- Reproductive System
- Uterus
- Growth
- FIG 13-1 Uterine growth pattern during pregnancy.
- Pattern of Uterine Growth
- Contractility
- Uterine Blood Flow
- FIG 13-2 Cervical changes that occur during pregnancy. Note the thick mucous plug filling the cervical canal.
- Cervix
- Vagina and Vulva
- FIG 13-3 Breast changes that occur during pregnancy. The breasts increase in size and become more vascular, the areolae become darker, and the nipples become more erect.
- Ovaries
- Breasts
- Cardiovascular System
- Heart
- Heart Size and Position
- Heart Sounds
- Blood Volume
- Total Volume
- Plasma Volume
- Red Blood Cell Mass
- Cardiac Output
- Systemic Vascular Resistance
- Blood Pressure
- Effect of Position on Blood Pressure
- Supine Hypotension
- FIG 13-4 Supine hypotensive syndrome. When the pregnant woman is supine, the weight of the uterus partially occludes the vena cava and the descending aorta. A side-lying position corrects supine hypotension.
- Blood Flow
- Blood Components
- Respiratory System
- Oxygen Consumption
- Hormonal Factors
- Progesterone
- Estrogen
- TABLE 13-1 LABORATORY VALUES IN NONPREGNANT AND PREGNANT WOMEN
- Physical Changes
- Gastrointestinal System
- Mouth
- Esophagus
- Stomach
- Large and Small Intestine
- Liver and Gallbladder
- Urinary System
- Bladder
- Kidneys and Ureters
- Changes in Size and Shape
- Functional Changes
- Integumentary System
- Skin
- Hyperpigmentation
- Cutaneous Vascular Changes
- Connective Tissue
- FIG 13-5 Linea nigra, a dark line of pigmentation from the fundus to the symphysis pubis, appears during pregnancy.
- Hair
- Musculoskeletal System
- Calcium Storage
- Postural Changes
- Abdominal Wall
- Endocrine System
- Pituitary Gland
- Thyroid Gland
- Parathyroid Glands
- Pancreas
- Adrenal Glands
- Changes Caused by Placental Hormones
- Human Chorionic Gonadotropin
- Estrogen
- Progesterone
- Human Chorionic Somatomammotropin (hCS)
- Relaxin
- Changes in Metabolism
- Weight Gain
- Water Metabolism
- Dependent Edema
- Carpal Tunnel Syndrome
- Carbohydrate Metabolism
- Sensory Organs
- Eye
- Ear
- Immune System
- Confirmation of Pregnancy
- Presumptive Indications of Pregnancy
- Amenorrhea
- Nausea and Vomiting
- Fatigue
- Urinary Frequency
- FIG 13-6 Maternal changes based on the date of the last menstrual period.
- TABLE 13-2 INDICATIONS OF PREGNANCY AND OTHER POSSIBLE CAUSES
- Breast and Skin Changes
- Vaginal and Cervical Color Changes
- FIG 13-7 Hegar’s sign—compressibility of the lower uterus—reflects softening of the isthmus of the cervix.
- Fetal Movement
- Probable Indications of Pregnancy
- Abdominal Enlargement
- Cervical Softening
- Changes in the Uterus
- Uterine Consistency
- FIG 13-8 When the cervix is tapped, the fetus floats upward in the amniotic fluid. A rebound is felt by the examiner when the fetus falls back.
- Ballottement
- Braxton Hicks Contractions
- Palpation of the Fetal Outline
- Uterine Souffle
- Pregnancy Tests
- Agglutination Inhibition Test
- Radioreceptor Assay
- Radioimmunoassay
- Inaccurate Pregnancy Test Results
- Positive Indications of Pregnancy
- Auscultation of Fetal Heart Sounds
- Fetal Movements Felt by Examiner
- Visualization of the Fetus
- Antepartum Assessment and Care
- Preconception and Interconception Care
- Initial Visit
- History
- Obstetric History
- BOX 13-1 CALCULATION OF GRAVIDA AND PARA
- Menstrual History and Estimated Date of Delivery
- CRITICAL THINKING EXERCISE 13-1
- Gynecologic and Contraceptive History
- Medical and Surgical History
- Family Health History
- Partner’s Health History
- Psychosocial History
- Physical Examination
- Vital Signs
- Blood Pressure
- Pulse
- Respiratory Effort
- Temperature
- Cardiovascular System
- Venous Congestion
- Edema
- Musculoskeletal System
- Posture and Gait
- Height and Weight
- Abdomen
- Neurologic System
- Integumentary System
- Endocrine System
- Gastrointestinal System
- Mouth
- Intestine
- Urinary System
- Protein
- Glucose
- Ketones
- Bacteria
- Reproductive System
- Breasts
- External Reproductive Organs
- TABLE 13-3 COMMON LABORATORY TESTS
- Internal Reproductive Organs
- Pelvic Measurements
- Laboratory Data
- Risk Assessment
- Subsequent Assessments
- TABLE 13-4 SUMMARY OF HIGH-RISK FACTORS IN PREGNANCY
- Vital Signs
- Weight
- Urinalysis
- Fundal Height
- FIG 13-9 Measuring the uterus involves measuring from the upper border of the symphysis pubis to the top of the fundus.
- Leopold’s Maneuvers
- Fetal Heart Rate
- Fetal Activity
- Signs of Labor
- Ultrasound Screen
- Glucose Screen
- Isoimmunization
- Pelvic Examinations
- Multifetal Pregnancy
- Diagnosis
- Maternal Adaptation to Multifetal Pregnancy
- Antepartum Care in Multifetal Pregnancy
- Common Discomforts of Pregnancy
- PATIENT-CENTERED TEACHING: How to Overcome the Common Discomforts of Pregnancy
- Nausea and Vomiting
- Heartburn
- Backache
- Round Ligament Pain
- Urinary Frequency
- Varicosities
- Constipation
- Hemorrhoids
- Leg Cramps
- Nausea and Vomiting
- Heartburn
- Backache
- Round Ligament Pain
- Urinary Frequency
- FIG 13-10 Posture during pregnancy may cause or alleviate backache. A, Incorrect posture. The neck is jutting forward, the shoulders are slumping, and the back is sharply curved, creating back pain and discomfort. B, Correct posture. The neck and shoulders are straight, the back is flattened, and the pelvis is tucked under and slightly upward.
- Varicosities
- Constipation
- Hemorrhoids
- FIG 13-11 Techniques for lifting. Squatting places less strain on the back. A, Incorrect technique. Stooping or bending places a great deal of strain on muscles of the lower back. B, Correct technique. Squatting and moving the object close permits the stronger muscles of the legs to do the lifting.
- Leg Cramps
- Nursing Care
- Family Responses to Physical Changes of Pregnancy
- Assessment
- Nursing Diagnosis and Planning
- FIG 13-12 Exercises to prevent backache.
- Expected Outcomes
- Interventions
- Teaching Health Behaviors
- Bathing
- NURSING CARE PLAN: Early Pregnancy Concerns
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnosis to Consider
- Hot Tubs and Saunas
- Douching
- Breast Care
- Clothing
- Exercise
- FIG 13-13 During the third trimester, pillows supporting the abdomen and back provide a comfortable position for rest.
- Sleep and Rest
- Nutrition
- Employment
- Maternal Safety
- Exposure to Teratogens
- Travel
- Immunizations
- Teaching Necessary Lifestyle Changes
- Prescription and Over-the-Counter Drugs
- Complementary and Alternative Therapies
- Tobacco
- Alcohol
- Illegal Drugs
- Signs of Possible Complications
- Evaluation
- SAFETY ALERT: Signs of Possible Complications During Pregnancy
- Psychological Responses to Pregnancy
- Maternal Responses
- First Trimester
- Uncertainty
- Ambivalence
- The Self as Primary Focus
- Second Trimester
- Physical Evidence of Pregnancy
- FIG 13-14 Fetal movement (quickening) confirms that a separate life is developing.
- The Fetus as Primary Focus
- Narcissism and Introversion
- Body Image
- NURSING CARE PLAN: Body Image During Pregnancy
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Changes in Sexuality
- Third Trimester
- Vulnerability
- Increasing Dependence
- FIG 13-15 During the third trimester, the mother feels increasingly vulnerable. She cradles her fetus to signify her protectiveness.
- Preparation for Birth
- TABLE 13-5 PROGRESSIVE CHANGES IN MATERNAL RESPONSES TO PREGNANCY
- Maternal Role Transition
- Transitions Experienced throughout Pregnancy
- Steps in Maternal Role Taking
- Mimicry
- Role Play
- Fantasy
- The Search for a Role Fit
- Grief Work
- Maternal Tasks of Pregnancy
- Seeking Safe Passage
- Securing Acceptance
- Learning to Give of Herself
- Committing Herself to the Unknown Child
- Paternal Adaptation
- Variations in Paternal Adaptation
- Developmental Processes
- Grappling with the Reality of Pregnancy and the Child
- Struggling for Recognition as a Parent
- FIG 13-16 Reality boosters such as hearing the sounds of the fetal heart make the fetus more real for the father.
- Creating the Role of Involved Father
- Parenting Information
- Couvade
- Adaptation of Grandparents
- Age
- Number and Spacing of Other Grandchildren
- Perceptions of the Role of Grandparents
- Adaptation of Siblings
- Toddlers
- Older Children
- Adolescents
- Factors that Influence Psychosocial Adaptations
- Age
- Multiparity
- CRITICAL THINKING EXERCISE 13-2
- FIG 13-17 A pregnant woman spends time with her child to provide affection and a sense of security.
- Social Support
- Absence of a Partner
- TABLE 13-6 IMPACT OF SOCIOECONOMIC FACTORS ON FAMILY’S RESPONSE TO PREGNANCY
- Socioeconomic Status
- Abnormal Situations
- Barriers to Prenatal Care
- EVIDENCE-BASED PRACTICE
- Cultural Influences on Childbearing
- Differences within Cultures
- Cultural Differences that May Cause Conflict
- Health Care Practices Beliefs ExemplarHealth Beliefs
- Health Maintenance During Pregnancy
- Belief in Fate
- Preventing Illness
- Restoring Health
- Modesty
- Female Genital Cutting
- Therapeutic communication ExemplarPatient Provider Communication ExemplarCommunication Techniques
- Language
- Communication Style
- NURSING CARE PLAN: Language Barrier During Pregnancy
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Developmental Family roles ExemplarDecision Making
- Eye Contact
- Touch
- Time Orientation
- Culturally Competent Nursing Care
- Cultural Assessment
- TABLE 13-7 PSYCHOSOCIAL ASSESSMENT
- Cultural Negotiation
- Nursing Care
- Psychosocial Concerns
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Providing Information
- Adapting Nursing Care to Pregnancy Progress
- Discussing Resources
- Helping the Family Prepare for the Birth
- Modeling Communication Techniques
- Identifying Cultural Factors that Could Cause Conflict
- Evaluation
- Childbirth education ExemplarPerinatal Education
- Providers of Education
- Class Participants
- Choices for Childbearing
- Setting and Health Care Provider
- FIG 13-18 An expectant mother may ask a sister or close female friend to be her labor partner and to attend classes with her.
- BOX 13-2 BIRTH PLAN CONSIDERATIONS
- Support Person
- Education
- Types of Classes Available
- Preconception Classes
- Early Pregnancy Classes
- Exercise Classes
- Childbirth Preparation Classes
- FIG 13-19 The nurse teaches the support person how to check for relaxation.
- Cesarean Birth Preparation Classes
- Breastfeeding Classes
- Parenting Classes
- Classes For Fathers
- Postpartum Classes
- KEY CONCEPTS
- References and Readings
- Chapter 14 Nutrition for Childbearing
- Learning Objectives
- Weight Gain During Pregnancy
- Recommendations for Total Weight Gain
- TABLE 14-1 RECOMMENDED WEIGHT GAIN DURING PREGNANCY
- Pattern of Weight Gain
- FIG 14-1 Distribution of weight gain in pregnancy for women of normal prepregnancy weight. The numbers represent a general distribution because variation among women is great. Weight increases with the greatest fluctuation are those attributed to extravascular fluids (edema) and maternal reserves of fat.
- Maternal and Fetal Distribution
- Factors that Influence Weight Gain
- Nutritional Requirements During Pregnancy
- Dietary Reference Intakes
- Energy
- Carbohydrates
- Fats
- TABLE 14-2 DIETARY REFERENCE INTAKES: RECOMMENDED ENERGY AND PROTEIN INTAKES
- Calories
- Protein
- Vitamins
- Folic Acid
- Minerals
- Iron
- TABLE 14-3 DIETARY REFERENCE INTAKES: RECOMMENDATIONS FOR VITAMINS AND MINERALS
- TABLE 14-4 FOODS HIGH IN IRON
- BOX 14-1 CALCIUM SOURCES APPROXIMATELY EQUIVALENT TO 1 CUP OF MILK
- Calcium
- BOX 14-2 FOODS HIGH IN SODIUM
- Sodium
- Nutritional Supplementation
- Purpose
- Disadvantages and Dangers of Nutritional Supplementation
- PATIENT-CENTERED TEACHING: Vitamins and Minerals
- Water
- Food Plan
- Whole Grains
- Vegetables and Fruits
- TABLE 14-5 FOOD PLAN FOR PREGNANCY AND LACTATION
- Dairy Group
- Protein Group
- Other Elements
- Food Precautions
- SAFETY ALERT: Food Safety During Pregnancy and Lactation
- Factors that Influence Nutrition
- Age
- Nutritional Knowledge
- Exercise
- Diet Nutrition ExemplarCulture
- Southeast Asian Dietary Practices
- Effect of Culture on Diet During Childbearing
- Increasing Nutrients with Traditional Foods
- Hispanic Dietary Practices
- Nutritional Risk Factors
- Socioeconomic Status
- Poverty
- Food Supplement Programs
- Adolescence
- Nutrient Needs
- Common Problems
- NURSING CARE PLAN: Nutrition for the Pregnant Adolescent
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Teaching the Adolescent
- Vegetarianism
- Meeting the Nutritional Requirements of the Pregnant Vegetarian
- Energy
- Protein
- Calcium
- Iron
- Zinc
- Vitamin B12
- Vitamin A
- Lactose Intolerance
- Nausea and Vomiting of Pregnancy
- Anemia
- Abnormal Prepregnancy Weight
- Eating Disorders
- Food Cravings and Aversions
- Pica
- CRITICAL THINKING EXERCISE 14-1
- Multiparity and Multifetal Pregnancy
- Substance Use and Abuse
- Smoking
- Caffeine
- Alcohol
- Drugs
- Other Risk Factors
- Nutrition After Birth
- Nutrition for the Lactating Mother
- Energy
- Protein
- Fats
- Vitamins and Minerals
- Specific Nutritional Concerns
- Dieting
- Adolescence
- Vegan Diet
- Avoidance of Dairy Products
- Inadequate Diet
- Alcohol
- Caffeine
- Fluids
- Foods to Avoid
- Nutrition for the Nonlactating Mother
- Weight Loss
- Nursing Care
- Nutrition for Childbearing
- Assessment
- Interview
- Appetite
- Eating Habits
- Food Preferences
- Identify Potential Problems
- Diet History
- Twenty-Four-Hour Diet History
- Food Intake Records
- Food-Frequency Questionnaires
- Physical Assessment
- FIG 14-2 Weight gain for pregnancy. The range for weight gain in women of normal prepregnancy weight is 11.5 to 16 kg (25 to 35 lb).
- Weight at Initial Visit
- CRITICAL THINKING EXERCISE 14-2
- Weight at Subsequent Visits
- Signs of Nutrient Deficiency
- Laboratory Tests
- Reassessing Nutritional Status at Each Visit
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Explaining Nutrient Needs
- Providing Reinforcement
- FIG 14-3 Women often make changes in their diets for the good of their unborn children that they would not consider for themselves alone.
- Evaluating Weight Gain
- Encouraging Supplement Intake
- Making Referrals
- Evaluation
- KEY CONCEPTS
- References And Readings
- Chapter 15 Prenatal Diagnostic Tests
- Learning Objectives
- Indications for Prenatal Diagnostic Tests
- Ultrasound
- Emotional Responses
- FIG 15-1 Two-dimensional sonogram showing the fetal body profile and details of the fetal arm, hand, and fingers.
- BOX 15-1 INDICATIONS FOR FETAL DIAGNOSTIC PROCEDURES
- Medical Conditions
- Demographic Factors
- Obstetric Factors
- Concurrent Maternal Factors
- FIG 15-2 Three-dimensional ultrasound image of a fetus in the third trimester, showing the detail of facial features.
- First Trimester
- Procedure
- Purposes
- Second and Third Trimesters
- Procedure
- Purposes
- FIG 15-3 The sonographer provides information as she moves the transducer over the mother’s abdomen to obtain an image.
- Advantages
- Disadvantages
- Doppler Ultrasound Blood Flow Assessment
- Purpose
- Color Doppler
- FIG 15-4 Color Doppler imaging of the umbilical vein and two arteries. Blood flow toward the transducer is typically shown as red whereas the flow away from the transducer is shown as blue.
- Alpha-Fetoprotein Screening
- Purpose
- BOX 15-2 CONDITIONS ASSOCIATED WITH ABNORMAL MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS
- Elevated Levels of Alpha-Fetoprotein (AFP)
- Low Levels of AFP
- Procedure
- Advantages
- Limitations
- Multiple-Marker Screening
- Chorionic Villus Sampling
- Purpose
- Indications
- Procedure
- FIG 15-5 Transcervical chorionic villus sampling. Tissue is aspirated to identify some genetic defects in the fetus. Transabdominal aspiration is an alternative method.
- Advantages
- Limitations
- Amniocentesis
- FIG 15-6 In amniocentesis, a needle is inserted through the mother’s abdomen to aspirate fluid from the amniotic sac. The fluid can then be tested to detect chromosomal abnormalities in fetal cells or other problems and to determine fetal lung maturity.
- Purposes
- Second-Trimester Amniocentesis
- Third-Trimester Amniocentesis
- BOX 15-3 COMMON INDICATIONS FOR SECOND-TRIMESTER AMNIOCENTESIS
- Tests to Determine Fetal Lung Maturity
- Test for Fetal Hemolytic Disease
- Procedure
- Advantages
- Disadvantages
- Risks
- FIG 15-7 In percutaneous umbilical blood sampling, a needle is inserted through the mother’s abdomen and into an umbilical vessel (vein or artery) to withdraw a sample of fetal blood.
- Percutaneous Umbilical Blood Sampling
- Procedure
- Risks
- Antepartum Fetal Surveillance
- Nonstress Test
- Purpose
- Procedure
- Interpretation
- FIG 15-8 A nonstress test is a noninvasive test that measures the ability of the fetal heart to accelerate, often in response to fetal movements. Here the nurse reassures the parents by pointing to fetal heart rate accelerations detected by the external fetal monitor.
- Advantages
- Disadvantages
- FIG 15-9 A, Several accelerations have a duration of at least 15 seconds, reaching a peak of 25 to 30 beats per minute in this example of a reactive nonstress test. Comparable accelerations without fetal movement are also reassuring. B, In this recording of a nonreactive nonstress test, accelerations are absent after fetal movement.
- Vibroacoustic (Acoustic) Stimulation
- Purpose and Procedure
- Fetal Responses
- Risks
- Contraction Stress Test
- Purpose
- Procedure
- Interpretation
- Advantages
- Disadvantages
- Biophysical Profile
- Purpose
- FIG 15-10 Interpretation of contraction stress test (CST). UPI, Uteroplacental insufficiency.
- FIG 15-11 Effects of gradual hypoxemia and worsening fetal acidosis.
- Procedure and Interpretation
- TABLE 15-1 SCORING THE BIOPHYSICAL PROFILE FOR A TERM FETUS
- Modified Biophysical Profile
- Advantages
- Disadvantages
- Maternal Assessment of Fetal Movement
- Advantages
- Disadvantages
- Nursing Care
- The Patient Who Has Diagnostic Testing
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Providing Information
- Providing Support
- Helping Patients Set Realistic Goals
- Supporting the Woman’s Decision
- Evaluation
- KEY CONCEPTS
- References and Readings
- Chapter 16 Giving Birth
- Learning Objectives
- Issues for New Nurses
- Pain Associated with Birth
- Inexperience or Negative Experiences
- Unpredictability
- Intimacy
- Physiologic Effects of the Birth Process
- Maternal Response
- Reproductive System
- Characteristics of Contractions
- Coordinated Contractions
- Involuntary Contractions
- Intermittent Contractions
- Contraction Cycle
- Uterine Body
- FIG 16-1 Contraction cycle.
- Cervical Changes
- FIG 16-2 Opposing characteristics of uterine contraction in the upper and lower segments of the uterus.
- Effacement
- Dilation
- Cardiovascular System
- Respiratory System
- Gastrointestinal System
- FIG 16-3 Cervical dilation and effacement. During labor, the multigravida’s cervix remains thicker than that of the primigravida.
- Urinary System
- Hematopoietic System
- Fetal Response
- Placental Circulation
- Cardiovascular System
- Pulmonary System
- Components of the Birth Process
- Powers
- Uterine Contractions
- Maternal Pushing Efforts
- Passage
- Passenger
- Fetal Head
- Bones, Sutures, and Fontanels
- Fetal Head Diameters
- Variations in the Passenger
- Fetal Lie
- Attitude
- Presentation
- FIG 16-4 Pelvic divisions and measurements. INLET The boundaries of the inlet are the symphysis pubis anteriorly, the sacral promontory posteriorly, and the linea terminalis on the sides. The inlet is slightly wider in its transverse diameter (13.5 cm) than in its anteroposterior (diagonal conjugate) diameter (11.5 cm or greater). The diagonal conjugate is slightly larger than both the obstetric and true conjugates. The obstetric conjugate is the narrowest of the three conjugate diameters but cannot be measured directly. The obstetric conjugate is estimated by first measuring the diagonal conjugate and then subtracting 1.5 to 2 cm. If the inlet is small, the fetal head may not be able to enter it. Because it is almost entirely surrounded by bone, except for cartilage at the sacroiliac joint and symphysis pubis, the inlet cannot enlarge much to accommodate the fetus. The bony measurements are essentially fixed.
- MIDPELVIS The midpelvis, or pelvic cavity, is the narrowest part of the pelvis through which the fetus must pass during birth. Midpelvic diameters are measured at the level of the ischial spines. The anteroposterior diameter averages 12 cm. The transverse diameter (bispinous or interspinous) averages 10.5 cm. Prominent ischial spines that project into the midpelvis can reduce the bispinous diameter.
- OUTLET Three important diameters of the pelvic outlet are (1) the anteroposterior, (2) the transverse (bi-ischial or intertuberous), and (3) the posterior sagittal. The angle of the pubic arch also is an important pelvic outlet measure. The anteroposterior diameter ranges from 9.5 to 11.5 cm, varying with the curve between the sacrococcygeal joint and the tip of the coccyx. The anteroposterior diameter can increase if the coccyx is easily movable. The transverse diameter is the bi-ischial, or intertuberous, diameter. This is the distance between the ischial tuberosities (“sit bones”). It averages 11 cm. The posterior sagittal diameter is normally at least 7.5 cm. It is a measure of the posterior pelvis. The posterior sagittal diameter measures the distance from the sacrococcygeal joint to the middle of the transverse (bi-ischial) diameter.
- The angle of the pubic arch is important because it must be wide enough for the fetus to pass under it. The angle of the pubic arch should be at least 90 degrees. A narrow pubic arch displaces the fetus posteriorly toward the coccyx as it tries to pass under the arch.
- FIG 16-5 A, Bones, sutures, fontanels of the fetal head. Note that the anterior fontanel has a diamond shape, whereas the posterior fontanel is triangular. B, Lateral view of the fetal head. Anteroposterior diameters vary with the amount of flexion or extension.
- FIG 16-6 Lie. A, In a longitudinal lie, the long axis of the fetus is parallel to the long axis of the woman. B, In a transverse lie, the long axis of the fetus is at right angles to the long axis of the mother. The woman’s abdomen has a wide, short appearance.
- Cephalic Presentation
- FIG 16-7 Attitude. A, The fetus is in the normal attitude of flexion, with the head, arms, and legs flexed tightly against the trunk. B, The fetus is in an abnormal attitude of extension. The head is extended, and the right arm is extended. A face presentation is illustrated.
- Vertex
- FIG 16-8 Four types of cephalic presentation. The vertex presentation is normal. Note positional changes of the anterior and posterior fontanels in relation to the maternal pelvis.
- Military
- Brow
- Face
- Breech Presentation
- Frank breech
- Full (or complete) breech
- Footling breech
- Shoulder
- Position
- Right (R) or Left (L)
- Occiput (O), Mentum (M), or Sacrum (S)
- Anterior (A), Posterior (P), or Transverse (T)
- FIG 16-9 Three variations of a breech presentation. Frank breech is the most common variation. Footling breeches may be single or double.
- FIG 16-10 Four quadrants of the maternal pelvis, used to describe fetal position.
- Psyche
- Interrelationships of the Components of Birth
- Individual and Cultural Values
- FIG 16-11 Fetal presentations and positions.
- Birth as an Experience
- Normal Labor
- Theories of Onset
- Premonitory Signs
- True Labor and False Labor
- Mechanisms of Labor
- PATIENT-CENTERED TEACHING: How to Know Whether Labor Is “Real”
- Stages and Phases of Labor
- First Stage of Labor
- Latent Phase
- Active Phase
- FIG 16-12 Mechanisms (cardinal movements) of labor.
- TABLE 16-1 CHARACTERISTICS OF NORMAL LABOR
- FIG 16-13 A labor curve, often called a Friedman curve, may be used to identify whether a woman’s cervical dilation is progressing at the expected rate. Typical labor curves for a multiparous and a nulliparous woman are illustrated for comparison of patterns.
- Second Stage of Labor
- Third Stage of Labor
- Fourth Stage of Labor
- EVIDENCE-BASED PRACTICE
- FIG 16-14 A, Fetal side of the placenta. B, Maternal side of the placenta. C, Separating membranes. D, Umbilical cord vessels—two arteries and one vein.
- Duration of Labor
- Nursing Care During Labor and Birth
- Admission to the Birth Center
- Nursing Responsibilities during Admission
- Establishing a Therapeutic Relationship
- Making the Family Feel Welcome
- PATIENT-CENTERED TEACHING: When to Go to the Hospital or Birth Center
- Contractions
- Ruptured Membranes
- Bleeding
- Decreased Fetal Movement
- Other Concerns
- CRITICAL THINKING EXERCISE 16-1
- Determining Family Expectations about Birth
- Conveying Confidence
- Assigning a Primary Nurse
- Using Touch for Comfort
- Respecting Cultural Values
- Assessments at the Time of Admission
- Focused Assessment
- Fetal Assessment
- Maternal Vital Signs
- Impending Birth
- Database Assessment
- Basic Information
- TABLE 16-2 INTRAPARTUM ASSESSMENT GUIDE Women who have had prenatal care have much of this information available on their prenatal record. The nurse need only verify it or update it as needed.
- PROCEDURE: Leopold’s Maneuvers
- Purposes
- First Maneuver
- Second Maneuver
- Third Maneuver
- Fourth Maneuver
- Fetal Assessments
- Labor Status
- Physical Examination
- Admission Procedures
- Notifying the Physician or Midwife
- Consent Forms
- CRITICAL THINKING EXERCISE 16-2
- Laboratory Tests
- Intravenous Access
- Assessments After Admission
- Fetal Assessments
- FHR
- Amniotic Fluid
- Maternal Assessments
- Vital Signs
- Contractions
- Progress of Labor
- Intake and Output
- Response to Labor
- PROCEDURE: Palpating Contractions
- Purpose
- The Support Person’s Response
- Nursing Care
- The Woman with False or Early Labor
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Providing Reassurance
- Teaching
- Evaluation
- Nursing Care
- The Woman in True Labor
- SAFETY ALERT: Conditions Associated with Fetal Compromise
- Fetal Oxygenation
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Promoting Placental Function
- Observing for Conditions Associated with Fetal Compromise
- Evaluation
- Discomfort
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Providing Comfort Measures
- Lighting
- Temperature
- Cleanliness
- Mouth Care
- Bladder
- Positioning
- Water
- Teaching
- First Stage of Labor
- Second Stage of Labor
- Laboring Down
- Positions
- Method and Breathing Pattern
- Labor Support
- Providing Encouragement
- FIG 16-15 Maternal positions for labor.
- Giving of Self
- Offering Pharmacologic Measures
- Caring for the Birth Partner
- Evaluation
- Preventing Injury
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Transfer to a Delivery Room
- Positioning for Birth
- Observing the Perineum
- BOX 16-1 ASSISTING WITH AN EMERGENCY BIRTH
- Nursing Priorities for an Emergency Birth in Any Setting
- Preparing for an Emergency Birth in the Birth Facility
- During the Birth
- After the Birth
- Evaluation
- Nursing Care During the Late Intrapartum Period
- Responsibilities During Birth
- Responsibilities After Birth
- Care of the Infant
- Maintaining Cardiopulmonary Function
- Supporting Thermoregulation
- FIG 16-16 Sequence of delivery.
- Identifying the Infant
- FIG 16-17 Vaginal birth.
- Care of the Mother
- Observing for Hemorrhage
- Vital Signs
- Fundus
- NURSING CARE PLAN: Normal Labor and Birth
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- TABLE 16-3 APGAR SCORE∗
- FIG 16-18 When the birthing room nurse turns over care of the newborn to the nursery nurse, both check the identification bands and record for the same information.
- Bladder
- Lochia
- Relieving Discomfort
- Ice Packs
- Analgesics
- TABLE 16-4 MATERNAL PROBLEMS DURING THE FOURTH STAGE OF LABOR
- Warmth
- Promoting Early Family Attachment
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 17 Intrapartum Fetal Surveillance
- Learning Objectives
- Fetal Oxygenation
- Uteroplacental Exchange
- Fetal Circulation
- Fetal Heart Rate Regulation
- Autonomic Nervous System
- Baroreceptors
- Chemoreceptors
- Adrenal Glands
- Central Nervous System
- Pathologic Influences on Fetal Oxygenation
- Maternal Cardiopulmonary Alterations
- BOX 17-1 POTENTIAL MATERNAL, FETAL, OR NEONATAL RISK FACTORS
- Antepartum Period
- Maternal History
- Problems Identified during Pregnancy
- Intrapartum Period
- Maternal Problems
- Fetal or Placental Problems
- Uterine Activity
- Placental Disruptions
- Interruptions in Umbilical Flow
- Fetal Alterations
- Risk Factors for Fetal Compromise
- Auscultation and Palpation
- Advantages
- Limitations
- Evaluating Auscultated Fetal Heart Rate Data
- FIG 17-1 Low intervention methods for evaluating fetal heart rate during labor. A, Fetoscope with head attachment to enhance conduction of faint fetal heart sounds. B, Doppler ultrasound transducer to sense the fetal heart rate electronically.
- Electronic Fetal Monitoring
- PROCEDURE: Auscultating the Fetal Heart Rate
- Purpose
- Advantages
- Limitations
- Electronic Fetal Monitoring Equipment
- Bedside Monitor Unit
- FIG 17-2 Paper strip for recording electronic fetal monitoring data. Each dark vertical line represents 1 minute, and each lighter vertical line represents 10 seconds. Computerized displays that depict the fetal heart rate and uterine activity patterns have a similar appearance.
- Paper Strip
- Remote Surveillance
- Devices for External Fetal Monitoring
- FIG 17-3 The nurse applies the uterine activity transducer to the woman’s upper abdomen, in the fundal area. The Doppler transducer for sensing the fetal heart rate is usually placed on her lower abdomen when the fetus is in the cephalic presentation.
- PROCEDURE: External Fetal Monitor
- Purposes
- FIG 17-4 Fetal scalp electrode and intrauterine pressure catheter (IUPC). A, Parts of the fetal scalp electrode before it is applied. B, Fetal scalp electrode and IUPC in place and connected to the bedside monitor unit.
- Fetal Heart Rate Monitoring with an Ultrasound Transducer
- Uterine Activity Monitoring with a Tocotransducer
- Devices for Internal Fetal Monitoring
- Fetal Heart Rate Monitoring with a Scalp Electrode
- FIG 17-5 Intrauterine pressure catheter (IUPC) with transducer in its tip. This model has a lumen for amnioinfusion and is shown with its introducer over the catheter. The amnioinfusion port is on the side of the catheter connection and has a blue cap covering it when not in use.
- Uterine Activity Monitoring with an Intrauterine Pressure Catheter
- Evaluating Electronic Fetal Monitoring Strips
- Baseline Fetal Heart Rate
- Baseline FHR Variability
- FIG 17-6 Electronic fetal monitor strip showing a reassuring pattern of fetal heart rate and uterine activity. The baseline fetal heart rate averages 135 beats per minute (bpm), with a moderate variability of 10 bpm. An acceleration to 150 bpm is present. The contraction frequency is approximately every 2 to 3 minutes, duration is about 50 to 60 seconds, intensity is 75 to 90 mm Hg, and uterine resting tone is approximately 10 mm Hg. Fetal scalp electrode and intrauterine pressure catheter (IUPC) are being used.
- Periodic Patterns in FHR
- Accelerations
- Decelerations
- Early Decelerations
- FIG 17-7 Contrasts in fetal heart rate variability. A fetal scalp electrode is being used. A, Minimal variability (less than 5 beats per minute [bpm]). Note the smooth, flat line in the upper graph for the fetal heart rate. B, Moderate variability (average 20 bpm variability). Note the zigzag appearance of the fetal heart rate line compared with the flat appearance in A.
- FIG 17-8 Accelerations in the fetal heart rate.
- FIG 17-9 Early decelerations. The slowing of the fetal heart rate is gradual, and the nadir of the deceleration occurs at the peak of the contraction. It returns to the baseline by the end of the contraction. Cause: fetal head compression.
- FIG 17-10 Late decelerations. Note that the decelerations look similar to early decelerations but are offset to the right. They begin at about the peak of the contraction, and the nadir occurs well after the peak of the contraction, often during the interval. Cause: uteroplacental insufficiency.
- Late Decelerations
- FIG 17-11 Variable decelerations. The decelerations are sharp in onset and offset. Note slight rate accelerations (shoulders) after each variable deceleration. These variable decelerations are periodic in that they occur during contractions. Cause: umbilical cord compression.
- SAFETY ALERT: Differences Between Early and Late Decelerations
- Both Early and Late Decelerations
- Early Decelerations
- Late Decelerations
- Variable Decelerations
- Uterine Activity
- Significance of FHR Patterns
- Reassuring Patterns
- Indeterminate Patterns
- Nonreassuring Patterns
- SAFETY ALERT: Nursing Responses to Nonreassuring Fetal Heart Rate Patterns
- FIG 17-12 Fetal scalp stimulation identifies fetal response to gentle massage. An acceleration in the fetal heart rate of 15 beats per minute for 15 seconds suggests that the fetus is in normal oxygen and acid-base balance. Accelerations often occur with vaginal examination unrelated to nonreassuring fetal heart rate patterns.
- TABLE 17-1 REASSURING (NORMAL) AND NONREASSURING (ABNORMAL) FETAL SURVEILLANCE ASSESSMENTS
- Clarification of Data
- Fetal Scalp Stimulation
- VAS
- Fetal Scalp Blood Sampling
- Fetal Oxygen Saturation Monitor
- Cord Blood Gases and pH
- Interventions for Nonreassuring Patterns
- FIG 17-13 Obtaining a blood sample to determine umbilical cord blood gas values and pH. Samples are drawn from the umbilical artery and vein. Arterial samples most closely reflect fetal oxygen and acid-base status. The samples in capped syringes may be kept for up to 60 minutes at room temperature.
- Identifying the Cause of a Nonreassuring Pattern
- Increasing Placental Perfusion
- Increasing Maternal Blood Oxygen Saturation
- Reducing Cord Compression
- FIG 17-14 The nurse teaches the woman and her partner about electronic fetal monitoring to reduce anxiety and promote the woman’s comfort during labor. Electronic fetal monitoring is only one method used to evaluate fetal well-being during labor.
- Nursing Care
- The Woman Having Intrapartum Fetal Monitoring
- Learning Needs
- Assessment
- NURSING CARE PLAN: Intrapartum Fetal Compromise
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Potential Complication
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Explaining FHR Auscultation with Uterine Palpation
- Explaining the Electronic Fetal Monitor
- Addressing Parents’ Safety Concerns
- Coping with Misleading Data
- PARENTS WANT TO KNOW: About Electronic Fetal Monitoring
- Can I move around with the monitor?
- What if I need to go to the bathroom?
- Will the monitor shock me? I don’t know if I want to be hooked to an electrical outlet, especially since my water has broken
- Why is the baby’s heart beating so fast?
- Why do those numbers for the baby’s heart rate change all the time?
- What do those numbers for contractions on the machine (external monitor) mean? They change all the time
- My contractions don’t look very strong, but they sure seem strong to me! (External uterine activity monitor is being used.)
- Will the internal monitor hurt my baby?
- Including the Labor Partner
- CRITICAL THINKING EXERCISE 17-1
- CRITICAL THINKING EXERCISE 17-2
- Enhancing Comfort
- Evaluation
- Fetal Oxygenation
- Assessment
- BOX 17-2 GUIDELINES FOR ASSESSMENT AND DOCUMENTATION OF FETAL HEART RATE AUSCULTATION FOR WOMEN AT LOW RISK
- Active First-Stage Labor
- Second-Stage Labor
- Other Times to Document Fetal Heart Rate
- Nursing Diagnosis and Planning
- Interventions
- Taking Corrective Actions
- Reassuring Parents
- Reporting Nonreassuring Patterns
- Documentation ExemplarDocumenting Assessments and Care
- Evaluation
- BOX 17-3 DOCUMENTING ELECTRONIC FETAL MONITORING
- Documentation When Monitoring Is Initiated
- Monitor Strip
- Labor Record (If Paper-Only Documentation)
- Continuing Documentation
- Monitor Strip
- Labor Record
- KEY CONCEPTS
- References and Readings
- Chapter 18 Pain Management for Childbirth
- Learning Objectives
- Unique Nature of Pain During Birth
- Adverse Effects of Excessive Pain
- Physiologic Effects
- Psychological Effects
- Variables in Childbirth Pain
- Physical Factors
- Sources of Pain
- Tissue Ischemia
- Cervical Dilation
- Pressure and Pulling on Pelvic Structures
- Distention of the Vagina and Perineum
- Factors Influencing the Perception or Tolerance of Pain
- FIG 18-1 Pathways of pain transmission during labor. Pain stimuli from cervical dilation enter the spinal cord at these segments. Pain stimuli from vaginal and perineal distention travel through the pudendal nerve and enter the spinal cord at these segments
- Intensity of Labor
- Cervical Readiness
- Fetal Position
- Characteristics of the Pelvis
- Fatigue
- Intervention of Caregivers
- Psychosocial Factors
- Culture
- Anxiety and Fear
- Previous Experiences with Pain
- Preparation for Childbirth
- Support System
- Standards for Pain Management
- Nonpharmacologic Pain Management
- Advantages
- Limitations
- Preparation for Pain Management
- FIG 18-2 General comfort measures such as the nurse’s reassuring presence or a cool, damp cloth applied to the face supplement other methods of nonpharmacologic and pharmacologic pain control.
- Application of Nonpharmacologic Techniques
- Relaxation techniques ExemplarRelaxation
- Environmental Comfort
- General Comfort
- Reducing Anxiety and Fear
- Implementing Specific Relaxation Techniques
- Cutaneous Stimulation
- Self-Massage
- Massage by Others
- FIG 18-3 The coach applies sacral pressure to counter the back pain that is common during labor.
- Thermal Stimulation
- Acupressure
- Hydrotherapy
- BOX 18-1 USE OF WATER THERAPY DURING LABOR
- Benefits
- Disadvantages
- Contraindications and Precautions
- Mental Stimulation
- Imagery ExemplarImagery
- FIG 18-4 A woman and her partner who are prepared for labor have learned a variety of skills to master pain as labor progresses. The coach uses hand signals to tell the woman how to change her pattern of paced breathing.
- Focal Point
- Breathing Techniques
- First-Stage Breathing
- Cleansing Breath
- FIG 18-5 Slow-paced breathing. Although a specific rate may or may not be taught, slow-paced breathing should be no slower than half the woman’s usual respiratory rate to ensure adequate oxygenation. This pace is generally about six to nine breaths per minute.
- FIG 18-6 Modified-paced breathing. The pattern for modified-paced breathing should be comfortable to the woman and no faster than twice her normal respiratory rate to prevent hyperventilation or interference with relaxation.
- Slow-Paced Breathing
- Modified-Paced Breathing
- Pattern-Paced Breathing
- FIG 18-7 Combining breathing techniques during a contraction. Slow- and modified-paced breathing can be combined by using the slower breathing at the beginning and end of the contraction and the more rapid breathing over the peak of the contraction.
- FIG 18-8 Pattern-paced breathing. Pattern-paced breathing adds a slight emphasis or “blow” on the exhalation in a pattern. The diagram shows the emphasis after every third inhalation.
- Controlling the Urge to Push
- Common Problems
- Second-Stage Breathing
- Pharmacologic Pain Management
- Special Considerations When Medicating a Pregnant Woman
- Effects on the Fetus
- Maternal Physiologic Alterations
- Cardiovascular Changes
- Respiratory Changes
- Gastrointestinal Changes
- Nervous System Changes
- Effects on the Course of Labor
- Effects of Complications
- Interactions with Other Substances
- Regional Pain Management Techniques
- Epidural Block
- FIG 18-9 A, Cross section of spinal cord, meninges, and protective vertebra. The dura and arachnoid lie close together. The pia mater is the innermost of the meninges and covers the brain and spinal cord. The subarachnoid space is between the arachnoid and pia mater. B, Sagittal section of spinal cord, meninges, and vertebrae. The epidural and subarachnoid spaces are illustrated. Note that the spinal cord ends at the L2 vertebra.
- Technique
- Dural Puncture
- Contraindications and Precautions
- FIG 18-10 Technique for epidural block.
- Adverse Effects of Epidural Block
- Maternal Hypotension
- Bladder Distention
- Prolonged Second Stage
- Migration of the Epidural Catheter
- Fever
- TABLE 18-1 DRUGS COMMONLY USED FOR INTRAPARTUM PAIN MANAGEMENT
- Adverse Effects of Epidural Opioids
- Nausea and Vomiting
- Pruritus
- Delayed Respiratory Depression
- Nursing Care
- Intrathecal (Subarachnoid) Opioid Analgesics
- Technique
- Adverse Effects of Intrathecal Opioids
- Nursing Care
- Subarachnoid (Spinal) Block
- Technique
- Contraindications and Precautions
- Adverse Effects of an SAB
- Systemic Drugs for Labor
- Opioid Analgesics
- FIG 18-11 Technique for subarachnoid block.
- FIG 18-12 Levels of anesthesia for epidural and subarachnoid blocks. A level of T10 through S5 is adequate for vaginal birth. A higher level, to T4-T6, is needed for cesarean birth.
- Opioid Antagonists
- Adjunctive Drugs
- FIG 18-13 Blood patch for relief of spinal headache. Ten to 15 mL of the woman’s blood is injected into the epidural space to seal a dural puncture.
- Sedatives
- Vaginal Birth Anesthesia
- Local Infiltration Anesthesia
- Pudendal Block
- FIG 18-14 Local infiltration anesthesia numbs the perineum just before birth for an episiotomy or after birth for suturing of a laceration. The birth attendant protects the fetal head by placing a finger inside the vagina while injecting the perineum in a fanlike pattern or as needed.
- General Anesthesia
- Technique
- FIG 18-15 Pudendal block provides anesthesia for an episiotomy and the use of low forceps. A needle guide (“trumpet”) protects the maternal and fetal tissues from the long needle needed to reach the pudendal nerve. Only about 1.25 cm (½ in) of the long needle protrudes from the guide.
- Adverse Effects of General Anesthesia
- Maternal Aspiration of Gastric Contents
- Respiratory Depression
- Uterine Relaxation
- Methods to Minimize Adverse Effects
- FIG 18-16 Sellick maneuver to prevent vomitus from entering the woman’s trachea while she is being intubated for general anesthesia. An assistant applies pressure to the cricoid cartilage to obstruct the esophagus. Once the woman is successfully intubated with a cuffed endotracheal tube, gastric secretions cannot enter the trachea.
- Nursing Care
- Pain Management
- Pain
- Assessment
- NURSING CARE PLAN: Intrapartum Pain Management
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses and Collaborative Problems to Consider:
- Labor Status
- CRITICAL THINKING EXERCISE 18-1
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Promoting Relaxation
- Reducing Outside Sources of Discomfort
- Reducing Anxiety and Fear
- Helping the Woman Use Nonpharmacologic Techniques
- Massage
- Mental Stimulation
- Breathing
- Incorporating Pharmacologic Methods
- PARENTS WANT TO KNOW: How Will This Medicine Affect Our Baby?
- Evaluation
- Respiratory Compromise
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Identifying Risk Factors
- Reducing Risk for Aspiration or Lung Injury
- Perioperative Care
- TABLE 18-2 PHARMACOLOGIC METHODS OF INTRAPARTUM PAIN MANAGEMENT
- Postoperative Care
- Evaluation
- KEY CONCEPTS
- References and Readings
- Chapter 19 Nursing Care During Obstetric Procedures
- Learning Objectives
- Amniotomy
- Indications
- Risks
- Prolapse of the Umbilical Cord
- Infection
- Abruptio Placentae
- Technique
- FIG 19-1 A, Disposable plastic membrane perforator (Amnihook). B, Hook end of plastic membrane perforator. C, Correct method of opening the package. D, Technique for artificial rupture of membranes.
- Nursing Considerations
- Obtaining Baseline Information
- Assisting with Amniotomy
- Providing Care after Amniotomy
- Identifying Complications
- CRITICAL THINKING EXERCISE 19-1
- Promoting Comfort
- Induction and Augmentation of Labor
- Indications
- Determining Whether Induction Is Indicated
- Contraindications
- TABLE 19-1 BISHOP SCORING SYSTEM TO EVALUATE THE CERVIX
- Risks
- Technique
- Cervical Ripening
- Medical Methods
- TABLE 19-2 PROSTAGLANDIN PREPARATIONS FOR CERVICAL RIPENING AT TERM
- Mechanical Methods
- Oxytocin Administration
- FIG 19-2 Intravenous (IV) pump setup for infusion from two IV lines. Fluid in the primary line (nonadditive, or maintenance line) contains no medication but is regulated by the infusion pump to maintain the correct rate. Oxytocin solution is regulated in the secondary line in the same pump, giving the nurse options to change or discontinue the oxytocin infusion rate while maintaining the primary line infusion at the same rate. A single IV line at the lower part of the pump connects to the woman’s infusion site.
- Nursing Considerations
- DRUG GUIDE: Oxytocin (Pitocin)
- CRITICAL THINKING EXERCISE 19-2
- Observing the Fetal Response
- Observing the Mother’s Response
- SAFETY ALERT: Signs of Tachysystole
- Nursing Actions for Tachysystole
- Version
- Indications
- External Cephalic Version
- Internal Version
- Contraindications
- Risks
- Technique
- External Version
- FIG 19-3 External version. Intravenous (IV) access is established in case of emergency or for some tocolytic drugs. If terbutaline is the tocolytic drug, it is given by subcutaneous injection.
- Internal Version
- Nursing Considerations
- Providing Information
- Promoting Maternal and Fetal Health
- Reducing Anxiety
- Operative Vaginal Birth
- Indications
- Contraindications
- FIG 19-4 Obstetric forceps and their application.
- Risks
- Technique
- FIG 19-5 Birth assisted with a vacuum extractor. The chignon is scalp edema that often forms under the suction cup when the vacuum extractor is used.
- Nursing Considerations
- FIG 19-6 A, Vacuum extractor with a low-profile cup that can be used for occiput posterior fetal positions. Note the green band that denotes adequate suction and the red band that warns of excess suction. B, Application of the low-profile cup to the fetal head in an occiput posterior position.
- Episiotomy
- Technique
- Nursing Considerations
- FIG 19-7 Types of episiotomies.
- Cesarean Birth
- VBAC
- BOX 19-1 VAGINAL BIRTH AFTER CESAREAN BIRTH
- Indications
- Contraindications
- Risks
- Technique
- Preparation
- FIG 19-8 Skin (abdominal wall) incisions for cesarean birth.
- Surgical incision ExemplarIncisions
- FIG 19-9 Uterine incisions for cesarean birth. The abdominal and uterine incisions do not always match. VBAC, Vaginal birth after cesarean.
- Nursing Considerations
- Providing Emotional Support
- BOX 19-2 NURSING CARE FOR A WOMAN HAVING A CESAREAN BIRTH
- Before the Cesarean Birth
- During the Recovery Period
- NURSING CARE PLAN: Cesarean Birth
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Teaching
- Promoting Safety
- Providing Postoperative Care
- KEY CONCEPTS
- References and Readings
- Chapter 20 Postpartum Adaptations
- Learning Objectives
- Reproductive System
- Involution of the Uterus
- Descent of the Uterine Fundus
- Afterpains
- Etiology
- Nursing Considerations
- FIG 20-1 Involution of the uterus. Height of the uterine fundus decreases by approximately 1 cm/day. The fundus is no longer palpable by 14 days.
- Lochia
- Changes in Color
- Amount
- FIG 20-2 Guidelines for assessing the volume of lochia based on the amount of stain on a perineal pad in 1 hour.
- TABLE 20-1 CHARACTERISTICS OF LOCHIA
- Cervix
- Vagina
- BOX 20-1 LACERATIONS OF THE BIRTH CANAL
- Perineum
- Periurethral Area
- Vaginal Wall
- Cervix
- Perineum
- Discomfort
- Nursing Considerations
- Cardiovascular System
- Cardiac Output
- Plasma Volume
- Blood Values
- Coagulation
- Gastrointestinal System
- Urinary System
- FIG 20-3 A full bladder displaces and prevents contraction of the uterus.
- Musculoskeletal System
- Muscles and Joints
- Abdominal Wall
- Integumentary System
- FIG 20-4 Diastasis recti occurs when the longitudinal muscles of the abdomen separate during pregnancy.
- FIG 20-5 Abdominal exercises for diastasis recti. A, The woman inhales and supports the abdominal wall firmly with her hands. B, Exhaling, the woman raises her head as she pulls the abdominal muscles together.
- Neurologic System
- Endocrine System
- Resumption of Ovulation and Menstruation
- Lactation
- Weight Loss
- Postpartum Assessments
- Clinical Pathways
- Initial Assessments
- Chart Review
- Need for Rho(D) Immune Globulin
- Need for Vaccines
- Rubella Vaccine
- Pertussis Vaccine
- DRUG GUIDE: Rubella Vaccine
- Risk Factors for Hemorrhage and Infection
- SAFETY ALERT: Postpartum Risk Factors
- Hemorrhage
- Infection
- Focused Assessments after Vaginal Birth
- Vital Signs
- Blood Pressure
- Orthostatic Hypotension
- TABLE 20-2 OBSERVATIONS OF THE UTERINE FUNDUS AND NURSING ACTIONS
- Pulse
- Respirations
- Temperature
- Pain
- Fundus
- Lochia
- PROCEDURE: Assessing the Uterine Fundus
- Purpose
- Perineum
- Bladder Elimination
- SAFETY ALERT: Signs of a Distended Bladder
- PROCEDURE: Assessing the Perineum
- Purpose
- Breasts
- Lower Extremities
- Homans Sign
- Edema and Deep Tendon Reflexes
- Care in the Immediate Postpartum Period
- Providing Comfort Measures
- Ice Packs
- Sitz Baths
- Perineal Care
- Topical Medications
- Sitting Measures
- Analgesics
- Promoting Bladder Elimination
- CRITICAL THINKING EXERCISE 20-1
- Providing Fluids and Food
- Preventing Thrombophlebitis
- Nursing Care After Cesarean Birth
- Assessment
- Pain Relief
- Respirations
- Abdomen
- Intake and Output
- Interventions
- The First 24 Hours
- Providing Pain Relief
- Overcoming the Effects of Immobility
- Providing Comfort
- After 24 Hours
- Resuming Normal Activities
- Assisting the Mother with Infant Care
- Preventing Abdominal Distention
- Nursing Care
- Teaching After Birth
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Preparing for Teaching
- Determining Teaching Topics
- NURSING CARE PLAN: Postpartum Hypotension, Fatigue, and Pain
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Teaching the Process of Involution
- Teaching Self-Care
- Handwashing
- Breast Care for Lactating Mothers
- Measures to Suppress Lactation
- Care of the Cesarean Incision
- Perineal Care
- Kegel Exercises
- Promoting Rest and Sleep
- Rest at the Birth Facility
- Rest at Home
- Providing Nutrition Counseling
- Food Supply
- Diet
- Promoting Regular Bowel Elimination
- Promoting Good Body Mechanics
- Exercise
- Preventing Back Strain
- Counseling about Sexual Activity
- FIG 20-6 Postpartum exercises.
- Instructing About Follow-up Appointments
- Teaching about Signs and Symptoms that Should Be Reported
- Ensuring that All Elements Have Been Taught
- Documenting Teaching
- Evaluation
- The Process of Becoming Acquainted
- FIG 20-7 The infant is quiet and alert during the initial sensitive period. The newborn gazes at the mother and responds to her voice and touch. The mother touches only with her fingertips at first.
- Bonding
- Attachment
- FIG 20-8 The mother begins to stroke her infant as she progresses in becoming acquainted.
- NURSING QUALITY ALERT: Reciprocal Attachment Behaviors
- Maternal Touch
- FIG 20-9 Mothers progress from exploratory touching to enfolding the infant. Their pleasure is enhanced by skin-to-skin contact.
- FIG 20-10 The binding-in, or claiming, process includes the mother’s identification of her baby’s specific features, relating them to other family members. This mother states, “His long toes are exactly like mine.”
- Verbal Behaviors
- The Process of Maternal Role Adaptation
- Puerperal Phases
- Taking-In Phase
- Taking-Hold Phase
- Letting-Go Phase
- CRITICAL THINKING EXERCISE 20-2
- Maternal Role Attainment
- Heading Toward a New Normal
- Appreciating the Body
- Settling In
- Becoming a New Family
- Redefining Roles
- Role Conflict
- NURSING CARE PLAN: Adaptation of the Working Mother
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Major Maternal Concerns
- Body Image
- Smoking
- Postpartum Blues
- FIG 20-11 Fathers’ behaviors at initial contact with their infants often correspond to maternal behaviors. The intense fascination that fathers exhibit is called engrossment. Note the eye-to-eye contact between father and infant.
- Expanding family ExemplarThe Process of Family Adaptation
- Fathers
- FIG 20-12 A, Although they may hesitate to touch the infant, children often want to be close. B, This boy’s relief and joy are obvious as he reclaims a favorite spot.
- Siblings
- Grandparents
- FIG 20-13 Grandparents may develop strong bonds with grandchildren.
- Factors Affecting Family Adaptation
- Discomfort and Fatigue
- Knowledge of Infant Needs
- Previous Experience
- Expectations about the Newborn
- Maternal Age
- Maternal Temperament
- Temperament of the Infant
- Availability of a Strong Support System
- Other Factors
- Cesarean Birth
- Preterm or Ill Infant
- Birth of Multiple Infants
- NURSING QUALITY ALERT: Factors That Affect Adaptation
- Cultural Influences on Adaptation
- Communication
- Dietary Practices
- Health Beliefs
- Nursing Care
- Maternal Adaptation
- Assessment
- TABLE 20-3 ASSESSING MATERNAL ADAPTATION
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Assisting the Mother through Recovery Phases
- “Mother” the Mother
- Monitor and Protect
- Listen to the Birth Experience
- Foster Independence
- Promote Bonding and Attachment
- FIG 20-14 By teaching about the newborn and family, the nurse helps parents develop confidence in their ability to provide care for the infant.
- Involve Parents in Infant Care
- Evaluation
- Nursing Care
- Family Adaptation
- Assessment
- Fathers
- Siblings
- Support System
- Nonverbal Behavior
- Nursing Diagnosis and Planning
- Expected Outcomes
- TABLE 20-4 ASSESSING FAMILY ADAPTATION
- Interventions
- Teaching the Family about the Newborn
- Infant Needs
- Infant Signals
- Helping the Family Adapt
- Providing Anticipatory Guidance about Stress Reduction
- Helping the Father Co-parent
- Providing Ways to Reduce Sibling Rivalry
- Identifying Resources
- Evaluation
- Postpartum Home and Community Care
- Criteria for Discharge
- EVIDENCE-BASED PRACTICE
- Community-Based Care
- KEY CONCEPTS
- References and Readings
- Chapter 21 The Normal Newborn: Adaptation and Assessment
- Learning Objectives
- Initiation of Respirations
- Development of the Lungs
- FIG 21-1 Internal causes of the initiation of respirations are the chemical changes that take place at birth. External causes of respirations include thermal, sensory, and mechanical factors.
- Causes of Respirations
- Chemical Factors
- Mechanical Factors
- Thermal Factors
- Sensory Factors
- Continuation of Respirations
- Cardiovascular Adaptation: Transition from Fetal to Neonatal Circulation
- Ductus Venosus
- Foramen Ovale
- Pulmonary Blood Vessels
- Ductus Arteriosus
- Changes at Birth
- CRITICAL THINKING EXERCISE 21-1
- Neurologic Adaptation: Thermoregulation
- Newborn Characteristics Leading to Heat Loss
- Methods of Heat Loss
- FIG 21-2 Methods of heat loss.
- Nonshivering Thermogenesis
- FIG 21-3 Sites of brown fat in the neonate.
- Effects of Cold Stress
- Neutral Thermal Environment
- FIG 21-4 Effects of cold stress.
- BOX 21-1 HAZARDS OF COLD STRESS
- Hyperthermia
- Hematologic Adaptation
- Factors Affecting the Blood
- Blood Values
- Erythrocytes and Hemoglobin
- TABLE 21-1 LABORATORY VALUES IN THE NEWBORN
- Hematocrit
- Leukocytes
- Risk of Clotting Deficiency
- Gastrointestinal System
- Stomach
- Intestines
- Digestive Enzymes
- Stools
- Hepatic System
- Blood Glucose Maintenance
- Conjugation of Bilirubin
- Source and Effect of Bilirubin
- Normal Conjugation
- FIG 21-5 Sources of bilirubin and how it is removed from the body.
- Risk Factors for Elevated Bilirubin
- Hyperbilirubinemia
- Physiologic Jaundice
- Nonphysiologic (Pathologic) Jaundice
- Jaundice Associated with Breastfeeding
- Breastfeeding or Early Onset Jaundice
- True Breast Milk Jaundice
- Blood Coagulation
- Iron Storage
- Drug Metabolism
- Urinary System
- Kidney Development
- Kidney Function
- Fluid Balance
- Water Distribution
- BOX 21-2 INTAKE AND OUTPUT IN THE NEWBORN
- First 3 to 5 Days of Life
- After the First 3 to 5 Days
- Insensible Water Loss
- Urine Dilution and Concentration
- Acid-Base and Electrolyte Balance
- Immune System
- IgG
- IgM
- IgA
- Psychosocial Adaptation
- Periods of Reactivity
- First Period of Reactivity
- Period of Sleep or Decreased Activity
- Second Period of Reactivity
- Behavioral States
- Deep or Quiet Sleep State
- Light or Active Sleep State
- Drowsy State
- Quiet Alert State
- Active Alert State
- Crying State
- Early Assessments
- SAFETY ALERT: Protection from Bloodborne Infections
- TABLE 21-2 SUMMARY OF NEWBORN ASSESSMENT
- History
- Assessment of Cardiorespiratory Status
- Airway
- Respiratory Rate
- Breath Sounds
- Infant respiratory distress syndrome ExemplarSigns of Respiratory Distress
- Tachypnea
- PROCEDURE: Assessing Vital Signs in the Newborn
- Purpose
- Temperature
- Respirations
- Apical Pulse
- Retractions
- Flaring of the Nares
- Cyanosis
- FIG 21-6 Acrocyanosis.
- Grunting
- Seesaw or Paradoxical Respirations
- Asymmetry
- Choanal Atresia
- Color
- Pallor
- Ruddy Color
- Heart Sounds
- Position
- Rhythm and Murmurs
- Brachial and Femoral Pulses
- Blood Pressure
- Capillary Refill
- Assessment of Thermoregulation
- FIG 21-7 The infant is held securely to prevent injury and obtain an accurate reading when taking the temperature.
- BOX 21-3 NORMAL VITAL SIGNS IN THE NEWBORN
- Assessing for Anomalies
- Head
- Molding
- Fontanels
- FIG 21-8 Palpation of the anterior fontanel. Note elevation of the head.
- Caput Succedaneum
- FIG 21-9 Caput succedaneum is an edematous area on the head from pressure against the cervix. It may cross suture lines.
- Cephalhematoma
- Face
- Neck and Clavicles
- FIG 21-10 A cephalhematoma is characterized by bleeding between the bone and its covering, the periosteum. It may occur on one or both sides and does not cross suture lines.
- Cord
- Extremities
- Hands and Feet
- Hips
- Vertebral Column
- Measurements
- Weight
- FIG 21-11 Assessment of the hips. Place the fingers over the infant’s greater trochanter and thumbs over the femur. Flex the knees and hips. A, Barlow test: adduct the hips, and apply gentle pressure down and back with the thumbs. In hip dysplasia, the examiner can feel the femoral head move out of the acetabulum. B, Ortolani test: abduct the thighs, and apply gentle pressure forward over the greater trochanter. A “clunking” sensation indicates a dislocated femoral head moving into the acetabulum. A hip click is normal from ligament movement.
- FIG 21-12 Note the symmetry of gluteal and thigh creases.
- FIG 21-13 A tape is placed alongside the infant to measure the length. A mark can be made on the bed at the head and foot and the distance between the marks measured.
- Length
- Head and Chest Circumference
- CRITICAL THINKING EXERCISE 21-2
- Assessment of Body Systems
- Neurologic System
- Reflexes
- Sensory Assessment
- Ears
- Eyes
- Sense of Smell and Taste
- Other Neurologic Signs
- FIG 21-14 Reflexes.
- FIG 21-15 An imaginary line is drawn from the outer canthus of the eye to the ear. The line should intersect with the area where the upper ear joins the head.
- TABLE 21-3 SUMMARY OF NEONATAL REFLEXES
- BOX 21-4 RISK FACTORS FOR HYPOGLYCEMIA
- Assessment of Hepatic Function
- Blood Glucose
- SAFETY ALERT: Signs of Hypoglycemia
- PROCEDURE: Obtaining Blood Samples from the Newborn by Heel Puncture
- Purpose
- EVIDENCE-BASED PRACTICE
- Bilirubin
- BOX 21-5 RISK FACTORS FOR HYPERBILIRUBINEMIA
- Gastrointestinal System
- Mouth
- Suck
- Initial Feeding
- Abdomen
- Stools
- Genitourinary System
- Kidney Palpation
- Urine
- Genitalia
- Female
- Male
- Integumentary System
- Skin
- FIG 21-16 The testes are palpated from front to back with the thumb and forefinger. Placing a finger over the inguinal canal holds the testes in place for palpation.
- Color
- Harlequin Color Change
- Mottling
- Vernix Caseosa
- Lanugo
- Milia
- FIG 21-17 Lanugo is abundant on this slightly preterm infant.
- FIG 21-18 Milia.
- FIG 21-19 Erythema toxicum.
- Erythema Toxicum
- Birthmarks
- FIG 21-20 Mongolian spots.
- FIG 21-21 Nevus simplex (stork bite, salmon patch).
- FIG 21-22 Nevus flammeus (port-wine stain).
- Marks from Delivery
- Other Skin Assessments
- Documentation
- Breasts
- Hair and Nails
- Assessment of Gestational Age
- Assessment Tools
- Neuromuscular Characteristics
- Posture
- Square Window
- Arm Recoil
- Popliteal Angle
- FIG 21-23 New Ballard Score.
- Scarf Sign
- FIG 21-24 Posture in newborns. A, The healthy, full-term infant remains in a strongly flexed position. B, The preterm infant’s extremities are extended.
- FIG 21-25 The square window sign is performed on an arm without an identification bracelet. The nurse flexes the wrist and measures the angle. A, Infant near full term. B, Preterm infant.
- Heel to Ear
- Physical Characteristics
- Skin
- Lanugo
- FIG 21-26 Arm recoil. A, Arms flexed. B, Arms extended. C, Recoil for the full-term infant.
- FIG 21-27 The popliteal angle is measured by flexing the thigh against the abdomen and extending the lower leg to the point of resistance. A, Full-term infant. B, Preterm infant.
- FIG 21-28 Scarf sign. The nurse determines how far the arm will move across the chest and observes the position of the elbow when resistance is felt. A, Full-term infant. B, Preterm infant. (Note the many visible veins in the preterm infant and the absence of visible veins in the full-term infant.)
- FIG 21-29 Heel to ear. The nurse grasps the foot and brings it up toward the ear. The score is recorded when resistance is felt. A, Full-term infant. B, Preterm infant.
- FIG 21-30 Plantar creases begin to develop at the base of the toes and extend to the heel. A, The postterm infant has deep creases. B, The preterm infant has few creases on the entire foot.
- Plantar Surface
- Breasts
- Eyes and Ears
- FIG 21-31 The nurse places a finger on either side of the breast bud and measures the size. In the full-term infant, the areola is raised and the nipple is easily distinguished from surrounding skin. (Note the peeling skin.)
- Genitals
- FIG 21-32 Ear maturation. A, The nurse folds the ears and notes how quickly they return to position. B, Ears in the full-term infant are well formed and have instant recoil. C, In the preterm infant, ears show less incurving of the pinna and recoil slowly or not at all.
- FIG 21-33 Female genitals. As the female fetus matures, the labia majora cover the labia minora and clitoris completely; in the preterm infant, these structures are not covered. A, Near-term infant. B, Preterm infant.
- Scoring
- Gestational Age and Infant Size
- FIG 21-34 Male genitals. A, The full-term infant has a pendulous scrotum with deep rugae. B, In the preterm infant, the testes may not be descended and rugae are few.
- Assessment of Behavior
- Periods of Reactivity
- Behavioral Changes
- Orientation
- Habituation
- Self-Consoling Activities
- Parents’ Response
- KEY CONCEPTS
- References and Readings
- Chapter 22 The Normal Newborn: Nursing Care
- Learning Objectives
- Early Care
- Administering Vitamin K
- Providing Eye Treatment
- DRUG GUIDE: Vitamin K1 (phytonadione)
- FIG 22-1 Administration of ophthalmic ointment. The nurse gently cleans the eyes of blood or vernix wiping from inner to outer canthus. Then, placing a finger and thumb near the edge of each lid, the nurse gently presses against the periorbital ridges to open the eyes, avoiding pressure on the eye itself. A ribbon of ointment is squeezed into each conjunctival sac.
- DRUG GUIDE: Erythromycin Ophthalmic Ointment
- Nursing Care
- Cardiorespiratory Status
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Positioning and Suctioning
- PROCEDURE: Using a Bulb Syringe
- Purpose
- Providing Continuing Care
- Evaluation
- Nursing Care
- Thermoregulation
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Preventing Heat Loss
- Preparing the Environment Before Birth
- Providing Immediate Care
- FIG 22-2 Radiant warmers allow easy access to the infant without increasing heat loss caused by exposure. The nurse should be careful not to come between the infant and the overhead source of heat when giving care.
- Providing Ongoing Prevention
- Restoring Thermoregulation
- Performing Expanded Assessments
- Evaluation
- Nursing Care
- Hepatic Function
- NURSING CARE PLAN: The Normal Newborn
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Blood Glucose
- Assessment
- Nursing Diagnosis and Planning
- Interventions
- Maintaining Safe Glucose Levels
- Repeating Glucose Tests
- Providing Other Care
- Evaluation
- CRITICAL THINKING EXERCISE 22-1
- Bilirubin
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Evaluation
- Ongoing Assessments and Care
- Providing Skin Care
- Bathing
- Cleansing the Diaper Area
- Providing Cord Care
- Assisting with Feedings
- FIG 22-3 The cord clamp is removed when the end of the cord is dry and crisp. The clamp is cut (A) and separated (B).
- Positioning the Infant
- Protecting the Infant
- Identifying the Infant
- Preventing Infant Abduction
- FIG 22-4 The nurse unwraps the infant to compare the infant’s identification band with the mother’s band. The mother may be asked to read the identification number on her band as the nurse checks the infant’s band or the nurse may look at both bands together.
- BOX 22-1 PRECAUTIONS TO PREVENT INFANT ABDUCTIONS
- FIG 22-5 The nurse uses a code to open the door to maternity units.
- Preventing Infection
- Circumcision
- Reasons for Choosing Circumcision
- Reasons for Rejecting Circumcision
- Pain Relief
- Methods
- Nursing Considerations
- Assisting in Decision Making
- FIG 22-6 Circumcision using the Gomco (Yellen) clamp. The physician pulls the prepuce over a cone-shaped device that rests against the glans. A clamp is placed around the cone and prepuce and is tightened to provide enough pressure to crush the blood vessels. This procedure prevents bleeding when the prepuce is removed after 3 to 5 minutes.
- FIG 22-7 Circumcision using the PlastiBell. The physician places the PlastiBell, a plastic ring, over the glans, draws the prepuce over it, and ties a suture around the prepuce and PlastiBell. This procedure prevents bleeding when the excess prepuce is removed. The handle is removed, leaving only the ring in place over the glans. The PlastiBell usually falls off in 7 to 14 days.
- PATIENT-CENTERED TEACHING: How to Care for an Uncircumcised Penis
- Providing Care during Circumcision
- Evaluating Pain
- Providing Postprocedure Care
- FIG 22-8 The infant is placed on the circumcision board just before the procedure is begun.
- FIG 22-9 An infant with a newly circumcised penis.
- PATIENT-CENTERED TEACHING: How to Care for a Circumcision Site
- PATIENT-CENTERED TEACHING: Techniques for Infant Care
- Handling the Infant
- Head Support
- Positioning
- Wrapping
- Normal Body Processes
- Breathing
- Using a Bulb Syringe
- Temperature
- Using a Thermometer
- Urine Output
- Stool Output
- Diarrhea
- Skin Care
- Cord
- Diaper Area
- Bathing
- Sponge Baths
- Tub Bath
- Behavior
- Sleep Phases
- Awake Phases
- Socialization
- Teaching Parents
- SAFETY ALERT: Signs of Complications after Circumcision
- Nursing Care
- Parents’ Knowledge of Newborn Care
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Determining Who Teaches
- Setting Priorities
- Using Various Teaching Methods
- Modeling Behavior
- Teaching Intermittently
- Including the Father
- Documenting Teaching
- Incorporating Cultural Considerations
- Providing for Follow-up Care
- Evaluation
- Immunization
- Newborn Screening
- Hearing Screening
- Other Screening Tests
- Discharge and Newborn Follow-Up Care
- Discharge
- Follow-up Care
- Home Visits
- Content of the Home Visit
- Identification of Jaundice
- Feeding Concerns
- General Considerations in Home Visits
- Outpatient Visits
- Telephone Counseling
- Follow-up Calls
- Warm Lines
- Telephone Techniques
- Guidelines and Documentation
- KEY CONCEPTS
- References and Readings
- Chapter 23 Newborn Feeding
- Learning Objectives
- Nutritional Needs of the Newborn
- Calories
- Nutrients
- Water
- BOX 23-1 DAILY CALORIE AND FLUID NEEDS OF THE NEWBORN
- Breast Milk and Formula Composition
- Breast Milk
- Changes in Composition
- Lactogenesis I
- Lactogenesis II
- Lactogenesis III
- Nutrients
- Protein
- Carbohydrate
- Fat
- Vitamins
- Minerals
- Enzymes
- Infection-Preventing Components
- Effect of Maternal Diet
- Formulas
- Cow’s Milk
- Formulas for Infants with Special Needs
- Considerations in Choosing a Feeding Method
- Breastfeeding
- BOX 23-2 BENEFITS OF BREASTFEEDING
- For the Infant
- For the Mother
- Formula Feeding
- Combination Feeding
- Factors Influencing Choice
- Support from Others
- Culture
- Employment
- Staff Knowledge
- Other Factors
- Normal Breastfeeding
- Breast Changes during Pregnancy
- Milk Production
- Hormonal Changes at Birth
- Prolactin
- Oxytocin
- Continued Milk Production
- Preparation of Breasts for Breastfeeding
- FIG 23-1 Effect of prolactin and oxytocin on milk production. When the infant begins to suckle at the breast, nerve impulses travel to the hypothalamus and cause the anterior pituitary to secrete prolactin to increase milk production. Suckling causes the posterior pituitary to secrete oxytocin, producing the let-down reflex, which releases milk from the breast. Oxytocin also causes the uterus to contract, which aids in involution.
- FIG 23-2 Normal everted nipple and other types of nipples that may cause the infant difficulty in latching on. Nipples shown after stimulation.
- Nursing Care
- Breastfeeding
- Assessment
- Maternal Assessment
- Breasts and Nipples
- BOX 23-3 HUNGER CUES IN INFANTS
- Knowledge
- Assessment of Infant Feeding Behaviors
- LATCH Scoring Tool
- Nursing Diagnosis and Planning
- Expected Outcomes
- FIG 23-3 For the cradle hold, the mother positions the infant’s head at or near the antecubital space and level with her nipple, with her arm supporting the infant’s body. Her other hand is free to hold the breast. Once the infant is positioned, pillows or blankets can be used to support the mother’s arm, which may tire from holding the baby.
- Interventions
- Assisting with the First Feeding
- Teaching Feeding Techniques
- Position of the Mother and Infant
- FIG 23-4 For the football or clutch hold, the mother supports the infant’s head in her hand, with the infant’s body resting on pillows alongside her hip. This method allows the mother to see the position of the infant’s mouth on the breast, helps her control the infant’s head, and is especially helpful for mothers with heavy breasts. This hold also avoids pressure against an abdominal incision.
- FIG 23-5 The cross-cradle or modified cradle hold is helpful for infants who are preterm or have a fractured clavicle. The mother holds the infant’s head in the hand opposite the side on which the infant will feed and supports the infant’s body across her lap with her arm. The other hand holds the breast. The mother can guide the infant’s head to the breast and see the mouth on the breast during the feeding.
- FIG 23-6 The side-lying position avoids pressure on episiotomy or abdominal incisions and allows the mother to rest while feeding. She lies on her side, with her lower arm supporting her head or placed around the infant. Pillows behind her back and between her legs provide comfort. Her upper hand and arm are used to position the infant on the side at nipple level and hold the breast. When the infant’s mouth opens to nurse, the mother draws the infant to her to insert the nipple into the mouth.
- Position of the Mother’s Hands
- Latch-On Techniques
- Eliciting Latch-On
- FIG 23-7 C position of hand on breast. The hand is positioned so the thumb is on top of the breast while the fingers support the breast from below. Note the flaring of the infant’s lips.
- FIG 23-8 Position of infant’s mouth while suckling. When the nipple and areola are properly positioned in the infant’s mouth, the gums compress the areola instead of the nipple. The tongue is between the lower gum and the breast. The infant’s lips are flared outward.
- Position of the Mouth
- Suckling Pattern
- Removal from the Breast
- Frequency of Feedings
- Length of Feedings
- Preventing Problems
- Teaching
- Minimizing Interruptions
- EVIDENCE-BASED PRACTICE
- Formula Gift Packs
- Formula Supplements
- Insufficient Milk Supply
- Increasing Confidence
- Providing Resources
- Evaluation
- MOTHERS WANT TO KNOW: Is My Baby Getting Enough Milk?
- Common Breastfeeding Concerns
- Infant Problems
- SAFETY ALERT: Infant Signs of Breastfeeding Problems
- Sleepy Infant
- Nipple Confusion
- Latch-on Problems
- Infant Complications
- Jaundice
- Prematurity
- NURSING CARE PLAN: Breastfeeding an Infant with a Complication
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Late Preterm Infants
- Illness and Congenital Defects
- Maternal Concerns
- SAFETY ALERT: Maternal Signs of Breastfeeding Problems
- Common Breast Problems
- Engorgement
- Nipple Pain
- Flat and Inverted Nipples
- Plugged Ducts
- Illness in the Mother
- FIG 23-9 Note the cracked area on this nipple.
- FIG 23-10 Rolling helps flat nipples become erect in preparation for latch-on.
- PATIENT-CENTERED TEACHING: Solutions to Common Breastfeeding Problems
- Problem: Sleepy Infant
- Prevention
- Solutions
- Problem: Nipple Confusion
- Prevention
- Solution
- Problem: Latch-on Difficulty
- Prevention
- Solution
- Problem: Engorgement
- Prevention
- Solutions
- Problem: Nipple Pain
- Prevention
- Solutions
- Problem: Flat or Inverted Nipples
- Prevention
- Solutions
- Drug Transfer to Breast Milk
- FIG 23-11 To massage the breasts the mother places her hands against the chest wall with her fingers encircling the breasts. She gently slides her hands forward until the fingers overlap. The position of the hands is rotated to cover all breast tissue. Massaging with the fingertips in a circular motion over all areas of the breast also is helpful.
- Conditions in which Breastfeeding Should Be Avoided
- Previous Breast Surgery
- Employment
- Milk Expression and Storage
- FIG 23-12 To express milk from the breast, the mother places her hand just behind the areola, with the thumb on top and the fingers supporting the breast. The tissue is pressed back against the chest wall; then the fingers and thumb are brought together and toward the nipple to cause the milk to flow. The action is repeated to simulate the infant’s suckling. Moving the hands around the areola allows compression of all areas and complete removal of milk from the breast. Compression should be gentle to avoid trauma.
- FIG 23-13 The nurse helps the mother use an electric breast pump.
- Hand Expression
- Use of a Breast Pump
- Milk Storage
- Breastfeeding after Multiple Births
- Weaning
- Home Care
- Other Concerns
- Formula Feeding
- Nursing Care
- Formula Feeding
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Teaching about Formula
- Types of Formula
- Ready-to-Use
- Concentrated Liquid
- Powdered Formula
- Equipment
- Preparation
- SAFETY ALERT: Formula Dilution
- Explaining Feeding Techniques
- Positioning
- Burping
- FIG 23-14 This mother holds her infant close during bottle feeding. The bottle is positioned so the nipple is filled with milk at all times. The father offers encouragement.
- Frequency and Amount
- Cautions
- Infant Variations
- Evaluation
- Key Concepts
- References and Readings
- Chapter 24 The Childbearing Family with Special Needs
- Learning Objectives
- Adolescent Pregnancy
- Incidence of Teenage Pregnancy
- Factors Associated with Teenage Pregnancy
- BOX 24-1 FACTORS THAT CONTRIBUTE TO TEENAGE PREGNANCY
- Sex Education
- FIG 24-1 Pregnant adolescent. Of teenage girls who become pregnant, approximately 1 in 5 have had a previous birth.
- Preconception Counseling
- Options When Pregnancy Occurs
- Socioeconomic Implications of Teenage Pregnancy
- Implications for Maternal Health
- Implications for Fetal-Neonatal Health
- The Teenage Expectant Father
- Impact of Teenage Pregnancy on Parenting
- Nursing Care
- The Pregnant Teenager
- Assessment
- Physical Assessment
- Cognitive Development
- Knowledge of Infant Needs
- Family Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Eliminating Barriers to Health Care
- NURSING CARE PLAN: An Adolescent’s Responses to Pregnancy and Birth
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Applying Teaching or Learning Principles
- Nutrition counseling ExemplarCounseling
- Nutrition
- Self-Care
- Stress Reduction
- Attachment to the Fetus
- Breastfeeding
- Promoting Family Support
- Providing Support during Labor
- Providing Referrals
- Evaluation
- Delayed Pregnancy
- Maternal and Fetal Implications of Delayed Pregnancy
- Advantages of Delayed Childbirth
- Disadvantages of Delayed Childbirth
- FIG 24-2 Older primigravidas bring maturity and problem-solving skills to the maternal role, but they are at somewhat increased risk for physiologic problems related to pregnancy and birth.
- Nursing Considerations
- Preconception Care
- Reinforcing and Clarifying Information
- Facilitating Expression of Emotions
- Providing Parenting Information
- Substance Abuse
- Incidence
- Maternal and Fetal Effects
- Tobacco
- TABLE 24-1 MATERNAL AND FETAL OR NEONATAL EFFECTS OF COMMONLY ABUSED SUBSTANCES
- Alcohol
- Marijuana
- Cocaine
- Actions
- Maternal and Fetal Effects
- Neonatal Effects
- Amphetamines and Methamphetamines
- Maternal and Fetal Effects
- Neonatal Effects
- Antidepressants
- Maternal and Fetal Effects
- Neonatal Effects
- Opioids
- Fetal Effects
- Neonatal Effects
- Diagnosis and Management of Substance Abuse
- Nursing Care
- Maternal Substance Abuse
- Antepartum Period
- Assessment
- CRITICAL TO REMEMBER: Behaviors Associated with Substance Abuse
- Medical and Obstetric History
- History of Substance Abuse
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Examining Attitudes
- Preventing Substance Abuse
- Communicating with the Woman
- Helping the Woman Identify Strengths
- Providing Ongoing Care
- Evaluation
- Intrapartum Period
- Assessment
- Cocaine
- CRITICAL TO REMEMBER: Signs and Symptoms of Recent Cocaine Use
- Heroin
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Preventing Injury
- Admitting Procedure
- Setting Limits
- Initiating Seizure Precautions
- Maintaining Effective Communication
- Providing Pain Control
- Preventing Heroin Withdrawal
- Evaluation
- Postpartum Period
- Birth of an Infant with Congenital Anomalies
- Factors Influencing Emotional Responses of Parents
- Timing and Manner of Being Told
- Prior Knowledge of the Defect
- FIG 24-3 Touching and cuddling between parents and the infant with a congenital anomaly foster attachment and help resolve the grieving process. This infant has anomalies of the hand and arm.
- Type of Defect
- Irreparable Defect
- Grief and Mourning
- Nursing Considerations
- Assisting with the Grieving Process
- Promoting Bonding and Attachment
- Providing Accurate Information
- Facilitating Communication
- Participating in Infant Care
- Planning for Discharge
- Providing Referrals
- Perinatal Loss
- Early Pregnancy Loss
- Concurrent Death and Survival in Multifetal Pregnancy
- Previous Pregnancy Loss
- Nursing Care
- Pregnancy Loss
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Allowing Expression of Feelings
- Acknowledging the Infant
- Presenting the Infant to the Parents
- Preparing a Memory Box or Packet
- Respecting Cultural Practices
- Assisting with Other Needs
- Providing Referrals
- Evaluation
- Adoption
- Intimate Partner Violence
- FIG 24-4 The woman who is abused by her partner lives with an ever-present risk of violence. Because they may not seek help, all women should be asked about abuse whenever they receive health care.
- EVIDENCE-BASED PRACTICE
- Effects of Intimate Partner Violence during Pregnancy
- Factors that Promote Violence
- Characteristics of the Abuser
- TABLE 24-2 MYTHS AND REALITIES OF VIOLENCE AGAINST WOMEN
- Cycle of Violence
- Nurses’ Role in Prevention of Abuse
- Nursing Care
- The Battered Woman
- Assessment
- FIG 24-5 Types of behaviors evident in each step of the cycle of violence.
- CRITICAL THINKING EXERCISE 24-1
- CRITICAL TO REMEMBER: Cues Indicating Violence Against Women
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Listening
- Developing a Personal Safety Plan
- Affirming She Is Not to Blame
- Providing Education
- Providing Referrals
- Evaluation
- Key Concepts
- References and Readings
- Chapter 25 Pregnancy-Related Complications
- Learning Objectives
- Hemorrhagic Conditions of Early Pregnancy
- Abortion
- Spontaneous Abortion
- FIG 25-1 Three types of spontaneous abortion.
- Threatened Abortion
- Manifestations
- Therapeutic Management
- Inevitable Abortion
- Manifestations
- Therapeutic Management
- Incomplete Abortion
- Manifestations
- Therapeutic Management
- Complete Abortion
- Manifestations
- Therapeutic Management
- Missed Abortion
- Manifestations
- Therapeutic Management
- Disseminated Intravascular Coagulation (Consumptive Coagulopathy)
- Recurrent Spontaneous Abortion
- Manifestations
- Therapeutic Management
- Nursing Considerations
- CRITICAL THINKING EXERCISE 25-1
- Ectopic Pregnancy
- Incidence and Etiology
- FIG 25-2 Sites of tubal ectopic pregnancy. Numbers indicate the order of prevalence. (1) Ampular, (2) Fimbrial, (3) Isthmic, (4) Interstitial.
- BOX 25-1 RISK FACTORS FOR ECTOPIC PREGNANCY
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Gestational Trophoblastic Disease (Hydatidiform Mole)
- FIG 25-3 Hydatidiform mole.
- Incidence and Etiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Nursing Care
- The Woman with a Hemorrhagic Condition of Early Pregnancy
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Providing Information about Tests and Procedures
- Teaching Measures to Prevent Infection
- Providing Dietary Information
- Teaching Signs of Infection to Report
- Emphasizing the Importance of Follow-up Care
- Evaluation
- Hemorrhagic Conditions of Late Pregnancy
- Placenta Previa
- Incidence and Etiology
- FIG 25-4 The three classifications of placenta previa.
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Home Care
- Inpatient Care
- Abruptio Placentae
- Incidence and Etiology
- Manifestations
- Therapeutic Management
- FIG 25-5 Types of abruptio placentae.
- SAFETY ALERT: Signs and Symptoms Suggesting Concealed Hemorrhage in Abruptio Placentae
- CRITICAL THINKING EXERCISE 25-2
- Nursing Considerations
- Nursing Care
- The Woman with a Hemorrhagic Condition of Late Pregnancy
- Assessment
- NURSING CARE PLAN: Antepartum Bleeding
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Nursing Diagnosis and Planning
- Interventions
- Monitoring for Signs of Hypovolemic Shock
- SAFETY ALERT: Signs and Symptoms of Impending Hypovolemic Shock Caused by Blood Loss
- Monitoring the Fetus
- Promoting Tissue Oxygenation
- Collaborating with the Physician for Fluid Replacement
- Providing Emotional Support
- Care Related to Surgery
- Evaluation
- Hyperemesis Gravidarum
- Etiology
- Therapeutic Management
- Nursing Considerations
- Reducing Nausea and Vomiting
- Maintaining Nutrition and Fluid Balance
- Providing Emotional Support
- Preeclampsia ExemplarHypertension During Pregnancy
- TABLE 25-1 CLASSIFICATIONS OF HYPERTENSION IN PREGNANCY
- Preeclampsia
- Risk Factors
- BOX 25-2 RISK FACTORS FOR PREGNANCY-RELATED HYPERTENSION
- Pathophysiology
- Preventive Measures
- Manifestations
- Classic Signs
- Additional Signs
- FIG 25-6 Generalized edema is a possible sign identified with preeclampsia, although it may occur in both normal pregnancy or in a pregnancy complicated by another disorder. A, Facial edema may be subtle. B, Pitting edema of the lower leg.
- TABLE 25-2 ASSESSMENT OF EDEMA
- Symptoms
- Therapeutic Management
- Home Care for Mild Preeclampsia
- Activity Restrictions
- Fetal Activity
- Blood Pressure
- TABLE 25-3 MILD VS SEVERE PREECLAMPSIA
- Weight
- Urinalysis
- Diet
- Fetal Assessment
- Inpatient Management for Severe Preeclampsia
- Antepartum Management
- Bed rest
- Anticonvulsant Medications
- DRUG GUIDE: Magnesium Sulfate
- Antihypertensive Medications
- Intrapartum Management
- Postpartum Management
- PROCEDURE: Assessing Deep Tendon Reflexes
- Purpose
- Deep Tendon Reflex Rating Scale
- TABLE 25-4 NURSING ASSESSMENTS FOR PREECLAMPSIA AND MAGNESIUM TOXICITY
- Therapeutic Management of Eclampsia
- Nursing Care
- The Woman with Preeclampsia
- Assessment
- Assessments for Magnesium Toxicity
- Psychosocial Assessment
- NURSING CARE PLAN: Preeclampsia
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Potential Complications to Consider
- Nursing Diagnosis and Planning
- Interventions
- Interventions for Seizures
- Initiating Preventive Measures
- Monitoring for Signs of Impending Seizures
- Preventing Seizure-Related Injury
- Protecting the Woman and Fetus during a Seizure
- Providing Information and Support for the Family
- Interventions for Magnesium Toxicity
- Monitoring for Signs of Magnesium Toxicity
- Responding to Signs of Magnesium Toxicity
- Evaluation
- HELLP Syndrome
- Chronic Hypertension
- Incompatibility Between Maternal and Fetal Blood
- Rh Incompatibility
- Pathophysiology
- Fetal and Neonatal Implications
- FIG 25-7 The process of maternal sensitization to the Rh factor.
- PARENTS WANT TO KNOW: About Rh Incompatibility
- Prenatal Assessment and Management
- DRUG GUIDE: Rho(D) Immune Globulin (RhoGAM, HypRho-D, Gamulin Rh)
- Postpartum Management
- ABO Incompatibility
- Key Concepts
- References and Readings
- Chapter 26 Concurrent Disorders During Pregnancy
- Learning Objectives
- Diabetes Mellitus
- Pathophysiology
- Etiology
- Effect of Pregnancy on Fuel Metabolism
- Early Pregnancy
- Late Pregnancy
- Classification
- BOX 26-1 CLASSIFICATION OF DIABETES MELLITUS
- Incidence
- Pathology
- Preexisting Diabetes Mellitus
- Maternal Effects
- Fetal Effects
- Congenital Malformation
- Variations in Fetal Size
- NURSING CARE PLAN: Pregnancy and Diabetes Mellitus
- Focused Nursing Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Neonatal Effects
- Hypoglycemia
- Hypocalcemia
- Hyperbilirubinemia
- Respiratory Distress Syndrome
- Maternal Assessment
- History
- Physical Examination
- Laboratory Tests
- Fetal Surveillance
- Therapeutic Management
- Preconception Care
- Diet
- Self-Monitoring of Blood Glucose (SMBG)
- Insulin Therapy
- First Trimester
- Second and Third Trimesters
- During Labor
- Postpartum
- Timing of Delivery
- Diabetes, gestational ExemplarGestational Diabetes Mellitus
- Risk Factors
- Identifying Gestational Diabetes Mellitus
- Glucose Challenge Test
- Oral Glucose Tolerance Test
- Maternal, Fetal, and Neonatal Effects
- TABLE 26-1 MAJOR EFFECTS OF DIABETES MELLITUS ON PREGNANCY
- Therapeutic Management
- Diet
- Exercise
- Glucose Level Monitoring
- Fetal Surveillance
- Nursing Considerations
- Increasing Effective Communication
- Providing Opportunities for Control
- Providing Normal Pregnancy Care
- Nursing Care
- The Pregnant Woman with Diabetes Mellitus
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Teaching Self-Care Skills
- Self-Monitoring of Blood Glucose
- Insulin Administration
- Continuous Subcutaneous Insulin Infusion
- Teaching Dietary Management
- Recognizing and Correcting Hypoglycemia and Hyperglycemia
- Hypoglycemia ExemplarHypoglycemia
- SAFETY ALERT: Signs and Symptoms of Maternal Hypoglycemia
- Hyperglycemia
- SAFETY ALERT: Signs and Symptoms of Maternal Hyperglycemia
- Explaining Procedures, Tests, and Plan of Care
- Evaluation
- Heart failure ExemplarCardiac Disease
- SAFETY ALERT: Signs and Symptoms of Congestive Heart Failure
- Incidence and Classification
- EVIDENCE-BASED PRACTICE
- U.S. Preventive Services Task Force (USPSTF) CHD Screening Recommendations
- Implications for Nursing Practice
- Rheumatic Heart Disease
- Congenital Heart Disease
- Left-to-Right Shunt
- Atrial Septal Defect
- Ventricular septal defect ExemplarVentricular Septal Defect
- Patent Ductus Arteriosus
- Right-to-Left Shunt
- Tetralogy of Fallot
- Eisenmenger Syndrome
- Mitral Valve Prolapse
- Peripartum and Postpartum Cardiomyopathy
- Diagnostic Evaluation of Cardiac Disease
- Therapeutic Management
- Class I and Class II Heart Disease
- BOX 26-2 NEW YORK HEART ASSOCIATION FUNCTIONAL CLASSIFICATION OF HEART DISEASE
- Class III and Class IV Heart Disease
- Drug Therapy
- Anticoagulants
- Antidysrhythmics
- Antiinfectives
- Drugs for Heart Failure
- Intrapartum Management
- Postpartum Management
- Nursing Considerations
- Anemias
- Iron deficiency (anemia) ExemplarIron Deficiency Anemia
- Maternal Effects
- Fetal and Neonatal Effects
- Therapeutic Management
- Folic Acid Deficiency (Megaloblastic) Anemia
- Maternal Effects
- Fetal and Neonatal Effects
- Therapeutic Management
- Sickle Cell Disease
- Maternal Effects
- Fetal and Neonatal Effects
- Therapeutic Management
- Thalassemias
- Maternal Effects
- Fetal and Neonatal Effects
- Therapeutic Management
- Immune Complex Diseases
- Systemic Lupus Erythematosus
- Antiphospholipid Syndrome
- Hashimoto’s Thyroiditis
- Seizure Disorders: Epilepsy
- Infections During Pregnancy
- TABLE 26-2 INFECTIONS THAT IMPACT PREGNANCY: SEXUALLY TRANSMITTED DISEASES, VAGINAL AND URINARY TRACT INFECTIONS
- Viral Infections
- Cytomegalovirus
- Fetal and Neonatal Effects
- Therapeutic Management
- Rubella
- Fetal and Neonatal Effects
- Therapeutic Management
- Varicella-Zoster Virus
- Fetal and Neonatal Effects
- Therapeutic Management
- Herpesvirus Serotypes 1 and 2
- Fetal and Neonatal Effects
- Therapeutic Management
- Parvovirus B19
- Fetal and Neonatal Effects
- Therapeutic Management
- Hepatitis B
- Fetal and Neonatal Effects
- Therapeutic Management
- Human Immunodeficiency Virus (HIV)
- Pathophysiology
- Fetal and Neonatal Effects
- Prevention
- Therapeutic Management
- Nursing Considerations
- BOX 26-3 RECOMMENDATIONS FOR PREVENTION OF PERINATAL HUMAN IMMUNODEFICIENCY VIRUS INFECTION OF THE INFANT
- Nonviral Infections
- Toxoplasmosis
- Fetal and Neonatal Effects
- Therapeutic Management
- Group B Streptococcus Infection
- Fetal and Neonatal Effects
- Therapeutic Management
- Tuberculosis
- Fetal and Neonatal Effects
- Therapeutic Management
- TABLE 26-3 MEDICAL CONDITIONS AND THEIR EFFECT ON PREGNANCY
- KEY CONCEPTS
- References and Readings
- Chapter 27 The Woman with an Intrapartum Complication
- Learning Objectives
- Dysfunctional Labor
- Problems of the Powers
- Ineffective Contractions
- TABLE 27-1 PATTERNS OF LABOR DYSFUNCTION
- Hypotonic Labor Dysfunction
- Hypertonic Labor Dysfunction
- Ineffective Maternal Pushing
- Problems with the Passenger
- Fetal Size
- Macrosomia
- Shoulder Dystocia
- FIG 27-1 Methods used to relieve shoulder dystocia. A, McRoberts maneuver. The woman flexes her thighs sharply against her abdomen, which straightens the pelvic curve. A supported squat has a similar effect and adds gravity to her pushing efforts. B, Suprapubic pressure by an assistant pushes the fetal anterior shoulder downward to displace it from above the mother’s symphysis pubis. Fundal pressure should not be used because it will push the anterior shoulder more firmly against the mother’s symphysis.
- Abnormal Fetal Presentation or Position
- Rotation Abnormalities
- CRITICAL THINKING EXERCISE 27-1
- FIG 27-2 A hands-and-knees position helps the fetus rotate from a left occiput posterior (LOP) position to an occiput anterior position.
- FIG 27-3 The “lunge” to one side promotes rotation of the fetal occiput from a posterior position to an anterior one.
- Deflexion Abnormalities
- Breech Presentation
- Multifetal Pregnancy
- FIG 27-4 Twins can present in any combination of presentations and positions.
- Fetal Anomalies
- Problems of the Passage
- Pelvis
- Maternal Soft Tissue Obstructions
- Problems of the Psyche
- Abnormal Labor Duration
- Prolonged Labor
- FIG 27-5 Pelvic shapes.
- Precipitate Labor
- Nursing Care
- The Woman in Dysfunctional Labor
- Intrauterine Infection
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Reducing the Risk for Infection
- Identifying Infection
- Evaluation
- SAFETY ALERT: Signs Associated with Intrapartum Infection
- Maternal Exhaustion
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Conserving Maternal Energy
- Promoting Coping Skills
- Evaluation
- Premature Rupture of the Membranes
- Etiology
- Complications
- Therapeutic Management
- Determining True Membrane Rupture
- Gestation Near Term
- Preterm Gestation
- Maternal Antibiotics
- Nursing Considerations
- Preterm Labor
- SAFETY ALERT: Late Preterm is Not Term
- EVIDENCE-BASED PRACTICE
- Associated Factors
- Manifestations
- Preventing Preterm Birth
- Community Education
- TABLE 27-2 MATERNAL RISK FACTORS FOR PRETERM LABOR
- During Pregnancy
- Improving Access to Care
- Identifying Risk Factors
- Progesterone Supplementation
- Promoting Adequate Nutrition
- Educating Women and Their Partners about Preterm Labor
- Empowering Women and Their Partners
- Therapeutic Management
- Predicting Preterm Birth
- Cervical Length
- Fetal Fibronectin
- Infections
- Identifying Preterm Labor
- Stopping Preterm Labor
- Initial Measures
- Identifying and Treating Infections
- Identifying Other Causes for Preterm Contractions
- Limiting Activity
- Hydrating the Woman
- Tocolytics
- Magnesium Sulfate
- Calcium Antagonists
- Prostaglandin Synthesis Inhibitors
- TABLE 27-3 DRUGS USED IN PRETERM LABOR
- Beta-Adrenergic Drugs
- Accelerating Fetal Lung Maturity
- DRUG GUIDE: Betamethasone, Dexamethasone
- Nursing Care
- The Woman in Preterm Labor
- Psychosocial Concerns
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Providing Information
- Promoting Expression of Concerns
- Teaching What May Occur during a Preterm Birth
- Evaluation
- Management of Home Care
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Caring for Children
- NURSING CARE PLAN: Preterm Labor
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Maintaining the Household
- Evaluation
- Boredom
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- Identifying Appropriate Activities
- Changing the Physical Surroundings
- Evaluation
- Prolonged Pregnancy
- Complications
- Therapeutic Management
- Nursing Considerations
- Intrapartum Emergencies
- Placental Abnormalities
- Prolapsed Umbilical Cord
- Etiology
- FIG 27-6 Variations of prolapsed umbilical cord.
- Manifestations
- Therapeutic Management
- SAFETY ALERT: Factors that Increase a Woman’s Risk for a Prolapsed Umbilical Cord
- FIG 27-7 Measures to relieve pressure on a prolapsed umbilical cord until delivery can take place.
- Nursing Considerations
- Uterine Rupture
- FIG 27-8 Uterine rupture in the lower uterine segment.
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Uterine Inversion
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Anaphylactoid Syndrome
- Trauma
- Therapeutic Management
- Nursing Considerations
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 28 The Woman with a Postpartum Complication
- Learning Objectives
- Postpartum Hemorrhage
- Early Postpartum Hemorrhage
- FIG 28-1 A, When the uterus remains contracted, the placental site is smaller, so bleeding is minimal. B, If uterine muscles fail to contract around the endometrial arteries at the placental site, hemorrhage occurs.
- Uterine Atony
- Predisposing Factors
- Manifestations
- BOX 28-1 COMMON PREDISPOSING FACTORS FOR POSTPARTUM HEMORRHAGE
- FIG 28-2 Technique for fundal massage.
- Therapeutic Management
- DRUG GUIDE: Methylergonovine (Methergine)
- DRUG GUIDE: Carboprost Tromethamine (Hemabate, Prostin/15M)
- Trauma
- FIG 28-3 Bimanual compression. One hand is inserted in the vagina, and the other compresses the uterus through the abdominal wall.
- Predisposing Factors
- Lacerations
- Hematomas
- Therapeutic Management
- Late Postpartum Hemorrhage
- Predisposing Factors
- Therapeutic Management
- Hypovolemic Shock
- Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Immediate Care
- SAFETY ALERT: Signs of Postpartum Hemorrhage
- Nursing Care
- The Woman with Excessive Bleeding
- Assessment
- Uterine Atony
- Trauma
- TABLE 28-1 NURSING ASSESSMENTS FOR POSTPARTUM HEMORRHAGE
- Nursing Diagnosis and Planning
- Interventions
- Preventing Hemorrhage
- Collaborating with the Health Care Provider
- Providing Support for the Family
- Posthemorrhage Care
- Home Care
- CRITICAL THINKING EXERCISE 28-1
- Evaluation
- Subinvolution of the Uterus
- Therapeutic Management
- Nursing Considerations
- Venous thrombosis ExemplarThromboembolic Disorders
- Incidence and Etiology
- Venous Stasis
- BOX 28-2 FACTORS THAT INCREASE THE RISK OF THROMBOSIS
- Hypercoagulation
- Blood Vessel Injury
- Additional Predisposing Factors
- Superficial Venous Thrombosis
- Manifestations
- Therapeutic Management
- Deep Venous Thrombosis
- Diagnostic Evaluation
- Therapeutic Management
- Preventing Thrombus Formation
- Initial Treatment
- Subsequent Treatment
- Nursing Care
- The Mother with Deep Venous Thrombosis
- Assessment
- WOMEN WANT TO KNOW: How Do I Prevent Thrombosis (Blood Clots)?
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Monitoring for Signs of Bleeding
- Explaining Continued Therapy
- Helping the Family Adapt to Home Care
- Evaluation
- Pulmonary embolism ExemplarPulmonary Embolism
- Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Monitoring for Signs
- Facilitating Oxygenation
- Seeking Assistance
- Puerperal Infection
- Definition
- Pathophysiology
- Etiology
- TABLE 28-2 RISK FACTORS FOR PUERPERAL INFECTION
- Specific Infections
- Endometritis
- Etiology
- Manifestations
- Therapeutic Management
- Complications
- Nursing Considerations
- Wound Infection
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Urinary Tract Infections
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Mastitis
- Etiology
- Manifestations
- FIG 28-4 Mastitis typically occurs in the breast of a woman who breastfeeds after 2 to 3 weeks following birth.
- Therapeutic Management
- Nursing Considerations
- Septic Pelvic Thrombophlebitis
- Manifestations
- Therapeutic Management
- Nursing Care
- The Woman with an Infection
- Assessment
- SAFETY ALERT: Signs and Symptoms of Postpartum Infection
- Nursing Diagnosis and Planning
- Expected Outcome
- NURSING CARE PLAN: Risk for Postpartum Infection
- Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Postpartum psychosis ExemplarAffective Disorders
- Postpartum Mood Disorders
- Postpartum Depression
- Incidence
- Etiology
- Manifestations
- Impact on the Family
- Therapeutic Management
- Postpartum Psychosis
- Bipolar II Disorder
- Postpartum Anxiety Disorders
- Nursing Care
- Postpartum Affective Disorders
- Assessment
- SAFETY ALERT: Signs and Symptoms of Postpartum Depression
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Providing Anticipatory Guidance
- EVIDENCE-BASED PRACTICE
- Demonstrating Caring
- Helping the Mother Verbalize Feelings
- Enhancing Sensitivity to Infant Cues
- Helping Family Members
- Discussing Options and Resources
- Evaluation
- CRITICAL THINKING EXERCISE 28-2
- KEY CONCEPTS
- References And Readings
- Chapter 29 The High-Risk Newborn: Problems Related to Gestational Age and Development
- Learning Objectives
- Care of High-Risk Newborns
- Late Preterm Infants
- Incidence and Etiology
- Characteristics of Late Preterm Infants
- FIG 29-1 The infant in a neonatal intensive care unit (NICU) is cared for by nurses with highly specialized skills.
- Therapeutic Management
- Nursing Considerations
- Assessment and Care of Common Problems
- Thermoregulation
- Feedings
- Discharge
- Preterm Infants
- Incidence and Etiology
- Scope of the Problem
- Causes
- Prevention
- Characteristics of Preterm Infants
- Appearance
- Behavior
- Assessment and Care of Common Problems
- Problems with Respiration
- Assessment
- Nursing Interventions
- Working with Respiratory Equipment
- FIG 29-2 The oxygen hood is one way of delivering oxygen to an infant who can breathe unassisted.
- Positioning the Infant
- Suctioning Secretions
- Maintaining Hydration
- Problems with Thermoregulation
- Assessment
- FIG 29-3 This preterm infant has mildly mottled skin and slight abdominal distention and retractions.
- SAFETY ALERT: Signs of Inadequate Thermoregulation
- Nursing Interventions
- Maintaining a Neutral Thermal Environment
- Weaning to an Open Crib
- Problems with Fluid and Electrolyte Balance
- Assessment
- Urinary Output
- Weight
- Signs of Dehydration or Overhydration
- SAFETY ALERT: Signs of Fluid Imbalance in the Newborn
- Dehydration
- Overhydration
- Nursing Interventions
- Problems with the Skin
- Assessment
- Nursing Interventions
- Problems with Infection
- Assessment
- Nursing Interventions
- Problems with Pain
- Assessment
- NURSING QUALITY ALERT: Common Signs of Pain in Infants
- Nursing Interventions
- EVIDENCE-BASED PRACTICE
- Nursing Care
- The Preterm Infant
- Environmentally Caused Stress
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- SAFETY ALERT: Signs of Overstimulation in Preterm Infants
- Oxygenation Changes
- Behavior Changes
- Interventions
- Scheduling Care
- Reducing Stimuli
- Promoting Rest
- Promoting Motor Development
- Individualizing Care
- Communicating Infants’ Needs
- Evaluation
- Nutrition
- Assessment
- Feeding Tolerance
- Readiness for Nipple Feeding
- NURSING QUALITY ALERT: Advancing to Nipple Feeding
- Signs of Readiness for Nipple Feedings
- Signs of Nonreadiness for Nipple Feedings
- Adverse Signs during Nipple Feedings
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Administering Parenteral Nutrition
- Administering Enteral Feedings
- Administering Gavage Feedings
- Administering Oral Feedings
- Preparing for Feedings
- FIG 29-4 The nurse feeds a preterm infant.
- Giving Bottle Feedings
- CRITICAL THINKING EXERCISE 29-1
- Facilitating Breastfeeding
- NURSING CARE PLAN: The Preterm Infant
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnoses to Consider
- Making Ongoing Assessments
- Evaluation
- Parenting
- Assessment
- NURSING QUALITY ALERT: Signs that Bonding May Be Delayed
- Nursing Diagnosis and Planning
- Expected Outcomes
- FIG 29-5 An infant in the NICU is surrounded by highly technologic equipment. This can be very frightening to parents at first. Preparing parents before they visit is an important nursing responsibility.
- Interventions
- Making Advance Preparations
- Assisting Parents at Birth
- Supporting Parents during Early Visits
- BOX 29-1 INTRODUCING PARENTS TO THE NEONATAL INTENSIVE CARE UNIT SETTING
- Before Parents Visit the Neonatal Intensive Care Unit (NICU)
- When Parents Visit the NICU
- Providing Information
- Instituting Kangaroo Care (KC)
- FIG 29-6 This mother holds her 27-week-gestation infant under her clothes against her skin as she gives kangaroo care.
- Facilitating Interaction
- FIG 29-7 To promote family bonding with the infant, parents are involved as much as possible in the care of their infant. This father bottle feeds his infant in a radiant warmer.
- Increasing Parental Decision Making
- FIG 29-8 The parents look on while the grandmother holds the infant in the NICU.
- Alleviating Concerns
- Helping with Ongoing Problems
- Preparing for Discharge
- Evaluation
- Common Complications of Preterm Infants
- Respiratory Distress Syndrome (RDS)
- Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Bronchopulmonary Dysplasia (Chronic Lung Disease)
- Intraventricular Hemorrhage
- Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Retinopathy of Prematurity
- Pathophysiology
- Therapeutic Management
- Nursing Considerations
- Necrotizing Enterocolitis (NEC)
- Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Postterm Infants
- Scope of the Problem
- FIG 29-9 The postmature infant has dry, cracked, peeling skin and no vernix.
- Assessment
- Therapeutic Management
- Nursing Considerations
- Small-for-Gestational-Age Infants
- Etiology
- Scope of the Problem
- Characteristics of Small-for-Gestational-Age (SGA) Infants
- Therapeutic Management
- Nursing Considerations
- Large-for-Gestational-Age Infants
- Etiology
- Scope of the Problem
- Therapeutic Management
- Nursing Considerations
- KEY CONCEPTS
- References and Readings
- Chapter 30 The High-Risk Newborn: Acquired and Congenital Conditions
- Learning Objectives
- Respiratory Complications
- Asphyxia
- Manifestations
- Infants at Risk
- DRUG GUIDE: Naloxone Hydrochloride (Narcan)
- Neonatal Resuscitation
- Transient Tachypnea of the Newborn
- Etiology
- Manifestations
- Therapeutic Management
- PROCEDURE: Performing Resuscitation in Newborns
- Purpose
- Nursing Considerations
- Meconium Aspiration Syndrome
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Persistent Pulmonary Hypertension of the Newborn
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Hyperbilirubinemia
- Etiology
- Therapeutic Management
- Phototherapy
- Exchange Transfusions
- Procedure
- Complications
- Role of the Nurse
- Nursing Care
- The Infant with Hyperbilirubinemia
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Maintaining a Neutral Thermal Environment
- NURSING CARE PLAN: The Infant with Jaundice
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Providing Optimal Nutrition
- Protecting the Eyes
- Enhancing Response to Therapy
- FIG 30-1 The infant receiving phototherapy is wearing eye patches to protect the eyes.
- Detecting Complications
- Teaching Parents
- Evaluation
- CRITICAL THINKING EXERCISE 30-1
- Infection
- Transmission of Infection
- Sepsis ExemplarSepsis Neonatorum
- Etiology
- TABLE 30-1 COMMON INFECTIONS IN THE NEWBORN
- Therapeutic Management
- Diagnostic Testing
- Treatment
- Nursing Considerations
- Assessment
- Risk Factors
- Signs of Infection
- Nursing Interventions
- Preventing Infection
- SAFETY ALERT: Signs of Sepsis in the Newborn
- General Signs
- Respiratory Signs
- Cardiovascular Signs
- Gastrointestinal Signs
- Central Nervous System Signs
- Signs that May Indicate Advanced Infection
- Providing Antibiotics
- Providing Other Supportive Care
- Supporting Parents
- Infant of a Diabetic Mother
- Scope of the Problem
- FIG 30-2 Macrosomia is common in infants of diabetic mothers.
- Characteristics of Infants of Diabetic Mothers (IDMs)
- Therapeutic Management
- Nursing Considerations
- Assessment
- Nursing Interventions
- Polycythemia
- Causes
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Hypocalcemia
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Prenatal Drug Exposure
- EVIDENCE-BASED PRACTICE
- Identification of Drug-Exposed Infants
- SAFETY ALERT: Signs of Intrauterine Drug Exposure
- Behavioral Signs
- Signs Relating to Feeding
- Respiratory Signs
- Other Signs
- Therapeutic Management
- Nursing Considerations
- Feeding
- Assessment
- Nursing Interventions
- Rest
- Assessment
- Nursing Interventions
- Bonding
- Assessment
- NURSING CARE PLAN: The Drug-Exposed Infant
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Nursing Diagnoses to Consider
- Nursing Interventions
- Phenylketonuria
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- KEY CONCEPTS
- References and Readings
- Chapter 31 Management of Fertility and Infertility
- Learning Objectives
- Contraception
- Role of the Nurse
- Considerations when Choosing a Contraceptive Method
- FIG 31-1 Success of contraception is more likely when both the woman and her partner are involved in discussions. The nurse demonstrates filling a foam applicator.
- TABLE 31-1 ADVANTAGES AND DISADVANTAGES OF MOST COMMON CONTRACEPTIVE METHODS
- Safety
- Protection from Sexually Transmitted Diseases
- Effectiveness
- Acceptability
- TABLE 31-2 PREGNANCY RATES OF COMMON TYPES OF CONTRACEPTION: UNITED STATES
- Convenience
- Education Needed
- Benefits
- Side Effects
- Effect on Spontaneity
- Availability
- Expense
- Preference
- Religious and Personal Beliefs
- Culture
- Other Considerations
- Informed Consent
- Adolescents
- Adolescent Knowledge
- Misinformation
- Risk-Taking Behavior
- Counseling Adolescents
- FIG 31-2 Although many adolescents choose oral contraceptives, the nurse emphasizes the need to use condoms for protection against sexually transmitted diseases. Demonstrating with actual contraceptives increases understanding.
- CRITICAL THINKING EXERCISE 31-1
- Perimenopausal Women
- Contraception ExemplarMethods of Contraception
- Sterilization
- Tubal Sterilization
- Vasectomy
- Intrauterine Devices (IUDs)
- FIG 31-3 The Copper T 380A (ParaGard) intrauterine device (IUD) and the levonorgestrel intrauterine system (LNG-IUS or Mirena). Currently, IUDs are considered a very safe method for preventing pregnancy.
- Action
- Side Effects
- Teaching
- Hormonal Contraceptives
- Hormone Implant
- Hormone Injections
- Oral Contraceptives
- Progestin Only
- Combination
- Benefits, Risks, and Cautions
- SAFETY ALERT: Cautions in Using Oral Contraceptives
- BOX 31-1 POTENTIAL BENEFITS, DISADVANTAGES, AND RISKS OF ORAL CONTRACEPTIVES
- Side Effects
- Teaching
- Blood Hormone Levels
- Missed Doses
- Postpartum and Lactation
- Other Medications
- Follow-up
- Emergency Contraception
- TABLE 31-3 ACHES∗Warning Signs of Oral Contraceptive Complications
- Transdermal Contraceptive Patch
- FIG 31-4 The vaginal contraceptive ring (NuvaRing) is 5 cm (2 in) across and 4 mm thick.
- Contraceptive Vaginal Ring
- Barrier Methods
- Chemical Barriers
- Mechanical Barriers
- Male Condom
- Female Condom
- FIG 31-5 The female condom. A woman can protect herself from sexually transmitted diseases without relying on use of the male condom.
- COUPLES WANT TO KNOW: What Is the Proper Way to Use Condoms?
- Sponge
- Diaphragm
- WOMEN WANT TO KNOW: How to Use a Diaphragm
- Cervical Cap
- Lea’s Shield
- Natural Family Planning Methods
- Calendar or Rhythm Method
- Standard Days Method
- Cervical Mucus and Two-Day Method
- TABLE 31-4 NATURAL FAMILY PLANNING METHODS
- COUPLES WANT TO KNOW: How to Assess Cervical Mucus and Basal Body Temperature
- Cervical Mucus Assessment
- Basal Body Temperature (BBT)
- Symptothermal Method
- Abstinence
- Least Reliable Methods of Contraception
- Breastfeeding
- Coitus Interruptus
- Nursing Care
- Choosing a Contraceptive Method
- Assessment
- Introducing the Subject
- Determining the Woman’s Understanding
- Assessing the Woman’s Satisfaction
- Assessing Appropriate Choices
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Increasing Understanding of the Chosen Method
- Teaching about Other Methods
- Protecting Against Sexually Transmitted Diseases
- Including the Woman’s Partner
- Ongoing Teaching
- Evaluation
- Infertility ExemplarRole of the Nurse in Infertility Care
- Extent of Infertility
- Factors Contributing to Infertility
- Factors in the Man
- Abnormalities of the Sperm
- Erectile dysfunction ExemplarAbnormal Erections
- Abnormal Ejaculation
- Abnormalities of Seminal Fluid
- Factors in the Woman
- Disorders of Ovulation
- Abnormalities of the Fallopian Tubes
- Abnormalities of the Cervix
- Repeated Pregnancy Loss
- Abnormalities of the Fetal Chromosomes
- Abnormalities of the Cervix or Uterus
- FIG 31-6 Types of uterine malformations that may cause infertility or repeated pregnancy loss.
- Endocrine Abnormalities
- Immunologic Factors
- Environmental Agents
- Infections
- Evaluation of Infertility
- Preconception Counseling
- History and Physical Examination
- INFERTILE COUPLES WANT TO KNOW: What Is Infertility Treatment Like?
- General
- Men
- Women
- History
- Physical Examination
- Diagnostic Tests
- Therapies to Facilitate Pregnancy
- TABLE 31-5 SELECTED DIAGNOSTIC TESTS IN INFERTILITY
- TABLE 31-6 SELECTED MEDICATIONS FOR INFERTILITY THERAPY
- Medications
- Surgical Procedures
- Therapeutic Insemination
- Egg Donation
- Surrogate Parenting
- Assisted Reproductive Techniques
- In Vitro Fertilization (IVF)
- FIG 31-7 In vitro fertilization (IVF). Multiple oocytes are obtained by using a transvaginal or laparoscopic approach. The retrieved oocytes are mixed with prepared sperm, incubated approximately 18 hours, and then evaluated for cell division. Embryos are then transferred to the uterus immediately or after 48 to 96 more hours to allow 5 days of further cell division before implantation.
- Gamete Intrafallopian Transfer (GIFT)
- Zygote Intrafallopian Transfer (ZIFT)
- Comparison of In Vitro Fertilization, Gamete Intrafallopian Transfer, and Zygote Intrafallopian Transfer
- Intracytoplasmic Sperm Injection (ICSI)
- Responses to Infertility
- Assumption of Fertility
- Growing Awareness of a Problem
- Seeking Help for Infertility
- Identifying the Importance of Having a Baby
- Sharing Intimate Information
- Considering Financial Resources
- Ethical Issues
- Committing to Involvement in Care
- Reactions During Evaluation and Treatment
- Influences on Decision Making
- Social, Cultural, and Religious Values
- Difficulty of Treatment
- Probability of Success
- Financial Concerns
- Psychological Reactions
- Guilt
- Isolation
- Depression
- Stress on the Relationship
- Outcomes After Infertility Therapy
- Pregnancy Loss After Infertility Therapy
- Parenthood After Infertility Therapy
- Choosing to Adopt
- Menopause After Infertility
- Nursing Care
- The Infertile Couple
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Interventions
- Assisting Communication
- Increasing the Couple’s Sense of Control
- Reducing Isolation
- Promoting a Positive Self-Image
- Evaluation
- Key Concepts
- References and Readings
- Chapter 32 Women’s Health Care
- Learning Objectives
- Women’s Health Initiative
- Healthy People 2020
- Health Maintenance
- Health History
- Physical Assessment
- Health promotion ExemplarPreventive Counseling
- BOX 32-1 HEALTH HISTORY
- Personal History
- Menstrual History
- Obstetric History
- Sexual History
- Family History
- Psychosocial History
- Screening Procedures
- Breast Self-Examination
- Clinical Breast Examination
- WOMEN WANT TO KNOW: How to Perform Breast Self-Examination (BSE)
- Inspection
- Palpation
- TABLE 32-1 SCREENING PROCEDURES
- BOX 32-2 RISK FACTORS FOR BREAST CANCER
- Mammography
- Vulvar Self-Examination
- Pelvic Examination
- External Organs
- Speculum Examination
- Bimanual Examination
- FIG 32-1 Bimanual palpation provides information about the uterus, fallopian tubes, and ovaries.
- Pap Test
- Purpose
- Procedure
- Classification of Cervical Cytology
- Rectal Examination
- Breast Disorders
- Benign Disorders of the Breast
- Fibrocystic Breast Changes
- Fibroadenoma
- Ductal Ectasia
- Intraductal Papilloma
- Diagnostic Evaluation
- Nursing Considerations
- Breast cancer mortality ExemplarBreast cancer ExemplarMalignant Tumors of the Breast
- Incidence
- Predisposing Factors
- Pathophysiology
- Manifestations
- Staging
- Therapeutic Management
- Surgical Treatment
- Adjuvant Therapy
- Radiation Therapy
- Chemotherapy
- Hormonal Therapy
- Immunotherapy
- Breast Reconstruction
- Timing
- Methods
- Psychosocial Consequences of Breast Cancer
- Nursing Considerations
- Cardiovascular Disease
- EVIDENCE-BASED PRACTICE
- Recognition of Coronary Artery Disease (CAD)
- Risk Factors
- BOX 32-3 RISK FACTORS FOR CORONARY ARTERY DISEASE IN WOMEN
- Prevention
- Hypertension
- Smoking Cessation
- Diet and Glucose Control
- Increased Activity
- Aspirin
- Menstrual Cycle Disorders
- Amenorrhea
- Primary Amenorrhea
- Etiology
- Therapeutic Management
- Secondary Amenorrhea
- Nursing Considerations
- Abnormal Uterine Bleeding
- Etiology
- Management
- Nursing Considerations
- Pain Associated with the Menstrual Cycle
- Mittelschmerz
- Primary Dysmenorrhea
- Manifestations
- Etiology
- Therapeutic Management
- Endometriosis
- FIG 32-2 Common sites of endometriosis.
- Etiology
- Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- BOX 32-4 SYMPTOMS OF PREMENSTRUAL SYNDROME (PMS)
- Physical Symptoms
- Behavioral Symptoms
- Premenstrual Syndrome (PMS)
- WOMEN WANT TO KNOW: How to Relieve Symptoms of Premenstrual Syndrome (PMS)
- Diet
- Exercise
- Stress Management
- Sleep and Rest
- Etiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- FIG 32-3 The woman uses a calendar to record occurrence and severity of premenstrual symptoms.
- Elective Termination of Pregnancy
- WOMEN WANT TO KNOW: Guidelines for Self-Care After Elective Termination of Pregnancy
- Methods of Induced Abortion
- Nursing Considerations Related to Elective Pregnancy Termination
- Menopause
- Age at Menopause
- Physiologic Changes
- Psychological Responses
- Therapy for Menopause
- Nursing Considerations Related to Menopause
- Osteoporosis
- Predisposing Factors
- Manifestations
- FIG 32-4 With progression of osteoporosis, the vertebral column collapses, causing loss of height and back pain. Dowager’s hump is the term used for this curvature of the upper back.
- Prevention and Therapeutic Management
- Drug Therapy
- Calcium and Vitamin D
- Exercise
- Nursing Considerations
- Nursing Diagnoses
- Pelvic Floor Dysfunction
- Vaginal Wall Prolapse
- Cystocele
- Enterocele
- FIG 32-5 Three types of vaginal wall prolapse. A, Note bulging of bladder into the vagina. B, Note loop of bowel between rectum and uterus. C, Note bulging of rectum into vagina. More than one type of vaginal wall prolapse may exist in the same woman.
- Rectocele
- FIG 32-6 Three degrees of uterine prolapse.
- Uterine Prolapse
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Pelvic Exercises
- Stress incontinence ExemplarUrinary Incontinence
- Disorders of the Reproductive Tract
- Benign Disorders
- Cervical Polyps
- Uterine Leiomyomas
- Ovarian Cysts
- SAFETY ALERT: Signs and Symptoms that Should Always Be Investigated
- BOX 32-5 RISK FACTORS FOR CANCER OF THE REPRODUCTIVE ORGANS
- Uterus
- Cervix
- Ovaries
- Malignant Disorders
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Cervical Cancer
- Endometrial Cancer
- Ovarian Cancer
- Infectious Disorders of the Reproductive Tract
- Candidiasis
- Sexually Transmitted Diseases (STDs)
- Incidence
- Types of Sexually Transmitted Diseases (STDs)
- Trichomoniasis
- Bacterial Vaginosis
- Chlamydial Infection
- WOMEN WANT TO KNOW: About Sexually Transmitted Diseases
- Gonorrhea
- Syphilis
- Herpes Genitalis
- Human Papillomavirus (HPV)
- Acquired Immunodeficiency Syndrome
- Nursing Considerations
- Pelvic Inflammatory Disease (PID)
- Etiology and Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Toxic Shock Syndrome
- Nursing Considerations
- Key Concepts
- References and Readings
- Pageburst Integrated Resource
- Animation
- Pediatric Nursing Care
- Interactive Review – Pediatric Nursing Care
- Chapter 33 Physical Assessment of Children
- Learning Objectives
- General Approaches to Physical Assessment
- Infants from Birth to 6 Months
- Infants from 6 to 12 Months
- NURSING QUALITY ALERT: Adapting the Physical Examination to the Child
- Toddlers
- Preschoolers
- FIG 33-1 During the assessment, the nurse allows the child to remain on her mother’s lap, enlisting the child’s trust and increasing the likelihood of a successful physical examination.
- School-Age Children
- Adolescents
- Techniques for Physical Examination
- Inspection
- Palpation
- NURSING QUALITY ALERT: Using the Hands for Palpation
- Percussion
- Auscultation
- Smell
- Sequence of Physical Examination
- General Appearance
- BOX 33-1 SOUNDS IDENTIFIED DURING PERCUSSION
- History Taking
- BOX 33-2 POTENTIAL INDICATORS OF CHILD ABUSE
- CRITICAL THINKING EXERCISE 33-1
- Recording Data
- BOX 33-3 THE COMPLETE HISTORY
- Vital Signs
- BOX 33-4 PROBLEM-ORIENTED HISTORY
- Temperature
- TABLE 33-1 NORMAL VITAL SIGNS BY AGE
- Pulse
- Respirations
- Blood Pressure
- Pain Assessment
- Anthropometric Measurement
- Height
- NURSING QUALITY ALERT: Importance of Anthropometric Measurements
- Weight
- Head Circumference
- FIG 33-2 Measuring head circumference. The head circumference is measured from birth through age 36 months. The nurse uses a nonstretching tape and measures in a “hat band” position, just above the eyebrows and around the occipital prominence in the back. Chest circumference is also routinely measured in the newborn; it is usually smaller than the newborn’s head circumference.
- Chest Circumference
- Midarm Circumference
- Triceps Skinfold
- Use of Growth Charts
- Skin, Hair, and Nails
- Skin
- Inspection
- BOX 33-5 SKIN COLOR TERMINOLOGY
- NURSING QUALITY ALERT: Skin Inspection in Dark-Skinned Children
- Palpation
- Hair
- Nails
- Lymph Nodes
- FIG 33-3 Location of superficial lymph nodes.
- Head, Neck, and Face
- Head
- BOX 33-6 CHARACTERISTICS OF ENLARGED LYMPH NODES AND MASSES
- BOX 33-7 HEAD SHAPE TERMINOLOGY
- FIG 33-4 Fontanels are inspected and palpated for size, tenseness, and pulsation.
- Neck
- Face
- FIG 33-5 The child’s ears are inspected for alignment. Low-set ears could indicate an intellectual disability or renal anomalies.
- Nose, Mouth, and Throat
- Nose
- Mouth and Throat
- FIG 33-6 The frontal, ethmoid, and maxillary sinuses.
- FIG 33-7 Sequence of eruption of primary and secondary teeth.
- Eyes
- Visual Acuity
- BOX 33-8 TYPES OF EYE CHARTS
- Color Vision
- Peripheral Vision
- Binocular Vision and Strabismus
- Corneal Light Reflex Test
- Field-of-Vision Test
- FIG 33-8 Visual fields (cranial nerve II) are tested in each eye separately. One eye is covered as the child stares straight ahead. An object is slowly moved from the side of the head into the field of vision. The child says “now” upon first seeing the object.
- Tests for Eye Muscle Function
- External Eye
- FIG 33-9 External structures of the eye.
- FIG 33-10 The cover/uncover test detects small degrees of deviated eye alignment. With one eye covered, the child gazes straight ahead with the uncovered eye. The cover is then removed, and the eye should continue to stare straight ahead. Movement in either eye suggests muscle weakness. Extraocular muscle function is controlled by cranial nerves III, IV, and VI.
- Ophthalmoscopic Examination
- Ears
- Hearing Acuity
- Infant Assessment
- Preschool and School-Age Assessment by Audiometry
- FIG 33-11 Landmarks of the external ear.
- Preschool, School-Age, and Adolescent Assessment: The Whisper Test
- Conduction Tests (Tuning Fork Hearing Tests)
- External Ear
- Otoscopic Examination
- Thorax and Lungs
- Inspection
- Palpation
- FIG 33-12 Inspection of the tympanic membrane with the otoscope. The auditory canal is inspected before the otoscope is inserted to see the child’s tympanic membrane.
- To straighten the ear canal of a child older than 3 years, the nurse pulls the child’s pinna up and back.
- For children younger than 3 years, the pinna is pulled down and back.
- Auscultation
- FIG 33-13 Anatomic landmarks of the thorax in infants and children.
- Adventitious Breath Sounds
- FIG 33-14 Common alterations in chest configuration.
- Heart
- Inspection
- FIG 33-15 To identify areas of fremitus, tenderness, symmetry, and depth and equality of expansion, the nurse palpates the child’s posterior and anterior chest. When palpating any area, warm hands increase the child’s comfort.
- Palpation
- FIG 33-16 Auscultation is most easily done when the child is quiet, so this part of the examination is best performed first if the child is quiet or asleep. To allay fears, the child can play with the stethoscope first and can be distracted with a toy while the nurse is listening. Warming the stethoscope bell increases comfort. Infants and toddlers can be held sitting upright in the parent’s lap while the nurse listens to breath sounds.
- If the child is upset, the examiner may have to listen to breath sounds between cries. Keeping this child in the comfort of her mother’s arms lessens distress.
- Auscultation
- FIG 33-17 Sequence for listening to breath sounds.
- TABLE 33-2 ORIGIN AND CHARACTERISTICS OF ADVENTITIOUS BREATH SOUNDS
- Normal Rate and Rhythm
- Extra Heart Sounds, Including Murmurs
- Peripheral Vascular System
- NURSING QUALITY ALERT: Normal Findings in Children
- FIG 33-18 Location of the heart within the thorax in the infant and the older child, showing landmarks and areas of auscultation.
- Breast
- Abdomen
- FIG 33-19 Abdominal quadrants and structures.
- FIG 33-20 Abdominal contours. The contour of the abdomen provides an indication of the child’s overall nutritional state.
- Inspection
- Auscultation
- Percussion
- Palpation
- Male Genitalia
- FIG 33-21 When a boy’s scrotum is examined, the cremasteric reflex may cause the testes to withdraw into the inguinal canal. To prevent this reflex, the examiner can have the boy sit in a tailor position. The examiner uses one hand to block the inguinal canal and the other to palpate.
- Female Genitalia
- FIG 33-22 Postpubertal female genitalia.
- Musculoskeletal System
- Infants
- Toddlers, Preschoolers, and School-Age Children
- Adolescents
- Range of Motion
- Muscle Strength and Mass
- Joints
- Gait
- BOX 33-9 SCREENING PROCEDURE FOR SCOLIOSIS
- Adam’s position demonstrates the rib hump of structural scoliosis. Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies. Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. It may be compensatory for other abnormalities such as leg-length discrepancy.
- Structural scoliosis is fixed; the curvature is evident both when the individual stands and when the individual bends forward. Note the rib hump with forward flexion. When the child is standing, unequal shoulder elevation, unequal scapulae, obvious curvature, unequal elbow level, and unequal hip level is seen.
- Neurologic System
- TABLE 33-3 GROSS MOTOR DEVELOPMENT IN THE INFANT: PROGRESSION TO WALKING
- Cerebral Function
- TABLE 33-4 ASSESSING CRANIAL NERVES∗
- BOX 33-10 SPECIFIC CEREBRAL FUNCTION TESTS
- Cranial Nerves
- Cerebellar Function
- Motor System
- Sensory System
- Reflex Status
- Neurologic “Soft” Signs
- BOX 33-11 CEREBELLAR FUNCTION: TESTS OF BALANCE AND COORDINATION
- Conclusion and Documentation
- TABLE 33-5 EVALUATING COMMON REFLEXES
- BOX 33-12 TESTS FOR EVALUATING SENSORY FUNCTION
- Primary Forms of Sensation
- Cortical and Discriminatory Forms of Sensation
- BOX 33-13 EXAMPLES OF NEUROLOGIC “SOFT” SIGNS
- Key Concepts
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 34 Emergency Care of the Child
- Learning Objectives
- CLINICAL REFERENCE
- General Guidelines for Emergency Nursing Care
- Encouraging parents to remain with their child in the emergency setting can bolster the family’s coping.
- PEDIATRIC EMERGENCY EQUIPMENT
- PEDIATRIC EMERGENCY MEDICATIONS
- BOX 34-1 WORKING WITH CHILDREN IN EMERGENCIES: DEVELOPMENTAL GUIDELINES
- Infants
- Toddlers
- Preschoolers
- School-Age Children
- Adolescents
- Growth and Development Issues in Emergency Care
- The Infant
- The Toddler
- The Preschooler
- The School-Age Child
- The Adolescent
- The Family of a Child in Emergency Care
- Emergency Assessment of Infants and Children
- Primary Assessment
- Airway Assessment
- NURSING QUALITY ALERT: Initial Observations for Triage
- TABLE 34-1 PRIMARY ASSESSMENT IN PEDIATRIC EMERGENCIES
- Breathing Assessment
- Cardiovascular Assessment
- Disability: Neurologic Assessment
- Hypothermia ExemplarExposure
- Secondary Assessment
- Vital Signs
- TABLE 34-2 SECONDARY ASSESSMENT IN PEDIATRIC EMERGENCIES
- History and Head-to-Toe Assessment
- Diagnostic Tests
- Weight
- Parent-Child Relationship
- EVIDENCE-BASED PRACTICE
- Cardiopulmonary Resuscitation of the Child
- Airway and Breathing
- Initial Assessment and Intervention
- Obstructed Airway Management
- SAFETY ALERT: Airway Obstruction in Children
- Circulation
- TABLE 34-3 HEALTH CARE PROFESSIONAL BASIC LIFE SUPPORT ELEMENTS FOR INFANTS AND CHILDREN
- Shock ExemplarThe Child in Shock
- Etiology
- Hypovolemic Shock
- Distributive Shock
- Cardiogenic Shock
- PATHOPHYSIOLOGY: Shock
- Hypovolemic Shock
- Distributive Shock
- Cardiogenic Shock
- BOX 34-2 MANIFESTATIONS OF SHOCK IN CHILDREN
- Hypovolemic Shock
- Distributive (Septic) Shock: Early
- Septic Shock: Late
- Cardiogenic Shock
- Manifestations
- SAFETY ALERT: Hypotension in Children with Shock
- TABLE 34-4 ASSESSING A CHILD’S GENERAL APPEARANCE: “LOOKS GOOD” VERSUS “LOOKS BAD”
- Diagnostic Evaluation
- Therapeutic Management
- Hypovolemic Shock
- Distributive Shock
- Cardiogenic Shock
- Nursing Care
- The Child in Shock
- Assessment
- Hypovolemic Shock
- Distributive Shock
- Cardiogenic Shock
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Maintaining Tissue Perfusion
- Ensuring Oxygenation
- Preventing Infection
- Enhancing Coping
- Evaluation
- Pediatric Trauma
- Mechanism of Injury
- Blunt Trauma
- Motor Vehicle Trauma
- Pedestrian Injury
- Penetrating Trauma
- Multiple Trauma
- Primary Survey
- FIG 34-1 Waddell’s triad of injuries.
- Airway Assessment and Management
- Breathing Assessment and Management
- FIG 34-2 The child with multiple trauma injuries must remain on an immobilization board (long backboard) with a cervical immobilization device in place until the child has been evaluated for spinal injuries.
- Circulation Assessment and Management
- NURSING QUALITY ALERT: Artificial Airways
- Disability
- Secondary Survey
- Obtaining a History of the Injury
- Trauma Scoring
- Assessing for Child Abuse
- BOX 34-3 HISTORY OF INJURY QUESTIONS
- For a Victim of a Motor Vehicle Collision
- For a Victim of a Fall
- For a Victim of a Penetrating Injury
- BOX 34-4 Trauma Scoring Systems
- Trauma Score (TS)
- Revised Trauma Score (RTS)
- Pediatric Trauma Score (PTS)
- Nursing Considerations
- The Child and Family
- The Child during Recovery
- Ingestions and Poisonings
- CRITICAL THINKING EXERCISE 34-1
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- TABLE 34-5 COMMON POISONOUS SUBSTANCES
- Removal of Dermal and Ocular Toxins
- Diluting the Ingested Toxin
- Activated Charcoal
- Antidotes
- Nursing Care
- The Child Who Has Ingested a Toxic Substance
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- NURSING QUALITY ALERT: Assessment of Poison Ingestion
- Evaluation
- Environmental Emergencies
- Animal, Human, Snake, and Spider Bites
- Etiology
- Animal and Human Bites
- Snake and Spider Bites
- Incidence
- Manifestations
- Animal and Human Bites
- Snake Bites
- Spider Bites
- Therapeutic Management
- Animal Bites
- Snake Bites
- Spider Bites
- Nursing Considerations
- Submersion Injuries (Near Drowning)
- Etiology
- Incidence
- Manifestations
- PATHOPHYSIOLOGY: Submersion Injury
- Therapeutic Management
- Prehospital Emergency Management
- Hospital Management
- Nursing Care
- The Child with a Submersion Injury
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Interventions
- Providing Respiratory Support
- Restoring Appropriate Circulatory Status
- Identifying and Preventing Neurologic Consequences
- Restoring Fluid Balance
- Controlling Infection
- Maintaining Nutritional Status
- Providing Emotional Care for the Family
- Evaluation
- NURSING QUALITY ALERT: Needs Expressed by Families of Critically Ill Children
- Heat-Related Illnesses
- Incidence
- Manifestations and Therapeutic Management
- Nursing Considerations
- TABLE 34-6 Heatstroke Exemplar HEAT-RELATED ILLNESS
- CRITICAL THINKING EXERCISE 34-2
- Dental Emergencies
- Incidence and Etiology
- Therapeutic Management
- Nursing Considerations
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 35 The Ill Child in the Hospital and Other Care Settings
- Learning Objectives
- Settings of Care
- The Hospital
- 24-Hour Observation
- Emergency Hospitalization
- Outpatient and Day Facilities
- Rehabilitative Care
- The Medical-Surgical Unit
- The Intensive Care Unit
- School based services exemplarSchool-Based Clinics
- FIG 35-1 Parents are encouraged to stay with their child whenever possible. This mother is holding her child in the postanesthesia recovery room, a setting that in the past was off limits to parents.
- Community Clinics
- FIG 35-2 Nurses today help take health care on the road to provide services to those who otherwise might not obtain them. This mobile van is stationed at a public school, where it offers health screenings and prevention services to children.
- Home Care
- Stressors Associated with Illness and Hospitalization
- NURSING QUALITY ALERT: Children’s Responses to Illness
- The Infant and Toddler
- Separation Anxiety
- BOX 35-1 STAGES OF SEPARATION
- Fear of Injury and Pain
- Loss of Control
- FIG 35-3 Separation is one of the stressors of hospitalization that affects both child and parent. A toddler exhibits separation anxiety by reacting with protest to leaving her parent’s arms.
- Rooming-in reduces the stress of hospitalization and provides opportunities for parent teaching.
- The Preschooler
- Separation Anxiety
- Fear of Injury and Pain
- NURSING QUALITY ALERT: Maintaining a Safe Place
- Loss of Control
- Guilt and Shame
- The School-Age Child
- Separation
- Fear of Injury and Pain
- FIG 35-4 Activities for the hospitalized child are important for growth and development, stress relief, socialization, and a sense of control. This model railroad “trainscape” in a pediatric hospital provides children and adults with a welcome respite from real-life stresses.
- Hospitalized teens need to interact with their peers, as they do when they are well. A lounge area that is separate from the playroom used by younger children fulfills this need.
- Loss of Control
- The Adolescent
- Separation
- Fear of Injury and Pain
- Loss of Control
- Fear of the Unknown
- Regression
- Factors Affecting a Child’s Response to Illness and Hospitalization
- Age and Cognitive Development
- Parental Response
- EVIDENCE-BASED PRACTICE
- BOX 35-2 DEVELOPMENTAL APPROACHES TO THE HOSPITALIZED CHILD
- Neonate
- Infant
- Toddler
- Preschooler
- School-Age Child
- Adolescent
- Preparing the Child and Family
- Coping Skills of the Child and Family
- Psychological Benefits of Hospitalization
- Play for the Ill Child
- FIG 35-5 To provide diversion and allow interaction with other children, the play therapist wheels the child, while still in bed with traction in place, to the playroom.
- Playrooms
- Therapeutic Play
- FIG 35-6 Therapeutic play can be used to teach children about medical procedures or help them work through their feelings about what has happened to them in the health care setting. Child life specialists are often members of the team in children’s hospitals to provide expert guidance for therapeutic play. Art materials allow children to express their thoughts and feelings about illness and hospitalization.
- Giving a doll an injection can help a child work through anxiety and anger about injections she may be receiving.
- Emotional Outlet Play
- Teaching through Play
- Enhancing Cooperation through Play
- Unstructured Play
- Evaluation of Play
- Admitting the Child to a Hospital Setting
- Taking the History
- FIG 35-7 To reduce the stress of unfamiliar surroundings and people, the nurse assesses the child who remains in the security of her mother’s arms.
- Physical Examination
- Initial Inspection
- Baseline Data
- NURSING CARE PLAN: The Child and Family in a Hospital Setting
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- The Ill Child’s Family
- Parents
- FIG 35-8 The family of a hospitalized child may not speak the prevailing language. Interpreters are available (on-site or on-call) at many hospitals to help parents and children communicate with health care team members. This arrangement provides a familiar link to the parents’ and child’s culture and language.
- PARENTS WANT TO KNOW: Information for Discharge
- CRITICAL THINKING EXERCISE 35-1
- Siblings
- BOX 35-3 CARING FOR THE SIBLINGS OF AN ILL OR HOSPITALIZED CHILD
- Factors that Add to the Stress of Siblings
- Nursing Care Guidelines for Meeting the Needs of Siblings
- Siblings of ill children may experience jealousy, insecurity, resentment, confusion, and anxiety. The nurse can help them cope by assessing and implementing care to meet their needs.
- KEY CONCEPTS
- References and Readings
- Chapter 36 The Child with a Chronic Condition or Terminal Illness
- Learning Objectives
- Chronic Illness Defined
- The Family of the Child with Special Health Care Needs
- Family Dynamics and Impact on the Family
- BOX 36-1 COMMON CHRONIC CONDITIONS OF CHILDHOOD
- Coping and the Grieving Process
- The Child with Special Health Care Needs
- Coping and Growth and Development Concerns
- BOX 36-2 THE ILLNESS EXPERIENCE: THE CHILD AND ADOLESCENT
- Infant
- Toddler
- Preschooler
- School-Age Child
- Adolescent
- Coping and Parental Responses to Developmental Issues
- NURSING QUALITY ALERT: Goals for Chronic Care
- Goals for the Child
- Goals for the Family
- The Child With a Chronic Illness
- FIG 36-1 The nurse or a child life specialist can use therapeutic play, medical play, and therapeutic art to enhance self-expression, education, and growth and development.
- Ongoing Care
- Education
- Communication
- Caring for Parents
- Grief Education and Support
- Cultural and Religious Beliefs
- Referrals
- Schooling
- The Nurse as Liaison
- Caring for Siblings
- FIG 36-2 Chronic illness is stressful for the siblings of an ill child. Siblings’ emotional needs may be overlooked. Siblings should be given the opportunity to express negative feelings, such as anger and jealousy, through therapeutic art and play, as well as through physical outlets, such as striking a punching bag, as this little girl is doing.
- NURSING QUALITY ALERT: Nursing Care for Children with Chronic Conditions and Their Families
- NURSING CARE PLAN: The Child with a Chronic Condition in the Community Setting
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Because more children with chronic conditions are living longer, more attend public school. However, these children are likely to be frequently hospitalized, so hospitals often provide an area where teachers can help them with their studies.
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- CRITICAL THINKING EXERCISE 36-1
- Death dying ExemplarThe Terminally Ill or Dying Child
- Coping and the Child’s Concept of Death
- Infants and Toddlers
- TABLE 36-1 THE CHILD’S CONCEPT OF DEATH
- Preschoolers
- School-Age Children
- Adolescents
- Coping and Responses to Death and Dying
- The Child’s Response
- The Parents’ Response
- The Siblings’ Response
- Caring for the Dying Child
- Nursing Professionalism and Boundaries
- FIG 36-3 The family of the child with a terminal condition needs compassion and support from the nurse. Nursing care includes physical care and support of the family’s care giving efforts, and assistance with the grieving process.
- Communication with patient or family ExemplarCommunication
- Family Dynamics, Beliefs, and Practices
- BOX 36-3 RESOURCES ON DEATH AND DYING FOR FAMILIES AND HEALTH PROFESSIONALS
- Internet Resources
- Book Selections for Children
- Book Selections for Adults—Parents and Nurses
- Book Selections for Nurses
- Pain Control
- Hospice Care
- The Dying Process and the Time of Death
- Privacy for the Child and Family
- Changes in Family Routines
- Family Concerns about Oral Intake
- Fluids and Oral Care
- Responsiveness and Communication
- Indicators of Imminent Death
- NURSING QUALITY ALERT: Nursing Care for the Dying Child and the Child’s Family
- NURSING CARE PLAN: The Terminally Ill or Dying Child
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- The Family after Death
- The Nurse’s Response to the Dying Child
- KEY CONCEPTS
- References and Readings
- Chapter 37 Principles and Procedures for Nursing Care of Children
- LEARNING OBJECTIVES
- Preparing Children for Procedures
- Explaining Procedures
- SAFETY ALERT: Standard Precautions
- BOX 37-1 TIPS FOR PREPARING AND SUPPORTING CHILDREN UNDERGOING PROCEDURES
- Before the Procedure
- During the Procedure
- After the Procedure
- FIG 37-1 Because a child should feel that the hospital room is a safe place, a treatment room is used for invasive or painful procedures. The parent is present, not to restrain the child, but to provide emotional support.
- Consent for Procedures
- NURSING QUALITY ALERT: Preparation for Procedures
- Holding and Transporting Infants and Children
- Safety Issues in the Hospital Setting
- FIG 37-2 Methods of transporting infants and children. The nurse carries the infant securely, anticipating sudden movement. A, Cradle carry. B, Football hold. C, Over-the-shoulder carry, which can be used until the infant is 6 to 7 months old. D, Transport can be fun for young children, especially when it is on wheels.
- SAFETY ALERT: Using Restraints
- Infection Control
- Hand Hygiene
- Standard Precautions
- Implementing Precautions
- Family Teaching
- Bathing Infants and Children
- Special Considerations
- FIG 37-3 Using hand to support infant’s neck and head. When giving an infant a tub bath, the nurse supports the infant’s body at all times.
- Documentation
- Parent Teaching
- Oral Hygiene
- Feeding
- Special Considerations
- Documentation
- Parent Teaching
- Vital Signs
- Measuring Temperature
- FIG 37-4 Four methods of temperature measurement.
- NURSING QUALITY ALERT: Measuring Temperature
- Measuring Pulse
- Evaluating Respirations
- Measuring Blood Pressure
- FIG 37-5 Locating the apical pulse. Apical pulse is lateral to the left midclavicular line (MCL) and fourth intercostal space (ICS) in children younger than 7 years and to the left MCL and fifth ICS in children older than 7 years.
- FIG 37-6 Blood pressures can be measured in the upper arm, lower arm, thigh, calf, or ankle. An appropriate-size cuff must be used to obtain accurate results.
- TABLE 37-1 RECOMMENDED DIMENSIONS FOR BLOOD PRESSURE CUFF BLADDERS
- Documenting Vital Sign Measurement
- Preparing the Child and Family
- Parent Teaching
- NURSING QUALITY ALERT: Measuring Vital Signs
- Special Considerations: Cardiorespiratory Monitors
- Fever-Reducing Measures
- Description of Fever
- Medications and Environmental Management
- DRUG GUIDE: Acetaminophen (Tylenol, Tempra, Panadol)
- Specimen Collection
- Urine Specimens
- Voided Specimens
- Urinary Catheterization
- PROCEDURE: Urine Specimen Collection from the Incontinent Child
- Purpose
- Home Adaptations
- PROCEDURE: Urinary Catheterization
- Purpose
- Home Adaptations
- BOX 37-2 GUIDELINES FOR URINARY CATHETER SELECTION BY AGE
- Stool Specimens
- PROCEDURE: Venipuncture
- Purpose
- Blood Specimens
- Jugular and Femoral Venipuncture
- FIG 37-7 Two additional sites for obtaining blood specimens from infants and young children are the large superficial external jugular veins and the femoral veins.
- Capillary Blood Sampling
- PROCEDURE: Capillary Blood Sampling
- Purpose
- Sputum Specimens
- Throat and Nasopharyngeal Specimens
- PROCEDURE: Nasal Washing
- Purpose
- PROCEDURE: Throat or Nasopharyngeal Culture
- Purpose
- SAFETY ALERT: Throat Cultures
- Cerebrospinal Fluid Specimens
- Bone Marrow Aspiration
- Gastrointestinal Tubes and Enteral Feedings
- Tube Route and Placement
- Tube Selection
- Safety Issues Related to Tube Placement
- PROCEDURE: Feeding Tube Insertions
- Purpose
- Home Adaptations
- Contraindications to Tube Placement
- Enteral Feedings
- NURSING QUALITY ALERT: Enteral Feedings
- PROCEDURE: Administering Enteral Feedings (via the Orogastric, Nasogastric, or Nasointestinal Route)
- Purpose
- Intermittent Feedings (Bolus)
- Continuous Feedings
- Home Adaptations
- Gastrostomy Tubes and Buttons
- CRITICAL THINKING EXERCISE 37-1
- Enemas
- Enema Administration
- Solutions and Volumes
- Ostomies
- TABLE 37-2 RECOMMENDED VOLUME AND DEPTH FOR ENEMA TIP INSERTION, BY AGE
- Oxygen Therapy
- Oxygen Administration
- FIG 37-8 When administering oxygen to children, special consideration is given to the size and type of equipment selected, and the needs of the child and family for education and support. A, Nasal cannula. B, Simple facemask.
- Documentation
- Parent Teaching
- FIG 37-9 A, The pulse oximeter is a reliable, noninvasive method that allows periodic or continuous measurement of blood oxygen saturation. The sensor is applied to a child’s finger (B) or an infant’s toe (C).
- Assessing Oxygenation
- PROCEDURE: Pulse Oximetry
- Purpose
- NURSING QUALITY ALERT: Assisting with Arterial Blood Gas Sampling
- Tracheostomy Care
- Suctioning
- Stoma Care
- PROCEDURE: Suctioning a Tracheostomy Tube
- Purpose
- Home Adaptations
- PROCEDURE: Care of a Tracheostomy
- Purpose
- Home Adaptations
- Surgical Procedures
- Preparation for Surgery
- Preoperative Medication and Anesthesia Induction
- BOX 37-3 GUIDELINES FOR PREOPERATIVE FASTING
- Postanesthesia Care
- Postoperative Care
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 38 Medication Administration and Safety for Infants and Children
- LEARNING OBJECTIVES
- Pharmacokinetics in Children
- Absorption
- Oral Route
- FIG 38-1 Physiologic differences between children and adults affect drug absorption, metabolism, distribution, and excretion. These differences are most significant for infants.
- Gastric Acidity
- Gastric Emptying
- Gastrointestinal Motility
- Enzyme Activity
- Other Routes
- Distribution
- Differences in Body Fluids
- Differences in Fat Percentages
- Differences in Proteins
- Blood-Brain Barrier
- Metabolism
- Excretion
- Concentration
- Psychological and Developmental Factors
- PARENTS WANT TO KNOW: Medication Administration and Parent Roles
- Infants
- Toddlers and Preschoolers
- School-Age Children
- Adolescents
- Calculating Dosages
- FIG 38-2 Nomogram for calculating body surface area (BSA), which is used for determining medication dosages for infants and children.
- Medication Administration Procedures
- Medication Reconciliation
- Administering Oral Medications
- CRITICAL THINKING EXERCISE 38-1
- Preparation
- FIG 38-3 Administering an oral medication to an infant using an oral syringe.
- CRITICAL THINKING EXERCISE 38-2
- Administration
- FIG 38-4 Two methods of holding a child for an intramuscular (IM) injection at the vastus lateralis site.
- Alternative Routes for Oral Medications
- Administering Injections
- Intramuscular Injections
- TABLE 38-1 PREFERRED INTRAMUSCULAR INJECTION SITES IN CHILDREN
- SAFETY ALERT: Guidelines for Maximum Safe Volumes for Intramuscular Injections∗
- CRITICAL THINKING EXERCISE 38-3
- Subcutaneous Injections
- Intradermal Injections
- Rectal Administration
- FIG 38-5 Two of the preferred subcutaneous injection sites for infants and toddlers.
- FIG 38-6 Intradermal injection site and technique.
- Vaginal Administration
- Ophthalmic Administration
- Otic Administration
- Nasal Administration
- Topical Administration
- PROCEDURE: Administering Otic Drops
- Purpose
- PROCEDURE: Administering an Ophthalmic Preparation
- Purpose
- Inhalation Therapy
- FIG 38-7 Administration of nebulized medication to an infant.
- Intravenous Therapy
- Intravenous Catheter Insertion
- FIG 38-8 Venous access sites in children.
- PROCEDURE: Using a Metered-Dose Inhaler (MDI)
- Purpose
- NURSING QUALITY ALERT: Using EMLA Anesthetic Cream
- FIG 38-9 Intravenous (IV) sites in children are secured and well-protected to allow for activities and prevent dislodging the IV catheter. A foot vein is an acceptable IV site for an infant who is not walking or crawling. A padded arm board gently limits movement of the hand, and a plastic shield allows visibility yet keeps the IV site intact.
- Intravenous Catheter Monitoring
- Intravenous Infusion Monitoring
- FIG 38-10 Alaris® System intravenous (IV) infusion pump.
- Infusion Rates and Methods
- Administering Intravenous Medications
- Intravenous Bolus Administration
- BOX 38-1 DAILY MAINTENANCE FLUID REQUIREMENTS AND RATES Formula for Calculating Daily Fluid Requirements∗
- Example 1:
- Example 2:
- Example 3:
- Intravenous Intermittent Infusion Administration
- CRITICAL THINKING EXERCISE 38-4
- Venous Access Devices
- Intermittent Infusion Ports
- Central Venous Access Devices
- Administration of Blood Products
- Child and Family Education
- PARENTS WANT TO KNOW: Medication Administration at Home
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 39 Pain Management for Children
- LEARNING OBJECTIVES
- Definitions and Theories of Pain
- Gate Control Theory
- Acute and Chronic Pain
- Research on Pain in Children
- TABLE 39-1 PAIN AND PAIN MANAGEMENT IN CHILDREN: MYTHS AND REALITIES
- Obstacles to Pain Management in Children
- BOX 39-1 PAIN MANAGEMENT RESOURCES ON THE INTERNET
- Assessment of Pain in Children
- BOX 39-2 INDICATORS OF PAIN ACCORDING TO DEVELOPMENTAL LEVELS
- Neonate and Infant
- Toddler
- Preschooler
- School-Age Child
- Adolescent
- Assessment According to Developmental Level
- Neonates and Infants
- Toddlers
- FIG 39-1 Infant total body response to pain with arms thrashing, tremors, and vigorous crying.
- CRITICAL THINKING EXERCISE 39-1
- Preschoolers
- School-Age Children
- FIG 39-2 Toddlers and preschoolers may express pain by guarding or touching the painful area. The toddler pulling on his ear is a characteristic expression of ear pain from otitis media.
- FIG 39-3 School-age children may become very quiet and withdrawn when ill or in pain. The child with asthma is not attentive or active; his mother knew that something was wrong because of his withdrawn behavior.
- Adolescents
- TABLE 39-2 PAIN ASSESSMENT TOOLS
- NURSING QUALITY ALERT: Assessing Pain in Children
- Assessment Tools
- Non-Pharmacologic and Pharmacologic Pain Interventions
- FIG 39-4 A, The Hispanic version of the Oucher pain scale. B, The African-American version.
- FIG 39-5 FACES Pain Rating Scale. Explain to the child that each face is for a person who feels happy because he or she has no pain (hurt) or sad because he or she has some or a lot of pain. Ask the child to choose the face that best describes his or her own pain.
- FIG 39-6 Adolescent and Pediatric Pain Tool (APPT). Use with 8- to 17-year-olds.
- BOX 39-3 PAIN EXPERIENCE HISTORY
- Child Form∗
- Parent Form
- Non-Pharmacologic Interventions
- PATIENT-CENTERED TEACHING: Pain Management for Children at Home
- FIG 39-7 The boy listens to music, which serves as a distraction to refocus attention and reduce pain.
- TABLE 39-3 NON-PHARMACOLOGIC PAIN RELIEF TECHNIQUES
- Pharmacologic Interventions
- Administration of Analgesics
- NURSING QUALITY ALERT: Disadvantages of Intramuscular (IM) Analgesics
- Patient-Controlled Analgesia
- FIG 39-8 Patient-controlled analgesia (PCA) allows the child greater control over her own pain management.
- BOX 39-4 ASPECTS OF PATIENT-CONTROLLED ANALGESIA (PCA) ORDERS
- Topical Anesthetic Agents
- Acetaminophen and Antiinflammatory Drugs
- DRUG GUIDE: Ibuprofen
- DRUG GUIDE: Acetaminophen
- DRUG GUIDE: Ketorolac
- Opioids
- DRUG GUIDE: Codeine
- DRUG GUIDE: Hydrocodone
- DRUG GUIDE: Oxycodone
- DRUG GUIDE: Morphine
- DRUG GUIDE: Hydromorphone
- DRUG GUIDE: Fentanyl
- Procedural Sedation
- NURSING QUALITY ALERT: Pain Management for Children
- DRUG GUIDE: Methadone
- Epidural Analgesia
- KEY CONCEPTS
- References and Readings
- Chapter 40 The Child with a Fluid and Electrolyte Alteration
- LEARNING OBJECTIVES
- Clinical Reference
- Review of Fluid and Electrolyte Imbalances in Children
- PEDIATRIC DIFFERENCES RELATED TO FLUID AND ELECTROLYTE BALANCE
- Infants
- Infants and Young Children
- Infants and Children
- Alterations in Acid-Base Balance in Children
- NURSING QUALITY ALERT: Treatment Goals in Acid-Base Imbalance
- OVERVIEW OF FLUID AND ELECTROLYTE DISORDERS
- ASSESSMENT OF FLUID DISTURBANCES
- COMMON LABORATORY AND DIAGNOSTIC TESTS FOR FLUID AND ELECTROLYTE IMBALANCE∗
- SELECTED LABORATORY VALUES FOR ACID-BASE DISTURBANCES
- • ACID-BASE DISTURBANCES: PRINCIPAL CAUSES, CLINICAL MANIFESTATIONS, AND TREATMENT
- Dehydration ExemplarDehydration
- Etiology and Incidence
- Manifestations
- TABLE 40-1 TYPES OF DEHYDRATION: ETIOLOGY, CLINICAL MANIFESTATIONS, AND LABORATORY VALUES
- SAFETY ALERT: Signs of Impending Shock in the Dehydrated Child
- TABLE 40-2 ASSESSMENT OF THE SEVERITY OF DEHYDRATION
- PATHOPHYSIOLOGY: Dehydration
- Diagnostic Evaluation
- Therapeutic Management
- Minimal Dehydration
- TABLE 40-3 ORAL REPLACEMENT AND REHYDRATION THERAPY IN CHILDREN WITH VOMITING OR DIARRHEA
- Mild to Moderate Dehydration
- Severe Dehydration
- BOX 40-1 MAINTENANCE FLUID REQUIREMENTS AND MINIMUM URINE OUTPUT
- Daily Fluid Requirements by Body Weight
- Minimum Urine Output by Age-Group
- SAFETY ALERT: Guidelines When Administering Potassium
- Adjunctive Management
- Nursing Care
- The Child with Dehydration
- Assessment
- FIG 40-1 Testing skin turgor. Turgor refers to the elasticity of the skin, which is affected by the extent of hydration. The nurse tests turgor by gently grasping the skin. When the skin is released, it should instantly spring back into place; if it does not, tissue turgor is considered poor.
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Interventions
- PATIENT-CENTERED TEACHING: Dehydration
- Signs and Symptoms of Dehydration
- Evaluation
- Diarrhea ExemplarDiarrhea
- EVIDENCE-BASED PRACTICE
- CRITICAL THINKING EXERCISE 40-1
- Etiology and Incidence
- PATHOPHYSIOLOGY: Diarrhea
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- TABLE 40-4 CAUSES AND MANIFESTATIONS OF DIARRHEA IN INFANTS AND CHILDREN
- Prognosis
- Nursing Care
- The Child with Diarrhea
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- PATIENT-CENTERED TEACHING: Caring for a Child with Diarrhea
- Diet
- Mild Diarrhea (Mushy Stools) in Children of Any Age
- Moderate Diarrhea (Watery or Frequent Stools) in Children Younger than 1 Year
- Moderate Diarrhea (Watery or Frequent Stools) in Children Older than 1 Year
- Preventing the Spread of Infection
- Skin Care
- When to Call the Physician
- Oral Rehydration Therapy
- Evaluation
- CRITICAL THINKING EXERCISE 40-2
- Vomiting ExemplarVomiting
- Etiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- PATHOPHYSIOLOGY: Vomiting
- Nursing Care
- The Vomiting Child
- Assessment
- NURSING QUALITY ALERT: Caring for the Child Who Is Vomiting
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Interventions
- Evaluation
- KEY CONCEPTS
- References and Readings
- Chapter 41 The Child with an Infectious Disease
- Learning Objectives
- Clinical Reference
- Review of Disease Transmission
- Chain of Infection
- Transmission of Pathogens
- Epidemiologic Investigations
- Infection and Host Defenses
- Immunity
- Viral Exanthems
- Nursing Considerations for the Child with a Viral Exanthem Infection
- Rubeola (Measles)
- Manifestations
- FIG 41-1 Sample notification letter from school nurse informing parents and caregivers about an exposure to an infectious disease.
- NURSING CARE PLAN: The Child with an Infection in the Community Setting
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- PATIENT-CENTERED TEACHING: How to Care for the Child with a Viral Exanthem
- Complications
- FIG 41-2 Rubeola (measles) lesions and rash distribution.
- Therapeutic Management
- Rubella (German Measles, 3-Day Measles)
- Manifestations
- Complications
- FIG 41-3 Rubella (German measles) lesions and rash distribution.
- FIG 41-4 Erythema infectiosum lesions and rash distribution.
- Therapeutic Management
- SAFETY ALERT: Congenital Rubella
- Erythema Infectiosum (Fifth Disease, Parvovirus B19)
- Manifestations
- Complications
- FIG 41-5 Roseola infantum lesions and rash distribution.
- Therapeutic Management
- Roseola Infantum (Exanthem Subitum)
- Manifestations
- Complications
- Therapeutic Management
- Enterovirus (Nonpolio) Infections (Coxsackieviruses, Group A and Group B), Echoviruses, and Enteroviruses
- Manifestations
- Complications
- Therapeutic Management
- FIG 41-6 Coxsackievirus mouth lesions.
- Nursing Considerations
- Varicella-Zoster Infections (Chickenpox, Shingles)
- FIG 41-7 Chickenpox and shingles lesions and rash distribution.
- Manifestations
- Varicella
- Herpes Zoster (Shingles)
- Complications
- Therapeutic Management
- Nursing Considerations
- SAFETY ALERT: Varicella and the Immunocompromised Child
- Other Viral Infections
- Mumps
- Manifestations
- Complications
- Therapeutic Management
- Nursing Considerations
- Cytomegalovirus (CMV)
- Therapeutic Management
- Nursing Considerations
- Epstein-Barr Virus (Infectious Mononucleosis)
- Manifestations
- Complications
- Therapeutic Management
- Nursing Considerations
- PATIENT-CENTERED TEACHING: How to Care for the Child with Infectious Mononucleosis
- Rabies
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Bacterial Infections
- Pertussis (Whooping Cough)
- Manifestations
- Complications
- Therapeutic Management
- BOX 41-1 STAGES OF MANIFESTATION OF PERTUSSIS
- Catarrhal
- Paroxysmal
- Convalescent
- Nursing Considerations
- Scarlet Fever
- Manifestations
- Complications
- Therapeutic Management
- Nursing Considerations
- Methicillin-Resistant Staphylococcus aureus (MRSA)
- FIG 41-8 Scarlet fever rash distribution and appearance. Note the characteristic skin peeling.
- PATIENT-CENTERED TEACHING: How to Care for the Child with Scarlet Fever
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Clostridium difficile
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Serious Bacterial Illness in Infants
- Rare Viral and Bacterial Infections
- Fungal Infections
- Rickettsial Infections
- Rocky Mountain Spotted Fever
- Manifestations
- Therapeutic Management
- TABLE 41-1 RARE VIRAL AND BACTERIAL INFECTIONS
- Nursing Considerations
- Borrelia Infections
- Relapsing Fever
- FIG 41-9 Lesions of variola are at the same stage of development on all body parts.
- BOX 41-2 PREVENTIVE MEASURES TO AVOID INSECT AND TICK BITES
- Manifestations
- FIG 41-10 Dog (wood) ticks and deer (black-legged) ticks compared with a pencil. Dog ticks: A, engorged female; B, female; C, male. Deer ticks: D, larvae; E, nymphs; F, males; G, females; H, engorged female.
- Therapeutic Management
- Nursing Considerations
- Lyme Disease
- FIG 41-11 Characteristic lesion of Lyme disease.
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Helminths
- Therapeutic Management
- Nursing Considerations
- TABLE 41-2 COMMON HELMINTHS
- PATIENT-CENTERED TEACHING: How to Prevent Parasitic Infections
- Sexually transmitted infections ExemplarSexually Transmitted Diseases
- Chlamydial Infection
- PATIENT-CENTERED TEACHING: Sexually Transmitted Diseases
- Manifestations
- Therapeutic Management
- Gonorrhea
- Manifestations
- Therapeutic Management
- Herpes Simplex Virus
- Manifestations
- Therapeutic Management
- CRITICAL THINKING EXERCISE 41-1
- Human Papillomavirus
- Manifestations
- Therapeutic Management
- Bacterial Vaginosis
- Manifestations
- Syphilis
- Manifestations
- Therapeutic Management
- Trichomoniasis
- Manifestations
- Therapeutic Management
- Nursing Considerations
- EVIDENCE-BASED PRACTICE
- KEY CONCEPTS
- References and Readings
- Chapter 42 The Child with an Immunologic Alteration
- Learning Objectives
- CLINICAL REFERENCE
- Review of the Immune System
- Nonspecific Immune Functions
- Specific Immune Functions
- The Humoral Response
- CELLS INVOLVED IN THE IMMUNE RESPONSE
- PEDIATRIC DIFFERENCES IN THE IMMUNE SYSTEM
- The Organs of the Immune System Mature during Infancy and Childhood
- Immaturity of the Immunologic System Places the Infant and Young Child at Greater Risk for Infection
- Disorders of the Immune System Manifest Differently in Children than in Adults
- The Cell-Mediated Response
- Development of Immunity
- Active Acquired Immunity
- Passive Acquired Immunity
- IMMUNOGLOBULIN FUNCTION AND PEDIATRIC IMPLICATIONS
- Common Laboratory and Diagnostic Tests of Immune Function
- Immunodeficiencies
- Allergy
- COMMON LABORATORY AND DIAGNOSTIC TESTS OF IMMUNE FUNCTION
- LABORATORY AND CLINICAL SCREENING TESTS FOR ALLERGY
- Human Immunodeficiency Virus Infection
- Etiology
- CRITICAL THINKING EXERCISE 42-1
- Incidence
- PATHOPHYSIOLOGY: HIV Infection
- Manifestations
- BOX 42-1 CLINICAL FINDINGS ASSOCIATED WITH IMMUNODEFICIENCY
- Frequently Present, Highly Indicative Signs
- Frequently Present, Somewhat Suggestive Signs
- Diagnostic Evaluation
- Diagnosing HIV-Exposed Infants
- Ongoing Diagnostic Monitoring
- Therapeutic Management
- HIV-Exposed Infants
- HIV-Infected Infants and Children
- Treatment Considerations
- Treatment Initiation
- Additional Issues Related to the Child with HIV Infection
- Multigenerational Problems
- TABLE 42-1 CONSIDERATIONS FOR INITIATING ANTIRETROVIRAL MEDICATIONS IN INFANTS AND CHILDREN WITH HIV
- Disclosure
- NURSING CARE PLAN: The Child with HIV Infection in the Community
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- TABLE 42-2 RECOMMENDATIONS FOR ROUTINE IMMUNIZATION OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN IN THE UNITED STATES
- HIV and School Settings
- PATIENT-CENTERED TEACHING: How to Care for the Child with an HIV Infection
- Transmission
- Prevention
- Testing
- Illness (AIDS)
- Medications
- Home Care
- NURSING CARE PLAN: The Adolescent with HIV Infection
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Corticosteroid Therapy
- Incidence
- Pathophysiology
- DRUG GUIDE: Prednisolone (Pediapred, Prelone)
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child Receiving Corticosteroids
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- SAFETY ALERT: The Child Taking Oral Corticosteroids
- Evaluation
- Immune Complex and Autoimmune Disorders
- Immune Complex Disorders
- Autoimmune Disorders
- Systemic Lupus Erythematosus
- Etiology
- Incidence
- Manifestations
- PATHOPHYSIOLOGY: Systemic Lupus Erythematosus
- Diagnostic Evaluation
- FIG 42-1 The butterfly rash of systemic lupus erythematosus.
- Therapeutic Management
- Nursing Care
- The Child with Systemic Lupus Erythematosus
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- TABLE 42-3 CLASSIFICATION OF ALLERGIC REACTIONS
- Evaluation
- Allergic Reactions
- TABLE 42-4 COMMON ALLERGIC CONDITIONS IN CHILDREN
- Anaphylaxis
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Anaphylaxis
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Anaphylaxis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Interventions
- PATIENT-CENTERED TEACHING: Communicating with the School about Peanut Allergies
- Evaluation
- PATIENT-CENTERED TEACHING: How to Prevent Insect Stings
- KEY CONCEPTS
- References and Readings
- Chapter 43 The Child with a Gastrointestinal Alteration
- Learning Objectives
- CLINICAL REFERENCE
- Review of the Gastrointestinal System
- Upper Gastrointestinal System
- Lower Gastrointestinal System
- Prenatal Development
- COMMON LABORATORY AND DIAGNOSTIC TESTS FOR GI DISORDERS
- MAJOR DIGESTIVE ENZYMES
- PEDIATRIC DIFFERENCES IN THE GASTROINTESTINAL SYSTEM
- Disorders of Prenatal Development
- Cleft Lip and Palate
- Incidence
- PATHOPHYSIOLOGY: Cleft Lip and Palate
- Child born with a cleft lip and palate, before (A) and after (B) repair. Repair of facial clefts usually requires multiple surgeries at different stages in the child’s growth. Early repair of a cleft lip facilitates parent-infant bonding and improves feeding. Children generally experience good outcomes with today’s surgical, orthodontic, and speech therapy techniques.
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- FIG 43-1 Before and after repair of a cleft lip or palate, special feeding techniques are essential for adequate nutrition. A feeder with compressible plastic sides allows gentle squeezing of the sides of the bottle to help eject the breast milk or formula. A slightly longer nipple allows the milk to be swallowed with less chance of milk entering the nasopharynx and without stimulating the gag reflex.
- Esophageal Atresia with Tracheoesophageal Fistula
- Etiology and Incidence
- Manifestations
- Diagnostic Evaluation
- NURSING CARE PLAN: The Child with a Cleft Lip or Palate
- Focused Assessment
- Nursing Diagnoses
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnoses
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Plannning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- PATIENT-CENTERED TEACHING: Home Care of the Child with Cleft Lip or Palate
- FIG 43-2 Most common type of esophageal atresia (EA) and tracheoesophageal fistula (TEF).
- Therapeutic Management
- PATHOPHYSIOLOGY: Esophageal Atresia and Tracheoesophageal Fistula
- Nursing Care
- The Infant with Tracheoesophageal Fistula
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcome
- SAFETY ALERT: Assessing and Managing the Child with Esophageal Atresia and Tracheoesophageal Fistula
- Interventions
- Minimizing Aspiration Risk
- Postoperative Care
- Gastrostomy Tube Use
- Home Care
- FIG 43-3 The skin-level gastrostomy button is good for children who require long-term gastrostomy feeding. It is relatively flat, reduces skin breakdown, increases comfort, and is fully immersible in water.
- Evaluation
- Upper Gastrointestinal Hernias
- Other Developmental Disorders
- Motility Disorders
- Gastroesophageal Reflux Disease
- Etiology
- Incidence
- TABLE 43-1 UPPER GI HERNIAS
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- TABLE 43-2 DEVELOPMENTAL GI DEFECTS
- BOX 43-1 TYPES OF GASTROESOPHAGEAL REFLUX
- Physiologic (Gastroesophageal Reflux [GER])
- Pathologic (Gastroesophageal Reflux Disease [GERD])
- PATIENT-CENTERED TEACHING: Home Care of the Child with a Gastrostomy Tube
- Diet
- Positioning
- Medications
- Treatment of Acute Bleeding
- PATHOPHYSIOLOGY: Gastroesophageal Reflux
- Surgery
- Nursing Care
- The Infant with Gastroesophageal Reflux Disease
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- Minimizing Reflux
- Family Education and Support
- Evaluation
- Constipation ExemplarConstipation and Encopresis
- PATHOPHYSIOLOGY: Constipation and Encopresis
- Etiology and Incidence
- Manifestations
- Constipation
- Encopresis
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Constipation or Encopresis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- Overcoming Withholding
- Dietary Changes
- Changing the Retention Habit
- Emotional Support
- Home Care
- Evaluation
- Recurrent Abdominal Pain/Irritable Bowel Syndrome
- Etiology and Incidence
- Manifestations and Diagnostic Evaluation
- Therapeutic Management and Nursing Considerations
- PATHOPHYSIOLOGY: Irritable Bowel Syndrome
- Inflammatory and Infectious Disorders
- Ulcers
- PATHOPHYSIOLOGY: Ulcers
- Etiology
- Incidence
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Providing Information
- Home Care
- Infectious Gastroenteritis
- Etiology
- PARENTS WANT TO KNOW: Care of the Child with an Ulcer
- Incidence
- TABLE 43-3 CHARACTERISTICS OF INFECTIOUS GASTROENTERITIS
- Manifestations
- PATHOPHYSIOLOGY: Infectious Gastroenteritis
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Infectious Gastroenteritis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- Maintaining Fluid Balance
- Decreasing Risk
- Home Care
- PATIENT-CENTERED TEACHING: Care of the Child with Infectious Gastroenteritis
- Evaluation
- Appendicitis
- Etiology and Incidence
- Manifestations and Diagnostic Evaluation
- PATHOPHYSIOLOGY: Appendicitis
- FIG 43-4 McBurney point is midway between the right anterior superior iliac crest and the umbilicus. It is usually the location of greatest pain in the child with appendicitis.
- Therapeutic Management
- Nursing Care
- The Child with Appendicitis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- NURSING QUALITY ALERT: Assessing Appendicitis in the Young Child
- Interventions
- Uncomplicated Appendicitis
- Ruptured Appendix
- Home Care
- Evaluation
- Ulcerative colitis ExemplarInflammatory Bowel Disease
- Etiology
- Incidence, Manifestations, and Diagnostic Evaluation
- Therapeutic Management
- TABLE 43-4 CROHN DISEASE AND ULCERATIVE COLITIS
- Nursing Care
- The Child with Inflammatory Bowel Disease
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- Medications
- Nutritional Management
- Family Education and Support
- PATHOPHYSIOLOGY: Inflammatory Bowel Disease
- Home Care
- Evaluation
- Obstructive Disorders
- Hypertrophic Pyloric Stenosis
- Etiology and Incidence
- Manifestations
- PATHOPHYSIOLOGY: Hypertrophic Pyloric Stenosis
- Diagnostic Evaluation
- Therapeutic Management
- NURSING QUALITY ALERT: Gathering Information from a Parent About Infant Vomiting
- Nursing Care
- The Child with Hypertrophic Pyloric Stenosis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- Preoperative Care
- Postoperative Care
- Home Care
- Evaluation
- CRITICAL THINKING EXERCISE 43-1
- Intussusception
- Etiology and Incidence
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Intussusception
- Assessment
- PATHOPHYSIOLOGY: Intussusception
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- Initial Care
- Post Reduction Care
- Family Education and Support
- Evaluation
- Volvulus
- Hirschsprung Disease
- Etiology and Incidence
- Manifestations and Diagnostic Evaluation
- PATHOPHYSIOLOGY: Hirschsprung Disease
- Therapeutic Management
- Nursing Care
- The Child with Hirschsprung Disease
- Assessment
- Nursing Diagnoses and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- Preparing the Child for Surgery
- Preventing Infection and Maintaining Skin Integrity
- Maintaining Nutritional and Hydration Status
- Reducing Pain
- Providing Education and Relieving Anxiety
- Evaluation
- Malabsorption syndromes ExemplarMalabsorption Disorders
- Lactose Intolerance
- Etiology and Incidence
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- PATHOPHYSIOLOGY: Lactose Intolerance
- Nursing Care
- The Child with Lactose Intolerance
- Assessment
- PARENTS WANT TO KNOW: Care of the Child with Lactose Intolerance
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Celiac Disease
- Etiology and Incidence
- Manifestations
- Diagnostic Evaluation
- PATHOPHYSIOLOGY: Celiac Disease
- Therapeutic Management
- Nursing Care
- The Child with Celiac Disease
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- PATIENT-CENTERED TEACHING: Care of the Child with Celiac Disease
- Evaluation
- Short Bowel Syndrome
- Etiology and Incidence
- Pathophysiology
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Hepatic Disorders
- Viral Hepatitis
- Etiology
- Incidence
- TABLE 43-5 DIFFERENTIATION OF VIRAL HEPATITIS
- Manifestations
- PATHOPHYSIOLOGY: Viral Hepatitis
- Diagnostic Evaluation
- Therapeutic Management
- Hepatitis A
- Hepatitis B
- Nursing Care
- The Child with Viral Hepatitis
- Assessment
- TABLE 43-6 HEPATITIS PROPHYLAXIS
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- Child and Parent Teaching
- Home Care
- Evaluation
- Biliary Atresia
- Etiology and Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Nutritional Support
- Skin Care
- Developmental Stimulation
- Continued Assessment
- Family Education and Support
- PATHOPHYSIOLOGY: Biliary Atresia
- Home Care
- Cirrhosis
- PATHOPHYSIOLOGY: Cirrhosis
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Nutritional Support
- Skin Care
- Prevention of Complications
- Developmental and Parental Support
- Home Care
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 44 The Child with a Genitourinary Alteration
- Learning Objectives
- CLINICAL REFERENCE
- Review of the Genitourinary System
- Structure
- PEDIATRIC DIFFERENCES IN THE GENITOURINARY SYSTEM
- Function
- COMMON LABORATORY AND DIAGNOSTIC TESTS FOR GENITOURINARY DISORDERS
- Enuresis
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Enuresis
- Manifestations
- Nocturnal Enuresis
- Diurnal Enuresis
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Enuresis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- CRITICAL THINKING EXERCISE 44-1
- Urinary tract infection ExemplarUrinary Tract Infections
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Urinary Tract Infections
- BOX 44-1 MANIFESTATIONS OF URINARY TRACT INFECTION IN INFANTS AND CHILDREN
- Infants
- Children
- Children with Pyelonephritis
- Manifestations
- PATHOPHYSIOLOGY: Hydronephrosis
- PATHOPHYSIOLOGY: Vesicoureteral Reflux
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with a Urinary Tract Infection
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- NURSING QUALITY ALERT: Evaluation after a Documented Urinary Tract Infection
- PATIENT-CENTERED TEACHING: How to Manage and Prevent Urinary Tract Infections
- Evaluation
- Cryptorchidism
- Incidence
- PATHOPHYSIOLOGY: Cryptorchidism
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- NURSING QUALITY ALERT: Assessing for Cryptorchidism
- Nursing Care
- The Child with Cryptorchidism
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Interventions
- Evaluation
- Hypospadias and Epispadias
- Etiology and Incidence
- FIG 44-1 Epispadias and hypospadias are congenital anomalies in which the urethral opening is above or below its normal location on the glans of the penis. Stenosis of the opening could occur, leading to possible urinary tract infections (UTIs) or hydronephrosis. Hypospadias might interfere with fertility if it is left uncorrected.
- PATHOPHYSIOLOGY: Hypospadias
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Hypospadias
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Miscellaneous Disorders and Anomalies of the Genitourinary Tract
- Acute Poststreptococcal Glomerulonephritis
- Etiology and Incidence
- Manifestations
- TABLE 44-1 MISCELLANEOUS DISORDERS AND ANOMALIES OF THE GENITOURINARY TRACT
- Diagnostic Evaluation
- Therapeutic Management
- PATHOPHYSIOLOGY: Acute Poststreptococcal Glomerulonephritis
- Nursing Care
- The Child with Acute Poststreptococcal Glomerulonephritis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Preventing the Consequences of Fluid Excess
- Providing Adequate Rest
- Maintaining Skin Integrity
- Maintaining Nutritional Status
- Relieving Anxiety
- Evaluation
- Nephrotic Syndrome
- NURSING QUALITY ALERT: Differences between Children with Glomerulonephritis and Children with Nephrotic Syndrome
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- PATHOPHYSIOLOGY: Nephrotic Syndrome
- Remission Induction
- NURSING CARE PLAN: The Child with Nephrotic Syndrome
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnoses
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Additional Therapy
- FIG 44-2 This child has nephrotic syndrome. He previously received steroid therapy and is now receiving CellCept immunosuppressant therapy to control the process. During the acute phase of the nephrotic syndrome, the child may have massive edema because blood proteins are lost in the urine. Skin pallor is also common.
- Acute Renal Failure
- Etiology and Incidence
- PATHOPHYSIOLOGY: Acute Renal Failure
- Manifestations
- Diagnostic Evaluation
- History
- Fluid Volume Status
- Laboratory Data
- PATHOPHYSIOLOGY: Hemolytic Uremic Syndrome
- Physical Examination
- Imaging Studies
- Therapeutic Management
- Fluid Imbalances
- Electrolyte Imbalances
- Potassium
- Sodium
- Acid-Base Imbalances
- Nutrition
- NURSING QUALITY ALERT: Indications for Dialysis in Acute Renal Failure
- Dialysis
- Nursing Considerations
- BOX 44-2 DIALYSIS
- Hemodialysis
- Teenager receiving hemodialysis.
- Peritoneal Dialysis
- Peritoneal dialysis. Implanted line allows instillation of the dialyzing fluid into this child’s peritoneal cavity.
- Infection of the peritoneal cavity is the chief hazard of peritoneal dialysis. When the lines are open to begin or end the dialyzing cycle, both adult and child wear masks.
- Peritoneal dialysis catheter exit site.
- Chronic Renal Failure and End-Stage Renal Disease
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Chronic Renal Failure
- End-Stage Renal Disease
- Kidney Transplantation
- Nursing Care
- The Child with Chronic Renal Failure and End-Stage Renal Disease
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 45 The Child with a Respiratory Alteration
- Learning Objectives
- CLINICAL REFERENCE
- Review of the Respiratory System
- The Upper Airway
- The Lower Airway
- Prenatal Respiratory Development
- Postnatal Respiratory Changes
- Gas Exchange and Transport
- Diagnostic Tests
- Blood Gas Analysis
- COMMON LABORATORY AND DIAGNOSTIC TESTS FOR RESPIRATORY DISORDERS
- Pulmonary Function Tests
- Pulse Oximetry
- Transcutaneous Monitoring
- End-Tidal Carbon Dioxide Monitoring
- PEDIATRIC DIFFERENCES IN THE RESPIRATORY SYSTEM
- Respiratory Illness in Children
- Allergic Rhinitis
- Etiology and Incidence
- PATHOPHYSIOLOGY: Allergic Rhinitis
- Manifestations
- FIG 45-1 Children with allergic rhinitis often have dark circles under their eyes, called allergic shiners, and may be seen rubbing their noses upward with the palm—the “allergic salute.”
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- PATIENT-CENTERED TEACHING: How to Implement Environmental Modifications
- Pollen and Dust
- Mold
- Dander
- Sinusitis
- Etiology and Incidence
- Manifestations
- PATHOPHYSIOLOGY: Sinusitis
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Otitis media ExemplarOtitis Media
- Etiology
- Incidence
- Manifestations
- PATHOPHYSIOLOGY: Otitis Media
- Diagnostic Evaluation
- Therapeutic Management
- FIG 45-2 Appearance of tympanic membrane in otitis media compared with normal tympanic membrane. A, Normal right tympanic membrane and middle ear. B, Acute otitis media: bulging right tympanic membrane. C, Otitis media with effusion: air-fluid level and bubbles visible through right retracted, translucent tympanic membrane. D, Otitis media with effusion: severely retracted, opaque right tympanic membrane.
- Nursing Care
- The Child with Otitis Media
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- EVIDENCE-BASED PRACTICE
- Pharyngitis and Tonsillitis
- Etiology
- Incidence
- Manifestations
- TABLE 45-1 COMPARISON OF VIRAL AND BACTERIAL PHARYNGITIS
- PATHOPHYSIOLOGY: Pharyngitis
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Nursing Care
- The Child Undergoing a Tonsillectomy
- Assessment: Preoperative Period
- Nursing Diagnosis and Planning: Preoperative Period
- Expected Outcome
- Expected Outcome
- Interventions: Preoperative Period
- Evaluation: Preoperative Period
- Assessment: Postoperative Period
- SAFETY ALERT: Caring for the Child Who Has Had a Tonsillectomy
- Nursing Diagnosis and Planning: Postoperative Period
- Expected Outcome
- PATIENT-CENTERED TEACHING: Caring for a Child after a Tonsillectomy
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions: Postoperative
- Evaluation: Postoperative
- CRITICAL THINKING EXERCISE 45-1
- Laryngomalacia (Congenital Laryngeal Stridor)
- Manifestations
- Therapeutic Management
- Nursing Considerations
- Croup
- Etiology and Incidence
- Manifestations
- TABLE 45-2 COMPARISON OF TYPES OF CROUP
- PATHOPHYSIOLOGY: Croup
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Croup
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Facilitating Airway Clearance
- Maintaining Fluid Balance
- Decreasing Fear
- Providing Teaching
- Evaluation
- Epiglottitis (Supraglottitis)
- Etiology and Incidence
- Manifestations
- Diagnostic Evaluation
- SAFETY ALERT: Cardinal Signs and Symptoms of Epiglottitis
- PATHOPHYSIOLOGY: Epiglottitis
- Therapeutic Management
- Nursing Considerations
- Bronchitis
- Etiology and Incidence
- PATHOPHYSIOLOGY: Bronchitis
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Bronchiolitis
- Etiology and Incidence
- PATHOPHYSIOLOGY: Bronchiolitis
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Bronchiolitis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Facilitating Gas Exchange
- Preventing Transmission
- Maintaining Fluid Balance
- Reducing Fever
- Decreasing Anxiety
- Evaluation
- Pneumonia ExemplarPneumonia
- Nursing Care
- The Child with Pneumonia
- Assessment
- TABLE 45-3 COMPARISON OF TYPES OF PNEUMONIA
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- PATIENT-CENTERED TEACHING: Home Management of the Child with Pneumonia
- Evaluation
- BOX 45-1 COMMON ITEMS OF ASPIRATION
- Foreign Body Aspiration
- Etiology and Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Pulmonary Noninfectious Irritation
- Acute Respiratory Distress Syndrome
- Pathophysiology
- Passive Smoking
- Pathophysiology
- Smoke Inhalation
- Pathophysiology
- TABLE 45-4 PULMONARY NONINFECTIOUS IRRITANTS
- Apnea
- Manifestations
- Diagnostic Evaluation
- TABLE 45-5 APNEA OF PREMATURITY COMPARED WITH INFANT APNEA
- Nursing Care
- The Infant with Apnea
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- FIG 45-3 Teaching the family about using an apnea monitor and how to respond to alarms is an important element in caring for the child with infant apnea. The nurse must assess the parents’ ability to tolerate the stressors of living with a child who is prone to apnea and support them as they deal with these stressors.
- Evaluation
- Sudden Infant Death Syndrome
- Etiology and Incidence
- BOX 45-2 HOME APNEA MONITORING
- PATHOPHYSIOLOGY: Sudden Infant Death Syndrome
- Manifestations
- Diagnostic Evaluation
- Nursing Care
- The Family of the Infant Who Has Died of SIDS
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Asthma ExemplarAsthma
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Asthma
- Immediate Reaction (Early-Phase Response)
- Delayed Reaction (Late-Phase Response)
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Acute Asthma Episode
- Long-Term Management
- Environmental Control
- Irritants and Allergens
- Exercise
- Infection
- Emotions
- Monitoring Symptoms
- SAFETY ALERT: Emergency Asthma Management
- BOX 45-3 MONITORING BREATHING CAPACITY WITH A PEAK FLOW METER
- Procedure
- Medications
- Rescue Medications
- Routine Medications
- FIG 45-4 Asthma action plan.
- BOX 45-4 CLASSIFICATION OF ASTHMA SEVERITY
- Intermittent
- Mild Persistent
- Moderate Persistent
- Severe Persistent
- Medication Delivery
- Bronchopulmonary Dysplasia
- Etiology
- Incidence
- PARENTS WANT TO KNOW: Tips on Using a Nebulizer
- The powered nebulizer delivers a bronchodilator to the child who is having an acute asthma episode. This boy has a viral respiratory infection, which is a common trigger of acute asthma episodes in the pediatric population.
- NURSING CARE PLAN: The Child Hospitalized with Asthma
- Focused Assessment
- Nursing Diagnoses
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- PATHOPHYSIOLOGY: Bronchopulmonary Dysplasia
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Oxygen Therapy
- Medications
- Nutrition
- Prognosis
- Nursing Considerations
- Cystic Fibrosis
- FIG 45-5 Example of a letter that can be used to notify the local public service company that a technology-dependent child is living in the service area.
- PATIENT-CENTERED TEACHING: Safe Use of Oxygen at Home
- Etiology
- Incidence
- FIG 45-6 Digital clubbing may be an indication of hypoxia, which often occurs in cystic fibrosis and other respiratory disorders.
- Manifestations
- Respiratory System
- Digestive System
- PATHOPHYSIOLOGY: Cystic Fibrosis
- Respiratory System
- Digestive System
- Integumentary System
- Reproductive System
- Exocrine Glands
- Reproductive System
- Diagnostic Evaluation
- Therapeutic Management
- Respiratory Problems
- Digestive Problems
- Nursing Care
- The Child with Cystic Fibrosis
- Assessment
- Respiratory Assessment
- Digestive Assessment
- Reproductive Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Facilitating Airway Clearance and Gas Exchange
- Preventing Infection
- Providing Optimal Nutrition for Growth
- Promoting Increased Exercise Tolerance
- Meeting the Child’s and Family’s Emotional Needs
- Home Care
- Evaluation
- Tuberculosis
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Tuberculosis
- BOX 45-5 RISK FACTORS FOR THE DEVELOPMENT OF TUBERCULOSIS
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management and Nursing Considerations
- Tuberculosis Infection
- BOX 45-6 DEFINITION OF A POSITIVE MANTOUX SKIN TEST
- Area of Induration ≥5 mm Considered Positive in:
- Area of Induration ≥10 mm Considered Positive in:
- Induration ≥15 mm Considered Positive in:
- Tuberculosis Disease
- Prevention and Screening
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 46 The Child with a Cardiovascular Alteration
- Learning Objectives
- CLINICAL REFERENCE
- Review of the Heart and Circulation
- Normal Cardiac Anatomy and Physiology
- Fetal Circulation
- A, Normal heart cycle, represented as an electrocardiographic configuration. B, Cardiac electrical conduction system.
- Normal pressures (in millimeters of mercury) and saturations (percents).
- Transitional and Neonatal Circulation
- DIFFERENCES IN THE HEART AND CIRCULATION OF NEONATES AND INFANTS
- COMMON DIAGNOSTIC TESTS FOR CARDIAC DISORDERS
- Congenital Heart Disease
- Classification of CHD
- TABLE 46-1 CLASSIFICATION OF CONGENITAL HEART DISEASE
- Shunting: Saturation Considerations
- Blood Flow Considerations
- Physiologic Consequences of CHD in Children
- Heart Failure
- Etiology
- Manifestations
- PATHOPHYSIOLOGY: Heart Failure
- Diagnostic Evaluation
- Therapeutic Management
- NURSING CARE PLAN: The Child with Heart Failure
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- EVIDENCE-BASED PRACTICE
- PATIENT-CENTERED TEACHING: Giving Your Child Digoxin Elixir
- NURSING QUALITY ALERT: Feeding the Infant or Child with Heart Failure
- Pulmonary Hypertension
- CRITICAL THINKING EXERCISE 46-1
- Cyanosis
- Hypercyanotic Episode
- Nursing Care
- The Child with Cyanosis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Assessment of the Child with a Cardiovascular Alteration
- TABLE 46-2 CARDIAC ASSESSMENT FOR THE CHILD WITH CHD∗
- NURSING QUALITY ALERT: Assessing Murmurs
- Cardiovascular Diagnosis
- Cardiac Catheterization
- Complications
- Nursing Care
- Congenital Cardiac Defects
- The Child Undergoing Cardiac Surgery
- Preoperative Preparation
- Postoperative Management
- TABLE 46-3 CONGENITAL CARDIAC DEFECTS
- FIG 46-1 A, A preoperative visit to the intensive care unit and other units should be directed at an age-appropriate level for the child and the family before the child undergoes cardiac surgery. The experience prepares the family for the sights and sounds of the unit. B, Going home.
- Monitoring Cardiac Output
- Supporting Respiratory Function
- Maintaining Fluid and Electrolyte Balance
- Promoting Comfort
- Promoting Healing and Recovery
- Acquired Heart Disease
- Infective Endocarditis
- Etiology
- PATIENT-CENTERED TEACHING: Care after Heart Surgery
- Activity
- Diet
- Incision
- School
- When to Call the Physician
- Checkup
- Incidence
- PATHOPHYSIOLOGY: Infective Endocarditis
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with IE
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Cardiac Dysrhythmias ExemplarDysrhythmias
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Dysrhythmias
- Tachydysrhythmias
- Supraventricular tachycardia.
- Bradydysrhythmias
- Heart block—two or three P waves for every QRS. Cardiac output is based on the rate of the QRS complexes—ventricular contraction.
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Fast Pulse Rate
- Supraventricular Tachycardia
- Ventricular Tachycardia
- Slow Pulse Rate
- Bradydysrhythmias
- Absent Rhythms
- Nursing Care
- The Child with a Dysrhythmia
- Assessment
- SAFETY ALERT: Dysrhythmias
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Rheumatic Fever
- Etiology
- PATHOPHYSIOLOGY: Rheumatic Fever
- Incidence
- Manifestations
- FIG 46-2 Clinical manifestations of rheumatic fever.
- Diagnostic Evaluation
- BOX 46-1 DIAGNOSIS OF ACUTE RHEUMATIC FEVER BY THE JONES CRITERIA—1992 UPDATE
- Major Manifestations
- Minor Manifestations
- Therapeutic Management
- Nursing Care
- The Child with RF
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- NURSING QUALITY ALERT: Streptococcal Prophylaxis for the Child with Rheumatic Fever
- Evaluation
- Kawasaki Disease
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Kawasaki Disease
- Manifestations
- Diagnostic Evaluation
- FIG 46-3 Erythematous rash of Kawasaki disease.
- Therapeutic Management
- Nursing Care
- The Child with Kawasaki Disease
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Hypertension ExemplarHypertension
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Hypertension
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Primary Hypertension
- Weight Reduction
- Physical Conditioning
- Dietary Modification
- Relaxation Techniques
- Pharmacologic Treatment
- Secondary Hypertension
- SAFETY ALERT: Infusing Intravenous Antihypertensive Medications
- Nursing Care
- The Child with Hypertension
- Assessment
- Blood Pressure Screening
- Physical Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Cardiomyopathies
- High Cholesterol Levels in Children and Adolescents
- Assessment of Children at Risk
- Therapeutic Management
- Nursing Considerations
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 47 The Child with a Hematologic Alteration
- Learning Objectives
- CLINICAL REFERENCE
- Review of the Hematologic System
- TYPES AND FUNCTIONS OF WHITE BLOOD CELLS
- PEDIATRIC HEMATOLOGIC SYSTEM
- Iron Deficiency Anemia
- Etiology and Incidence
- Manifestations
- Diagnostic Evaluation
- PATHOPHYSIOLOGY: Iron Deficiency Anemia
- PARENTS WANT TO KNOW: Home Care of the Child with Iron Deficiency Anemia
- Dietary Changes
- Administration of Iron
- Follow-up Care
- Therapeutic Management
- NURSING CARE PLAN: The Child with Iron Deficiency Anemia in the Community Setting
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- NURSING QUALITY ALERT: Obtaining a Dietary Intake History
- Sickle Cell Disease
- CRITICAL THINKING EXERCISE 47-1
- PATHOPHYSIOLOGY: Sickle Cell Disease
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- TABLE 47-1 CLINICAL MANIFESTATIONS AND THERAPEUTIC MANAGEMENT OF SICKLE CELL DISEASE COMPLICATIONS
- PATIENT-CENTERED TEACHING: Home Care of the Child with Sickle Cell Disease
- NURSING CARE PLAN: The Child with Sickle Cell Disease
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- EVIDENCE-BASED PRACTICE
- Thalassemia
- Etiology and Incidence
- Manifestations
- BOX 47-1 CHARACTERISTIC FEATURES OF A CHILD WITH BETA-THALASSEMIA
- PATHOPHYSIOLOGY: Beta-Thalassemia
- Diagnostic Evaluation
- Therapeutic Management
- PATIENT-CENTERED TEACHING: Home Chelation Therapy
- Subcutaneous Route by Infusion Pump
- Intravenous Route: Totally Implantable or Tunneled Access Device
- Nursing Care
- The Child with Beta-Thalassemia
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- Evaluation
- Hemophilia ExemplarHemophilia
- Etiology and Incidence
- Manifestations
- PATHOPHYSIOLOGY: Hemophilia
- FIG 47-1 Hemarthrosis and joint destruction are characteristic of hemophilia.
- NURSING CARE PLAN: The Child with Hemophilia
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Diagnostic Evaluation
- Therapeutic Management
- SAFETY ALERT: Acetylsalicylic Acid: Contraindication
- NURSING QUALITY ALERT: Interviewing a Child with Hemophilia
- Von Willebrand Disease
- Etiology
- Pathophysiology
- PATIENT-CENTERED TEACHING: Home Care of the Child with Hemophilia
- Control of deficient blood clotting in hemophilia requires injection of the missing clotting factors. This young man is injecting his factor into an implanted central venous access port. Sterile technique is essential.
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Von Willebrand Disease
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Immune Thrombocytopenic Purpura
- Etiology and Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- FIG 47-2 Multiple petechiae are characteristic of immune thrombocytopenic purpura. This disorder results in the destruction of circulating platelets and decreased bone marrow production of new platelets.
- Therapeutic Management
- Nursing Care
- The Child with Immune Thrombocytopenic Purpura
- Assessment
- PATIENT-CENTERED TEACHING: Home Care of the Child with Immune Thrombocytopenic Purpura∗
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Interventions
- SAFETY ALERT: Actions to Avoid in Children with Low Platelet Counts
- Evaluation
- Disseminated intravascular coagulation ExemplarDisseminated Intravascular Coagulation
- Etiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- PATHOPHYSIOLOGY: Disseminated Intravascular Coagulation
- BOX 47-2 CONFIRMATORY LABORATORY FINDINGS IN DISSEMINATED INTRAVASCULAR COAGULATION
- Aplastic Anemia
- Etiology and Incidence
- Manifestations
- Diagnostic Evaluation
- PATHOPHYSIOLOGY: Aplastic Anemia
- Therapeutic Management
- Nursing Care
- The Child with Aplastic Anemia
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 48 The Child with Cancer
- Learning Objectives
- Clinical Reference
- Review of Cancer
- CARDINAL SIGNS AND SYMPTOMS OF CANCER IN CHILDREN
- Overt Signs
- Signs and Symptoms That May Be Covert
- DIAGNOSTIC TESTS AND PROCEDURES FOR CANCER
- The Child With Cancer
- Incidence
- Childhood Cancer and Its Treatment
- FIG 48-1 Incidence of Cancers in Children. Rate per million children younger than age 20 years, 2003-2007.
- Therapeutic Management
- Chemotherapy
- BOX 48-1 COMMON SIDE EFFECTS OF CHEMOTHERAPY AND RADIATION THERAPY
- Chemotherapy Side Effects
- Suppression of the bone marrow because of chemotherapy or radiation therapy reduces the blood counts. Low platelet levels lead to spontaneous bruising, as shown. Nosebleeds and bleeding of the gums are other consequences. The nurse must make a special effort to observe for bruising in dark-skinned children because it will be more difficult to see.
- Radiation Side Effects
- Acute (During and Shortly after Irradiation)
- Mucositis (inflammation of the mucous membranes) and mouth ulcers are common side effects of chemotherapeutic drugs. Any mucous membrane can be affected.
- Subacute (1 to 6 Months after Irradiation)
- Late Effects (More Than 6 Months after Irradiation)
- Hair loss is a distressing side effect of cancer treatment. School-age children and adolescents are most likely to feel this distress. Activities such as crafts or playgroups help children feel more normal and provide interaction with others in an accepting environment.
- Surgery
- BOX 48-2 NURSING RESPONSIBILITIES AND PRECAUTIONS FOR CHEMOTHERAPY
- Radiation Therapy
- EVIDENCE-BASED PRACTICE
- Hematopoietic Stem Cell Transplantation
- Steroid Therapy
- Biologic Agents
- Complementary and Alternative Medical (CAM) Therapies
- CRITICAL THINKING EXERCISE 48-1
- Leukemia ExemplarLeukemia
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- FIG 48-2 Varicella (chickenpox) can be deadly in the immunocompromised child. Thrombocytopenia (low platelet count) associated with chemotherapy can cause the varicella lesions to be hemorrhagic, like those shown here. Secondary infections of the lesions are also common because of low white blood cell (WBC) counts.
- PARENTS WANT TO KNOW: Caring for the Child with Cancer
- PATHOPHYSIOLOGY: Leukemia
- NURSING CARE PLAN: The Child with Leukemia
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Malignant brain tumor ExemplarBrain Tumors
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- FIG 48-3 Lobes of the brain.
- PATHOPHYSIOLOGY: Brain Tumors
- NURSING QUALITY ALERT: Signs of Brain Tumor in Children
- Nursing Care
- The Child with a Brain Tumor
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- BOX 48-3 POTENTIAL FUNCTIONAL DEFICITS RELATED TO A BRAIN TUMOR
- Evaluation
- Malignant Lymphomas
- Non-Hodgkin Lymphoma
- Etiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- NURSING QUALITY ALERT: Tumor Lysis Syndrome
- Nursing Care
- The Child with Non-Hodgkin Lymphoma
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Hodgkin lymphoma ExemplarHodgkin Disease
- Etiology
- SAFETY ALERT: Prevention of Urinary Tract Infection in the Immunocompromised Child
- Manifestations
- Diagnostic Evaluation
- PATHOPHYSIOLOGY: Hodgkin Disease
- Therapeutic Management
- Nursing Considerations
- Neuroblastoma
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Neuroblastoma
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Osteosarcoma
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Osteosarcoma
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Ewing Sarcoma
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Rhabdomyosarcoma
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Wilms Tumor
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- NURSING QUALITY ALERT: Assessing the Child with a Wilms Tumor
- Nursing Care
- The Child with Wilms Tumor
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Retinoblastoma
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Retinoblastoma
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Rare Tumors of Childhood
- KEY CONCEPTS
- References and Readings
- Chapter 49 The Child with an Alteration in Tissue Integrity
- Learning Objectives
- Clinical Reference
- Review of the Integumentary System
- PEDIATRIC DIFFERENCES IN THE SKIN
- Variations in the Skin of Newborn Infants
- Common Birthmarks
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- PARENTS WANT TO KNOW: Care of Newborn and Infant Skin
- Skin Inflammation
- Seborrheic Dermatitis
- FIG 49-1 “Cradle cap,” the most frequent form of seborrheic dermatitis in infants. The condition often begins in the first 2 to 3 weeks of life and usually disappears by age 12 months.
- Contact Dermatitis
- Etiology
- FIG 49-2 Seborrheic diaper dermatitis.
- PATHOPHYSIOLOGY: Contact Dermatitis
- Incidence
- Manifestations
- FIG 49-3 Contact diaper dermatitis.
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Contact Dermatitis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Atopic Dermatitis
- Etiology
- Incidence
- Manifestations
- FIG 49-4 Atopic dermatitis, an allergic skin condition, usually begins in infancy and clears by age 2 to 3 years. However, it can continue into childhood. A, Lesions on cheeks often spread to the forehead, scalp, and extensor surfaces of arms and legs. B, Flexor surfaces of wrists, ankles, knees, and elbows may be affected in the childhood form of the disease.
- PATHOPHYSIOLOGY: Atopic Dermatitis
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Atopic Dermatitis
- Assessment
- Nursing Diagnosis and Planning
- DRUG GUIDE: Topical Corticosteroids
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Skin Infections
- Impetigo
- Etiology
- PATHOPHYSIOLOGY: Impetigo
- Incidence
- Manifestations
- FIG 49-5 Impetigo lesions are usually located around the mouth and nose but may be located on the extremities.
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Impetigo
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Interventions
- Evaluation
- SAFETY ALERT: Caring for a Child with Impetigo
- Cellulitis ExemplarCellulitis
- Etiology and Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Cellulitis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Candidiasis
- FIG 49-6 White, curdlike plaques of thrush (oral candidiasis, oral moniliasis), a common fungal infection in infants.
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- FIG 49-7 Diaper candidiasis.
- Nursing Care
- The Child with Candidiasis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Interventions
- FIG 49-8 Tinea (ringworm) is an infection caused by dermatophytes, a group of fungi. Tinea is classified according to the part of the body affected. Five common types of tinea are shown here. Tinea capitis (scalp); Tinea corporis (trunk, face, extremities); Tinea cruris (groin, buttocks, scrotum); Tinea pedis (feet); Tinea unguium (nails, nail beds).
- Evaluation
- Tinea Infection
- Etiology
- PATHOPHYSIOLOGY: Tinea Infection
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Tinea Capitis
- Tinea Corporis
- Tinea Cruris
- Tinea Pedis
- Nursing Care
- The Child with a Tinea Infection
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Herpes Simplex Virus Infection
- PATIENT-CENTERED TEACHING: Home Care for a Child or Adolescent with a Tinea Infection
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Herpes Simplex Type 1 Infection
- Manifestations
- Herpes Labialis (“Cold Sore,” “Fever Blister”)
- FIG 49-9 Herpes simplex infection in an infant.
- Herpetic Gingivostomatitis
- Herpetic Ocular Infection
- Herpetic Whitlow
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with a Herpes Simplex Infection
- Assessment
- Nursing Diagnoses and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Skin Infestations
- Lice Infestation
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Pediculosis
- Manifestations
- Pediculosis Capitis (Head Lice)
- FIG 49-10 Head lice (pediculosis capitis). Note the nits attached to the hair shafts.
- Pediculosis Corporis (Body Lice)
- Pediculosis Pubis (Pubic Lice, Crab Lice)
- Diagnostic Evaluation
- Therapeutic Management
- Killing Active Lice and Nits
- Addressing the Environment
- Nursing Care
- The Child with Pediculosis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Interventions
- Evaluation
- CRITICAL THINKING EXERCISE 49-1
- EVIDENCE-BASED PRACTICE
- Mite Infestation (Scabies)
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- FIG 49-11 Scabies lesions on an infant.
- Therapeutic Management
- Nursing Considerations
- Acne Vulgaris
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Acne Vulgaris
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- FIG 49-12 An adolescent with acne vulgaris.
- Nursing Care
- The Adolescent with Acne Vulgaris
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Miscellaneous Skin Disorders
- TABLE 49-1 SKIN DISORDERS
- Insect Bites or Stings
- Burns ExemplarBurn Injuries
- TABLE 49-2 SKIN LESIONS CAUSED BY INSECTS AND ARACHNIDS
- Etiology
- TABLE 49-3 AGE-RELATED RISKS FOR BURN INJURY
- BOX 49-1 PEDIATRIC DIFFERENCES IN THE EFFECTS OF BURN INJURY
- Incidence
- FIG 49-13 These burns were sustained when the child’s pajamas caught fire while he was playing with matches.
- FIG 49-14 These burns were sustained when the child sucked on an electrical socket.
- Pathophysiology
- PATIENT-CENTERED TEACHING: Measures to Prevent and Initially Manage a Burn
- Prevention
- Initial Emergency Burn Management
- BOX 49-2 BURN CENTER REFERRAL CRITERIA
- Depth of Burn Injury
- Extent of Burn Injury
- Severity of Burn Injury
- FIG 49-15 Calculating total body surface area (TBSA) burned in children. The standard “rule of nines” and standard body surface charts must be adapted because of the difference in body proportions between adults and children.
- TABLE 49-4 DEPTH OF BURN INJURY
- Manifestations
- Therapeutic Management
- Superficial Burn Injuries
- TABLE 49-5 CLASSIFICATION OF SEVERITY OF BURN INJURY IN CHILDREN
- Superficial Partial-Thickness Burn Injuries
- Wound Cleaning
- Débridement
- Application of Antimicrobial Agents and Dressings
- FIG 49-16 Burn dressings can be changed in the hydrotherapy room. The room is kept warm because children who have been burned have poor body temperature control. The child life therapist reads a book to the child to distract her from the discomfort associated with the procedure.
- TABLE 49-6 TOPICAL ANTIMICROBIAL AGENTS COMMONLY USED FOR BURNS
- PATIENT-CENTERED TEACHING: Home Care for a Child with Burns
- Parents will need to know the following to adequately care for the child:
- Teach the parents the following:
- NURSING CARE PLAN: The Child with a Minor Partial-Thickness Burn
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Conditions Associated with Major Burn Injuries
- Conditions Associated with Electrical Injury
- Cardiac Arrest or Dysrhythmia
- Tissue Damage
- Myoglobinuria
- Metabolic Acidosis
- TABLE 49-7 BODY SYSTEM ALTERATIONS AFTER MODERATE TO SEVERE BURNS
- Other Complications
- Key Concepts
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 50 The Child with a Musculoskeletal Alteration
- Learning Objectives
- Clinical Reference
- Review of the Musculoskeletal System
- Skeletal System
- Child with hand differences.
- Articular System
- Muscular System
- Cartilage
- PEDIATRIC DIFFERENCES IN THE MUSCULOSKELETAL SYSTEM
- Growth and Development
- Diagnostic and Laboratory Tests
- COMMON DIAGNOSTIC PROCEDURES FOR MUSCULOSKELETAL DISORDERS IN CHILDREN
- Casts, Traction, and Other Immobilizing Devices
- Splints
- Casts
- Traction
- FIG 50-1 Child in a synthetic cast.
- BOX 50-1 TYPES OF SKIN TRACTION
- Buck
- Bryant
- Skin Traction
- BOX 50-2 TYPES OF SKELETAL TRACTION
- Halo
- 90/90 Femoral
- Skeletal Traction
- External Fixation Devices
- FIG 50-2 Skeletal traction is used to reduce and immobilize fractures and allows greater pull than would be possible with skin traction. Osteomyelitis may be a serious complication because skeletal traction is invasive.
- SAFETY ALERT: The Child in a Cast or Traction
- Nursing Considerations
- Neurovascular Status
- FIG 50-3 Ilizarov external fixator.
- Special Considerations for the Child in Halo Traction
- TABLE 50-1 NEUROLOGIC ASSESSMENT FOR PATIENTS REQUIRING HALO TRACTION
- Assessing and Managing Compartment Syndrome
- Immobility
- Special Considerations for the Child in Traction
- Home Care
- TABLE 50-2 CONSEQUENCES OF IMMOBILITY
- Fracture ExemplarFractures
- Etiology
- FIG 50-4 Upper extremity fractures in children often occur when the child attempts to break a fall with an outstretched arm.
- PARENTS WANT TO KNOW: Home Care for the Child in a Cast
- Check the Edges of the Cast as Follows:
- To Assist with Drying the Cast, Do the Following:
- Swelling Generally Peaks within 24 to 48 Hours. To Prevent Problems, Do the Following:
- Protect the Cast as Follows:
- Contact the Physician If Any of the Following Occurs:
- When Preparing to Remove the Cast, Do the Following:
- Incidence
- Manifestations
- Therapeutic Management
- Reduction Methods
- Retention
- PATHOPHYSIOLOGY: Fractures and Physeal Growth Plate Injuries
- Nursing Considerations
- Initial Trauma Assessment
- Assessing and Managing Complications
- TABLE 50-3 SPORT-SPECIFIC INJURY RISK
- Soft Tissue Injuries: Sprains, Strains, and Contusions
- Etiology
- Incidence
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- NURSING QUALITY ALERT: The Child with a Soft Tissue Injury
- Osteomyelitis
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Osteomyelitis
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Osteomyelitis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Interventions
- Administering IV Antibiotics
- Providing Wound Care
- Maintaining Nutritional Status
- Teaching Home Management
- Promoting Optimal Development
- Evaluation
- Scoliosis
- TABLE 50-4 CLASSIFICATIONS OF SCOLIOSIS
- Adolescent Idiopathic Scoliosis
- Prevalence and Etiology
- Manifestations
- Diagnostic Evaluation
- School Screening
- FIG 50-5 Most spinal abnormalities in children are abnormal curvatures. In scoliosis, the spine curves laterally and the vertebrae rotate, pulling the ribs along. Kyphosis is a front-to-back rounding, usually of the thoracic spine; it is often accompanied by scoliosis. Lordosis is an exaggerated concave curvature of the spine, usually in the lumbar area.
- Physical Examination
- Radiographs
- FIG 50-6 Plain radiographs of scoliosis before (A, B) and after spinal fusion (C, D).
- Treatment
- Nonsurgical Interventions
- Surgical Intervention
- FIG 50-7 Adolescent with scoliosis brace.
- Surgical Complications
- Postoperative Management
- Follow-Up Care
- Kyphosis
- Scheuermann’s Kyphosis
- NURSING CARE PLAN: The Adolescent Undergoing a Spinal Fusion
- Focused Assessment
- Preoperative Assessment
- Postoperative Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Other Causes of Hyperkyphosis
- Limb Differences
- Etiology and Incidence
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Developmental Dysplasia of the Hip
- Etiology and Incidence
- TABLE 50-5 LIMB DIFFERENCES
- Manifestations
- FIG 50-8 Genu varum (bowlegs). In the child with genu varum, or bowlegs, a persistent space is present between the knees when the ankles are together. Genu varum is a normal finding for 1 year after the child begins walking.
- FIG 50-9 Genu valgum (knock knees). In the child with genu valgum, or knock knees, a space is present between the ankles when the knees are together. To remember the terminology, liken the r’s and g’s: genu var um—knees apar t; genu valg um—knees tog ether.
- Diagnostic Evaluation
- Therapeutic Management
- PATHOPHYSIOLOGY: Developmental Dysplasia of the Hip
- Nursing Care
- The Child with Developmental Dysplasia of the Hip
- Assessment
- FIG 50-10 An infant in a Pavlik harness to treat developmental dysplasia of the hip.
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcomes
- Interventions
- Teaching about the Pavlik Harness
- Teaching about Spica Cast Care
- FIG 50-11 Regular assessment of circulation, sensation, and movement in the lower extremities is essential when a child has a hip spica cast.
- Alleviating Anxiety
- Preventing Injury
- FIG 50-12 Use a car seat that can accommodate the wide leg spread caused by the spica cast or a car vest restraint for older children.
- Evaluation
- Legg-Calvé-Perthes Disease
- Etiology and Incidence
- PATHOPHYSIOLOGY: Legg-Calvé-Perthes Disease
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Legg-Calvé-Perthes Disease
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Interventions
- Facilitating Appropriate Activity
- Teaching Home Management
- Evaluation
- Slipped Capital Femoral Epiphysis
- Etiology and Incidence
- Pathophysiology
- Manifestations and Diagnostic Evaluation
- Therapeutic Management and Nursing Considerations
- CRITICAL THINKING EXERCISE 50-1
- Clubfoot
- Etiology and Incidence
- FIG 50-13 An infant with left clubfoot. Note the positional difference between the two feet.
- Manifestations and Diagnostic Evaluation
- Therapeutic Management
- Ponseti Casting Method
- Clubfoot Recurrence
- Nursing Considerations
- Education and Anticipatory Guidance
- Reduction of Discomfort and Pain
- Patient Advocacy
- Muscular Dystrophies
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- TABLE 50-6 MUSCULAR DYSTROPHIES OF CHILDHOOD
- Nursing Considerations
- TABLE 50-7 MAJOR TYPES OF JUVENILE IDIOPATHIC ARTHRITIS
- Rheumatoid arthritis ExemplarJuvenile Idiopathic Arthritis
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Juvenile Idiopathic Arthritis
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Drug Therapy
- DRUG GUIDE: Naproxen, Naproxen Sodium
- Physical and Occupational Therapy
- Surgical Treatment
- Nursing Care
- The Child with JIA
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- Managing Pain
- Promoting Mobility
- Managing Potential Infections
- Facilitating Emotional and Social Development
- Family Education
- Evaluation
- Syndromes and Conditions with Associated Orthopedic Anomalies
- TABLE 50-8 SYNDROMES AND CONDITIONS WITH ASSOCIATED ORTHOPEDIC ANOMALIES
- Key Concepts
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 51 The Child with an Endocrine or Metabolic Alteration
- Learning Objectives
- Clinical Reference
- Review of the Endocrine System
- PEDIATRIC DIFFERENCES IN THE ENDOCRINE SYSTEM
- Diagnostic Tests and Procedures
- COMMON LABORATORY AND DIAGNOSTIC TESTS OF ENDOCRINE FUNCTION
- Phenylketonuria
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- PATHOPHYSIOLOGY: Phenylketonuria
- Therapeutic Management
- Nursing Considerations
- Inborn Errors of Metabolism
- Congenital Adrenal Hyperplasia
- Etiology
- Manifestations
- TABLE 51-1 INBORN ERRORS OF METABOLISM
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- SAFETY ALERT: Congenital Adrenal Hyperplasia
- Congenital Hypothyroidism
- Etiology
- PATHOPHYSIOLOGY: Congenital Hypothyroidism
- Incidence
- Manifestations
- Diagnostic Evaluation
- FIG 51-1 A, This untreated 6-month-old infant with congenital hypothyroidism fed poorly and was constipated. She was lethargic and had no social smile or head control. Note her puffy face, large tongue, dull expression, and excessive hair growth (hirsutism) on the forehead. B, The same infant 4 months after treatment. Note the decreased facial puffiness, decreased forehead hirsutism, and an alert appearance.
- Therapeutic Management
- Nursing Care
- The Infant with Congenital Hypothyroidism
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- Interventions
- NURSING QUALITY ALERT: The Child with Congenital Hypothyroidism
- Evaluation
- Acquired Hypothyroidism
- Etiology
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- BOX 51-1 INDICATORS OF HYPOTHYROIDISM OR HYPERTHYROIDISM
- Therapeutic Management
- Nursing Care
- The Child with Acquired Hypothyroidism
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Hyperthyroidism (Graves Disease)
- Incidence
- Pathophysiology
- Manifestations
- NURSING QUALITY ALERT: Autoimmune Thyroid Disorders
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Hyperthyroidism
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Diabetes Insipidus
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- BOX 51-2 INDICATORS OF DIABETES INSIPIDUS OR SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH)
- Therapeutic Management
- NURSING QUALITY ALERT: Diabetes Insipidus
- Nursing Considerations
- PATHOPHYSIOLOGY: Diabetes Insipidus
- Syndrome of Inappropriate Antidiuretic Hormone
- Etiology
- Manifestations
- PATHOPHYSIOLOGY: Syndrome of Inappropriate Antidiuretic Hormone
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- NURSING QUALITY ALERT: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- BOX 51-3 SIGNS OF HYPONATREMIA
- Precocious Puberty
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Precocious Puberty
- Assessment
- PATHOPHYSIOLOGY: Precocious Puberty
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcomes
- Expected Outcome
- NURSING QUALITY ALERT: Precocious Puberty
- Interventions
- Evaluation
- Growth Hormone Deficiency
- Etiology
- Incidence
- Manifestations
- PATHOPHYSIOLOGY: Growth Hormone Deficiency
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Growth Hormone Deficiency
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- NURSING QUALITY ALERT: Criteria for Suspecting Growth Hormone Deficiency
- Interventions
- Evaluation
- CRITICAL THINKING EXERCISE 51-1
- Diabetes, Type 1 ExemplarDiabetes Mellitus
- Type 1 Diabetes Mellitus
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- TABLE 51-2 ACTIONS OF INSULIN
- TABLE 51-3 COMPARISON OF HYPOGLYCEMIA, HYPERGLYCEMIA, AND KETOACIDOSIS
- Therapeutic Management
- Insulin Therapy
- PATHOPHYSIOLOGY: Type 1 Diabetes Mellitus
- TABLE 51-4 INSULIN ACTION BY TYPE
- Schedule
- FIG 51-2 Peak action of insulin injections is timed to correspond with the child’s usual meal and snack times to minimize the chance of hypoglycemia. L/A, Lispro/Aspart (rapid-acting insulin).
- Administration
- FIG 51-3 Subcutaneous insulin injection sites most commonly used. Rate of absorption varies by site.
- Nutrition Therapy
- Physical Activity
- NURSING QUALITY ALERT: Managing the Child with Type 1 Diabetes Mellitus
- Insulin
- Nutrition
- Exercise
- Blood Glucose Monitoring
- Blood Glucose Monitoring
- Developmental Issues
- Infant and Toddler
- Preschooler
- School-Age Child
- Adolescent
- TABLE 51-5 EXAMPLES OF DIABETES MANAGEMENT TASKS DELEGATED TO CHILD (WITH SUPERVISION)
- NURSING CARE PLAN: The Child with Type 1 Diabetes Mellitus in the Community Setting
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Delegating Diabetes Management Responsibilities
- Diabetic ketoacidosis ExemplarDiabetic Ketoacidosis
- Etiology
- Manifestations
- PATIENT-CENTERED TEACHING: Home Management of Type 1 Diabetes Mellitus
- Outcomes
- General Information
- Medication Therapy
- The school-age child is usually able to perform daily self-monitoring of blood glucose with parental help. However, the child should not be expected to adjust the insulin dose based on the reading. By early adolescence, the child can be in charge of recording blood glucose values in the diary.
- Home Glucose Monitoring
- Hypoglycemia
- When other parts of the treatment regimen have become familiar, the injection technique can be taught. Initially, self-injecting insulin may be frightening for the school-age child, so the parent may insert the needle and have the child then push the plunger. The child can then progress to performing self-injection.
- Hyperglycemia
- Nutrition/Exercise
- Complications
- Psychological Adjustment and Family Involvement
- Community Resources
- BOX 51-4 SICK-DAY MANAGEMENT FOR THE CHILD WITH TYPE 1 DIABETES MELLITUS
- Diagnostic Evaluation
- Therapeutic Management
- Long-Term Health Care Needs for the Child with Type 1 Diabetes Mellitus
- NURSING CARE PLAN: The Child in Diabetic Ketoacidosis (DKA)
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Diabetes, Type 2 ExemplarType 2 Diabetes Mellitus
- Etiology
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Medication Therapy
- Nutrition Therapy
- Physical Activity
- Blood Glucose Monitoring
- Prevention
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 52 The Child with a Neurologic Alteration
- Learning Objectives
- Clinical Reference
- Review of the Central Nervous System
- Embryologic Development
- The Myelin Sheath
- PEDIATRIC DIFFERENCES IN THE CENTRAL NERVOUS SYSTEM
- The Neural System
- The Axial Skeleton
- The Meninges
- The Brain
- The Cranial Nerves
- The Spinal Cord
- CSF ANALYSIS IN CHILDREN: NORMAL FINDINGS
- CEREBROSPINAL FLUID ANALYSIS: FINDINGS IN PATHOLOGIC CONDITIONS
- Cerebrospinal Fluid
- Cerebral Blood Flow and Intracranial Regulation
- COMMON DIAGNOSTIC TESTS AND PROCEDURES FOR NEUROLOGIC DISORDERS
- LUMBAR PUNCTURE: EDUCATING THE FAMILY
- For the lumbar puncture: Place one hand farther down, under the child’s neck. Your forearm moves behind the child’s head to support the neck. Place the other arm farther under the child’s upper thighs and curl the child’s body by bringing the knees up to the head. Note that this nurse’s weight is supported on the edge of the examination table, and the nurse leans slightly over the child, controlling the arms and legs. Because direct visibility of the child’s respiratory status is limited in this position, a cardiorespiratory monitor must be used for the child.
- NURSING CARE PLAN: The Child with a Neurologic System Disorder
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Increased Intracranial Pressure
- Etiology
- Manifestations
- BOX 52-1 DEVELOPMENTAL MANIFESTATIONS OF INCREASED INTRACRANIAL PRESSURE
- TABLE 52-1 GLASGOW COMA SCALE MODIFIED FOR CHILDREN
- Level of Consciousness
- Behavior
- NURSING QUALITY ALERT: Delirium ExemplarStandard Terms for Level of Consciousness
- Pupil Evaluation
- Motor Function
- Vital Signs
- FIG 52-1 Flexion and extension posturing.
- PATHOPHYSIOLOGY: Increased Intracranial Pressure
- Diagnostic Evaluation and Therapeutic Management
- EVIDENCE-BASED PRACTICE
- BOX 52-2 INSTRUMENTS FOR MONITORING INCREASED INTRACRANIAL PRESSURE
- Spina Bifida
- Etiology and Incidence
- Manifestations
- FIG 52-2 Three forms of spina bifida.
- PATHOPHYSIOLOGY: Spina Bifida
- FIG 52-3 This infant has a repaired myelomeningocele. Note the left clubfoot. This deformity often accompanies the defect because normal intrauterine movement does not occur in the fetus with spina bifida, interfering with the development of the extremities. The legs are flaccid, and normal neonatal flexion is absent. The infant also dribbles stool and urine constantly. Hydrocephalus commonly accompanies these neural tube defects.
- Diagnostic Evaluation
- Therapeutic Management
- Hydrocephalus
- Etiology
- Incidence
- Manifestations and Diagnostic Evaluation
- TABLE 52-2 EARLY AND LATE MANIFESTATIONS OF HYDROCEPHALUS
- PATHOPHYSIOLOGY: Hydrocephalus
- Therapeutic Management
- Cerebral palsy ExemplarCerebral Palsy
- Etiology and Incidence
- FIG 52-4 A ventriculoperitoneal shunt may be implanted in the child with hydrocephalus to prevent excess accumulation of cerebrospinal fluid (CSF) in the ventricles. The tubing diverts the CSF from the ventricles into the peritoneal cavity, where it is reabsorbed. Nursing care includes monitoring for infection, obstruction, and pain, administering antibiotics and pain medications as ordered, and teaching the family how to change dressings and how to recognize shunt blockages or other problems.
- BOX 52-3 FACTORS ASSOCIATED WITH CEREBRAL PALSY
- Prenatal
- Perinatal
- Postnatal
- Manifestations
- Diagnostic Evaluation and Therapeutic Management
- PATHOPHYSIOLOGY: Cerebral Palsy
- NURSING CARE PLAN: The Child with Cerebral Palsy in the Community Setting
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Head Injury
- Types of Head Injuries
- FIG 52-5 Epidural and subdural hematomas are the two most common cranial hematomas, occurring in 6% to 7% of all children with head injuries. With epidural hematoma, a rapid decline in neurologic function may occur 4 to 8 hours after a brief period of lucidity. If untreated, the increased intracranial pressure (ICP) can cause death in a short time. A subdural hematoma is often caused when the head strikes an immovable object. A subdural hematoma (along with retinal hemorrhage) in an infant or child may occur as a result of child abuse involving aggressive shaking, blunt impact, or both (abusive head trauma).
- Skull Fractures
- Contusion
- Concussion
- Intracranial Hemorrhage
- Incidence
- BOX 52-4 CLASSIFICATION OF SEVERITY OF HEAD INJURIES BASED ON GLASGOW COMA SCALE (GCS)∗
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- PATHOPHYSIOLOGY: Head Injury
- PARENTS WANT TO KNOW: Guidelines for the Child with a Head Injury∗
- Postconcussion Syndrome
- Second Impact Syndrome
- Nursing Considerations
- Spinal cord injury ExemplarSpinal Cord Injury
- Etiology
- PATHOPHYSIOLOGY: Spinal Cord Injury
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- FIG 52-6 Children who have injuries or birth defects that involve the upper spine may be placed in halo traction to stabilize the spine and prevent added nerve damage. Spinal cord injury is a catastrophic event for the child and family; intense nursing support and education as well as referral to support groups, will be needed.
- Nursing Care
- The Child with a Spinal Cord Injury
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Seizure ExemplarSeizure Disorders
- Etiology
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- BOX 52-5 INTERNATIONAL CLASSIFICATION OF SEIZURES
- Generalized Seizures
- Tonic, Clonic, and Tonic-Clonic Seizures
- Atonic Seizures
- Myoclonic Seizures
- Absence Seizures
- Focal Seizures
- Unknown
- TABLE 52-3 COMMON SEIZURE MEDICATIONS
- NURSING CARE PLAN: The Child with a Seizure Disorder in the Community Setting
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- PATIENT-CENTERED TEACHING: Guidelines for the Child or Adolescent Taking Seizure Medication
- Status Epilepticus
- Etiology
- Incidence
- Pathophysiology
- NURSING QUALITY ALERT: Observations and Nursing Care during a Seizure
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Status Epilepticus
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions and Evaluation
- SAFETY ALERT: Drug Therapy for Generalized Tonic-Clonic Status Epilepticus
- Bacterial meningitis ExemplarViral meningitis ExemplarMeningitis
- Etiology
- FIG 52-7 As part of the assessment for meningitis, the nurse can attempt to elicit Kernig sign and Brudzinski sign. Both are early indicators of meningitis in children and adolescents. Kernig sign The child can easily extend the leg when in the supine position. However, when the thigh is flexed toward the abdomen, pain prevents complete extension of the leg. Brudzinski sign In the supine position, the child bends her head toward her chest (in the younger child, the nurse can bend the child’s head). This action usually produces involuntary hip and knee flexion in the child with meninigitis.
- Incidence
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- PATHOPHYSIOLOGY: Meningitis
- Nursing Care
- The Child with Meningitis
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Interventions
- NURSING QUALITY ALERT: Guidelines for the Child with Meningitis
- CRITICAL THINKING EXERCISE 52-1
- Evaluation
- Guillain-Barré Syndrome
- Incidence
- Pathophysiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with Guillain-Barré Syndrome
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- Neurologic Conditions Requiring Critical Care
- Headaches
- Etiology
- Incidence
- Manifestations
- Migraine
- Tension-Type Headaches
- Diagnostic Evaluation
- TABLE 52-4 NEUROLOGIC CONDITIONS REQUIRING CRITICAL CARE
- Nursing Care
- The Child with Headaches
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcome
- Interventions
- Evaluation
- KEY CONCEPTS
- References and Readings
- Pageburst Integrated Resource
- Animation
- Chapter 53 Psychosocial Problems in Children and Families
- Learning Objectives
- Clinical Reference
- Overview of Psychosocial Disorders of Childhood
- PSYCHOSOCIAL DISORDERS TYPICALLY MANIFESTED IN CHILDHOOD
- Precipitating Factors
- Diagnostic Evaluation
- MENTAL STATUS EXAMINATION OF CHILDREN
- EVIDENCE-BASED PRACTICE
- Emotional Disorders
- Anxiety Disorders
- Social Anxiety Disorder
- Separation Anxiety
- Panic attack ExemplarPanic Disorder
- Posttraumatic distress disorder ExemplarPosttraumatic Stress Disorder
- Obsessive compulsive disorder ExemplarObsessive-Compulsive Disorder
- Mood Disorders
- Depressive disorders ExemplarDepression ExemplarMajor Depressive Disorder and Dysthymic Disorder
- Adjustment Disorder
- Bipoar ExemplarBipolar disorder ExemplarBipolar Disorder
- Etiology and Physiology of Emotional Disorders
- Biologic Factors
- Environmental Factors
- Traumatic brain injury ExemplarTraumatic Brain Injury
- Manifestations
- Therapeutic Management of Children with Emotional Disorders
- Nursing Care
- The Child with an Emotional Disorder
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Self-harm ExemplarSuicide ExemplarSuicide
- NURSING QUALITY ALERT: Resources for People with Thoughts of Suicide
- Manifestations and Risk Factors
- Therapeutic Management
- Prevention
- When Prevention and Intervention Fail
- Nursing Care
- The Child or Adolescent at Risk for Suicide
- Assessment
- BOX 53-1 QUESTIONS TO ASSESS SUICIDE POTENTIAL
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Behavioral Disorders
- Etiology
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with ADHD
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcomes
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Anorexia nervosa ExemplarBulimia ExemplarEating Disorders: Anorexia Nervosa and Bulimia Nervosa
- Etiology
- Manifestations
- Anorexia Nervosa
- FIG 53-1 In anorexia nervosa, the adolescent refuses to maintain adequate body weight, partly because of a distorted body image: She perceives herself as overweight when in fact she is below minimum weight.
- Bulimia Nervosa
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child or Adolescent with an Eating Disorder
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Substance Abuse
- TABLE 53-1 Opioid ExemplarAlcohol intoxication ExemplarTobacco products Exemplar COMMONLY ABUSED DRUGS AND THEIR EFFECTS
- Etiology
- BOX 53-2 PHASES OF SUBSTANCE ABUSE
- Phase 1: Experimentation
- Phase 2: Early Drug Use
- Phase 3: True Drug Addiction
- Phase 4: Severe Drug Addiction
- Manifestations
- NURSING QUALITY ALERT: Relapse Among Substance Abusers
- Therapeutic Management
- Nursing Care
- The Child or Adolescent with a Substance Abuse Problem
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Child abuse ExemplarChildhood Physical and Emotional Abuse and Child Neglect
- Etiology
- Incidence
- BOX 53-3 CHARACTERISTICS OF THE ABUSIVE FAMILY
- Manifestations
- Indicators of Physical Abuse
- Indicators of Neglect
- FIG 53-2 Physical signs of child abuse. The nurse should be alert for the typical behavioral indicators of abuse.
- Nonaccidental distribution of bruises: All four surfaces of the torso are involved, but there are no bruises on arms and legs.
- Pattern of injury: Linear scars of various ages indicate repeated abuse with a switch or a whip. The loop pattern on the boy’s anterior torso is consistent with a looped electrical cord used as a whip.
- Scald burn of shoulder and neck: The typical distribution of a scald burn in a toddler. This type of injury occurs when a toddler pulls a cup of coffee or pan of water off a stove.
- Nonaccidental immersion scald: Involvement of virtually the entire posterior surface of the legs indicates that the legs were held under scalding water; even an infant this young would flex the knees to avoid the hot water.
- Indicators of Emotional Abuse
- Indicators of Sexual Abuse
- Other Specific Abusive Situations
- Abusive Head Trauma
- Munchausen Syndrome by Proxy
- CRITICAL THINKING EXERCISE 53-1
- NURSING CARE PLAN: The Abused Child
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- FIG 53-3 Disclosure of abuse may be slow because the child often has difficulty trusting any adult. Physical examination and interview of children who may be victims of sexual abuse require particular sensitivity because physical inspection of the child’s genitalia to detect signs of injury or sexually transmitted disease may frighten the child, who associates handling of the genitalia with pain or shame. Anatomically correct dolls are often used in the assessment of abuse within a family. These dolls help children express what they cannot express in words; young children in particular have a limited vocabulary to use when describing the events that have occurred. Note the communication techniques designed to reassure the child and give the child some power. The little girl is not immediately positioned for a genital examination. The physician first sits to talk with the child at her eye level and makes eye contact with her. Drawings may help to identify the abused child and assist in therapy. Art can also help the child express what cannot be expressed in words.
- KEY CONCEPTS
- References and Readings
- Chapter 54 The Child with a Developmental Disability
- Learning Objectives
- CLINICAL REFERENCE
- Genetics and Genomics
- COMMON DIAGNOSTIC TESTS FOR INTELLECTUAL AND DEVELOPMENTAL DISORDERS
- Intellectual and Developmental Disorders
- Developmental Disability and the Americans with Disabilities Act: The Impact of Public Policy
- Terminology
- Mental Age, Functional Age, Adaptive Functioning
- Intellectual Impairment and Intellectual Disability
- Intellectual Impairment versus Mental Retardation
- Autism Spectrum Disorders versus Pervasive Developmental Disorders
- Etiology of Intellectual Disabilities and Pervasive Developmental Disorders
- BOX 54-1 CAUSES OF INTELLECTUAL DISABILITY
- Genetic
- Alterations Occurring during Pregnancy
- Neonatal Alterations
- Acquired Childhood Conditions or Diseases
- Environmental Problems
- EVIDENCE-BASED PRACTICE
- Incidence of Intellectual and Developmental Disorders
- BOX 54-2 PROBLEMS RELATED TO INTELLECTUAL DISABILITY
- Mild
- Severe
- Manifestations
- FIG 54-1 Children with intellectual impairments may have other dysfunctions as well. The family of a child with an intellectual impairment often feels continual grief because the child does not meet their expectations. This child has additional dysfunctions that require respiratory and nutritional support.
- Diagnostic Evaluation
- BOX 54-3 EXPECTED SKILLS ACCORDING TO INTELLIGENCE QUOTIENT (IQ) SCORES
- Normal Intelligence (IQ 85 to 115)
- Borderline Intellectual Disability (IQ 71 to 84)
- Mild Intellectual Disability (IQ 50-55 to ~70)
- Moderate Intellectual Disability (IQ 35-40 to 50-55)
- Severe Intellectual Disability (IQ 20-25 to 35-40)
- Profound Intellectual Disability (IQ <20 to 25)
- TABLE 54-1 SAFETY CONCERNS FOR DEVELOPMENTALLY DELAYED OR IMPAIRED CHILDREN
- Management
- General Strategies
- Safety Challenges
- SAFETY ALERT: The Child with a Developmental Disorder
- Disorders Resulting in Intellectual or Developmental Disability
- NURSING CARE PLAN: The Child with a Developmental Disorder or Disability in the Community Setting
- Focused Assessment: The Child
- Focused Assessment: The Family
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- FIG 54-2 Special Olympics International is the largest recreational program in the world for people with intellectual impairment. With more than 1 million athletes in 125 countries, Special Olympics offers opportunities for social interaction with peers and assists children who are intellectually disabled in reaching their maximum potential.
- Down syndrome ExemplarDown Syndrome
- FIG 54-3 Children with delayed motor or cognitive function, whether temporary or pervasive, benefit from early and vigorous therapy to help them reach their maximum development.
- BOX 54-4 MEDICAL CONDITIONS ASSOCIATED WITH DOWN SYNDROME
- Conditions Frequently Identified during the Neonatal Period
- Conditions Frequently Identified during Childhood
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Down Syndrome
- Manifestations
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Care
- The Child with DS
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcomes
- Interventions
- Evaluation
- Fragile X Syndrome
- Etiology
- Incidence
- PATHOPHYSIOLOGY: Fragile X Syndrome
- Manifestations
- Intellectual Functioning
- Physical Characteristics
- Social and Emotional Relatedness
- Speech and Language Capability and Sensory Impairment
- Co-Morbid Disorders
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Rett Syndrome
- Fetal Alcohol Spectrum Disorder
- Etiology and Incidence
- PATHOPHYSIOLOGY: Fetal Alcohol Syndrome
- Manifestations
- Diagnostic Evaluation
- FIG 54-4 Toddler with fetal alcohol syndrome. Subtle indicators are flat mid-face, indistinct philtrum, and low-set ears.
- Nursing Care
- The Infant with FAS
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Expected Outcome
- Interventions
- Evaluation
- Nonorganic Failure to Thrive
- Etiology
- Incidence
- Manifestations and Risk Factors
- Diagnostic Evaluation
- Therapeutic Management
- Nursing Considerations
- Autism ExemplarAutism Spectrum Disorders
- Asperger Syndrome
- Autism
- TABLE 54-2 Schizophrenia Exemplar DIFFERENTIAL DIAGNOSIS OF AUTISM, INTELLECTUAL DISABILITY, AND SCHIZOPHRENIA
- Etiology
- Incidence
- Manifestations
- Social
- Language
- Restricted Behavioral Repertoire
- Diagnostic Evaluation
- Therapeutic Management
- CRITICAL THINKING EXERCISE 54-1
- Nursing Care
- The Child with Autism
- Assessment
- Nursing Diagnosis and Planning
- Expected Outcome
- Expected Outcomes
- Expected Outcomes
- Interventions
- NURSING QUALITY ALERT: Maintaining Routine for the Child with Autism
- Evaluation
- KEY CONCEPTS
- References and Readings
- Chapter 55 The Child with a Sensory Alteration
- Learning Objectives
- CLINICAL REFERENCE
- Review of the Eye
- Structure and Function
- Neonatal Development
- Review of the Ear
- Structure and Function
- Neonatal Development
- Speech Development
- PEDIATRIC DIFFERENCES IN SENSORY FUNCTION
- Vision
- Hearing
- Speech and Language
- Vision screening ExemplarDisorders of the Eye
- NURSING QUALITY ALERT: Vision Screening
- Nursing Considerations for the Child with Color Deficiency
- BOX 55-1 SIGNS AND SYMPTOMS OF POTENTIAL VISION PROBLEMS
- Nursing Considerations for the Child with a Blocked Lacrimal Duct
- Nursing Considerations for the Child with a Refractive Error
- TABLE 55-1 TYPES OF REFRACTIVE DISORDERS
- Nursing Considerations for the Child with Amblyopia
- Nursing Considerations for the Child with Strabismus
- PATIENT-CENTERED TEACHING: Information about Eye Patching
- BOX 55-2 TYPES OF STRABISMUS
- Child with early onset esotropia. The deviation may not be apparent until age 3 or 4 months.
- Child with left exotropia. Most exodeviations in childhood are intermittent.
- Glaucoma ExemplarNursing Considerations for the Child with Glaucoma
- Cataracts ExemplarNursing Considerations for the Child with a Cataract
- Eye Surgery
- NURSING CARE PLAN: The Child Having Eye Surgery
- Focused Assessment
- Nursing Diagnosis
- Planning
- Expected Outcomes
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Nursing Diagnosis
- Planning
- Expected Outcome
- Interventions and Rationales
- Evaluation
- Eye Infections
- Nursing Considerations for the Child with Conjunctivitis
- Nursing Considerations for the Child with Orbital Cellulitis
- Nursing Considerations for the Child with a Corneal Ulcer
- Eye Trauma
- Nursing Considerations for the Child with a Corneal Abrasion
- Nursing Considerations for the Child with Hemorrhage
- Nursing Considerations for the Child with Hyphema
- PARENTS WANT TO KNOW: How to Prevent Eye Injuries While Participating in Sports
- Nursing Considerations for the Child with a Chemical Splash Injury
- Conductive hearing loss ExemplarHearing Loss in Children
- Etiology
- SAFETY ALERT: Working with a Child Who Has a Visual Impairment
- Incidence
- BOX 55-3 TYPES AND ETIOLOGY OF HEARING LOSS
- BOX 55-4 RISK FACTORS INDICATING THE NEED FOR HEARING SCREENING
- Neonates (Birth to 28 Days)
- Infants (29 Days to 2 Years) Developing Certain Conditions Associated with Hearing Loss
- Diagnostic Evaluation
- PATHOPHYSIOLOGY: Hearing Loss
- BOX 55-5 HEARING TESTS USED FOR INFANTS
- Auditory Brainstem Response
- Evoked Otoacoustic Emissions
- Therapeutic Management
- Nursing Considerations for the Child with Hearing Loss
- PATIENT-CENTERED TEACHING: How to Encourage Language Development
- Talk
- Look
- Control Distance
- Loudness
- Be a Good Speech Model
- Play and Talk
- Read
- Do Not Wait
- CRITICAL THINKING EXERCISE 55-1
- Language Disorders
- FIGURE 55-1 Expressive speech disorders include disorders of voice, articulation, and fluency. A speech therapist works with the child to help the child speak more clearly and be better understood. Early intervention is important to correct speech disorders. The nurse should therefore assess speech patterns during each health screening. Referrals should be made for any problems noted.
- KEY CONCEPTS
- References and Readings
- Features
- Critical to Remember
- Drug Guide
- Nursing Care Plan
- Nursing Quality Alert
- Patient-Centered Teaching
- Procedure
- Safety Alert
- Want to Know
- Temperature Equivalents and Pediatric Weight Conversion
- Temperature Equivalents: Celsius and Fahrenheit
- Pediatric Weight Conversion: Pounds to Kilograms
- Glossary
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