Maternal and Child Health Nursing PDF

15610_FM.qxd 7/6/09 6:27 AM Page ii This page intentionally left blank. 15610_FM.qxd 7/24/09 1:37 AM Page i Maternal & Child Health Nursing: Care...

15610_FM.qxd 7/6/09 6:27 AM Page ii This page intentionally left blank. 15610_FM.qxd 7/24/09 1:37 AM Page i Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family 15610_FM.qxd 7/6/09 6:27 AM Page ii This page intentionally left blank. 15610_FM.qxd 7/23/09 12:56 AM Page iii Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family ❉ Adele Pillitteri, PhD, RN, PNP Associate Professor University of Southern California Los Angeles, California Former Director, Neonatal Nurse Practitioner Program State University of New York at Buffalo Buffalo, New York Edition 6 15610_FM.qxd 7/23/09 2:10 AM Page iv Acquisitions Editor: Jean Rodenberger Development Editor: Helene Caprari Marketing Manager: Laura Meiskey Art Director: Joan Wendt Illustration Coordinator: Brett McNaughton Manufacturing Coordinator: Karin Duffield Production Services: Maryland Composition/ASI 6th edition Copyright © 2010 Adele Pillitteri Copyright © 2007, 2003, 1999, 1995, 1992 by Adele Pillitteri. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by indi- viduals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To re- quest permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Pillitteri, Adele. Maternal and child health nursing : care of the childbearing and childrearing family/Adele Pillitteri.—6th ed. p. ; cm. Rev. ed. of: Maternal & child health nursing. 5th ed. c2007. Includes bibliographical references and index. ISBN 978-1-58255-999-5 1. Maternity nursing. 2. Pediatric nursing. I. Pillitteri, Adele. Maternal & child health nursing. II. Title. [DNLM: 1. Maternal-Child Nursing. 2. Family Health. WY 157.3 P641m 2009] RG951.P637 2009 618.2⬘0231—dc22 2008052578 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author, editors, and publisher are not responsible for errors or omissions or for any consequences from applica- tion of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The author, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing re- search, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice. LWW.com 15610_FM.qxd 7/6/09 6:28 AM Page v To my husband Joseph and my family: Rusty, Dawn, Bill, Heather, J. J., Lauren, Thomas, Lynn, Henry, and Lila with love 15610_FM.qxd 7/6/09 6:28 AM Page vi This page intentionally left blank. 15610_FM.qxd 7/6/09 6:28 AM Page vii ❉ Reviewers Kim Abel, MSN Kathleen Dolin, MSN, BSN, AAS Nursing Instructor Northampton Community College Illinois Valley Community College Bethlehem, PA Oglesby, IL Marian Theresa Doyle, RN, MSN, MS Susan Adrian, RN, MS, CPNP Associate Professor Assistant Professor Northampton Community College Trocaire College Bethlehem, PA Buffalo, NY Laura Dulski, RNC-HROB, MSN, CNE Terri Ashcroft, RN, MN Assistant Professor Instructor II West Suburban College of Nursing University of Manitoba Oak Park, IL Winnipeg, Manitoba Ada Franklin, RN, MSN Jennifer Beck, MS, RN Seattle Central Community College Associate Professor and Chair of Undergraduate Studies Seattle, WA Our Lady of the Lake College Baton Rouge, LA Carole Fusco, BSN, MSN Illinois Eastern Community College Mary Ann Breen, RN, MEd, MS Robinson, IL Associate Professor Director, AS & Professional Track Nursing Programs Dawn Lee Garzon, PhD, APRN, BC, CPNP Rivier College Assistant Professor Nashua, NH University of Missouri – St. Louis St. Louis, MO Pam Bowden, RN, MS, PNP Faculty Allison Green, MSN, BSN North Hennepin Community College Neumann College Brooklyn Park, MN Aston, PA Mary Ann Cantrell, PhD, RN Yolanda Green, RN, MSN Associate Professor Associate Professor of Nursing Villanova University Chattanooga State Community College Villanova, PA Chattanooga, TN Katrina H. Carter, RNC, MS Marsha L. Heims, RN, EdD Assistant Professor Associate Professor Emeritus McNeese State University Oregon Health & Science University Lake Charles, LA Portland, OR Linda Chipp, RN, BScN Rachel Hofstetter, RN Nursing Faculty Corning Community College Vanier College Corning, NY Saint Laurent, Quebec Susan M. Koos, MS, RN, CNE Karen Luana Davis, MSN, RN, CNE, LNC Professor of Nursing Assistant Clinical Professor Heartland College Community University of Arkansas for Medical Sciences Normal, IL Little Rock, AR Dorothy Bishop Kurylo, MSN, RN Pamela P. DiNapoli, RN, PhD Pediatric Nursing Instructor Associate Professor Citizens School of Nursing University of New Hampshire West Penn Allegheny Health System Durham, NH Pittsburgh, PA vii 15610_FM.qxd 7/6/09 6:28 AM Page viii viii Reviewers Robyn Leo, RN, MS Cordia A. Starling, RN, BSN, MS, EdD Associate Professor Professor and Dean Worcester State College Dalton State College Worcester, MA Dalton, GA Sharon McCleave, BSc (Hons), Dip (Med Tech) Glenda F. Tali, RN, MSN, WHCNP-BC Seneca College Campus College Chair, Nursing & Health Administration King City, ON University of Phoenix, Hawaii Campus Honolulu, HI Joanna McGrath, RN, MSN Assistant Clinical Faculty Mary Thibault, RN, MSN, MEd Villanova University Professor Villanova, PA Owens State Community College Toledo, OH Lucille K. Morrison, MEd, MSN, CRNP (Current DNP student) Sharon Tighe, EdD, MN, BSN, AA, AS Assistant Professor Daytona Beach Community College Mercyhurst College Daytona Beach, FL Erie, PA Maureen Tippen, RN, C, MS Margaret O’Connor, MS, RN University of Michigan Flint Assistant Clinical Professor Clinical Assistant Professor Lawrence Memorial/Regis College Nursing Program Flint, MI Medford, MA Maureen Waller, MSN, RN Michelle R. Offutt, MSN, ARNP Professor Assistant Professor College of DuPage St. Petersburg College Glen Ellyn, IL St. Petersburg, FL Wendy M. Wheeler, RN, BScN, MN Katherine Perrozi, MSN, RN Instructor Robert Morris University Coraopolis Red Deer College Moon Township, PA Red Deer, AB Karen Reach, MS, RN, LCCE, FACCE Threasia L. Witt, EdD, MSN, BSN Instructor and Curriculum Chairperson Chairperson, Department of Nursing Ellis Hospital School of Nursing Director, LPN-BSN Program Schenectady, NY Director, RN-BSN Program Director, International Nursing Program Suzan Shane, RN, APN, EdD Alderson-Broaddus College St. Francis Medical Center Philippi, WV Peoria, IL Koreen W. Smiley, RN, MSN, MSEd Professor St. Charles Community College Cottleville, MO 63376 15610_FM.qxd 7/6/09 6:28 AM Page ix ❉ P re fa c e Maternal-newborn and child health nursing are expanding spent. Students can familiarize themselves with these goals areas as a result of the broadening scope of practice within by referring to the Focus on National Health Goals dis- the nursing profession and the recognized need for better plays that appear at the beginning of each chapter. preventive and restorative care in these areas. The impor- The importance of health teaching with families as a tance of this need is reflected in the fact that many of the cornerstone of nursing responsibility: The teaching role health goals for the nation focus on these areas of nursing. of the nurse has greater significance in the new health care At the same time that the information in these areas of milieu as the emphasis on preventive care and short stays nursing is increasing, less time is available in nursing pro- in the acute care setting create the need for families to be grams for teaching it. It’s difficult for students to read all of better educated in their own care. Focus on Family the material contained in overlapping textbooks. Teaching displays present detailed health information for Maternal and Child Health Nursing: Care of the the family, emphasizing the importance of a partnership Childbearing and Childrearing Family, Sixth Edition, is writ- between nurses and clients in the management of health ten with this challenge in mind. It views maternal-newborn and illness. and child health care not as two separate disciplines but as a The importance of individualizing care according to continuum of knowledge. It is designed to present the con- sociocultural uniqueness: This is a reflection of both tent of the two disciplines comprehensively but not redun- greater cultural sensitivity and an increasingly diverse dantly. It is based on a philosophy of nursing care that re- population of caregivers and care recipients. Greater em- spects clients as individuals, yet views them as part of families phasis is being placed on the implications of multiple so- and society. ciocultural factors in terms of how they affect responses to The book is designed for undergraduate student use in ei- health and illness. Focus on Communication boxes are in- ther a combined course in maternal-newborn and child cluded in each chapter to give examples of effective and health or for a curriculum in which these courses are taught less effective communication. separately. It provides a comprehensive, in-depth discussion The importance of basing nursing care on nursing of the many facets of maternal and child health nursing, process and evidence based practice: The variety of while promoting a sensitive, holistic outlook on nursing new care settings, as well as the diversity of roles in practice. As such, the book will also be useful for practicing which nurses practice, is reflected both in the prolifera- nurses or graduate students who are interested in reviewing tion of community-based nursing facilities and also in or expanding their knowledge in these areas. the increase in the numbers of nurse-midwives and pe- Basic themes that are integrated into this text include diatric and neonatal nurse practitioners. This new edi- the experience of wellness and illness as family-centered tion places emphasis on the need for nurses to practice events, the perception of pregnancy and childbirth as peri- based on solid evidence in all settings. Focus on ods of wellness, and the importance of knowing normal Evidence-Based Practice boxes in each chapter supply child development in the planning of nursing care. Also in- concrete examples of research and how it could be ap- cluded are themes reflective of changes in health care deliv- plicable to nursing practice. Focus on Nursing Care ery and the importance of meeting the needs of a culturally Planning boxes detail the use of nursing process in mul- diverse population. tidisciplinary oriented care. Nursing process: Nursing process serves as the founda- tion for nursing practice. Nursing Process Overview boxes THE CHANGING HEALTH CARE SCENE included in each chapter provide a strong theoretical un- Managed care has drastically changed the health care delivery derpinning for nursing process and ways to use the nurs- system, increasing the role of the nurse from a minor to a ing process in clinical practice. major player. It has made understanding multidisciplinary approaches to care more important than ever before. An in- creasingly multicultural population is reflected among both ORGANIZATION OF THE TEXT nurses and the clients they care for, necessitating fine-tuning of culturally sensitive care. In order that nurses can be pre- Maternal and Child Health Nursing follows the family from pared for this new level of responsibility, educational changes the pregnancy period, through labor, delivery, and the post- have to keep pace with this health care reform by emphasiz- partal period; it then follows the child in the family from ing expected outcomes, a greater focus on communication, birth through adolescence. Coverage includes ambulatory therapeutic interventions, and critical thinking. and in-patient care and focuses on primary as well as sec- Nursing issues that grow out of the current climate of ondary and tertiary care. change include: The book is organized in eight units: Unit I provides an introduction to maternal and child An emphasis on National Health Goals: As a way to health nursing. A framework for practice is presented, as well focus care and research, National Health Goals have as current trends and the importance of considering child- gained wider attention at a time when there is a greater bearing and childrearing within a diverse socioeconomic and need than ever to be wise in the choice of how dollars are family/community context. ix 15610_FM.qxd 7/6/09 6:28 AM Page x x Preface Unit II examines the nursing role in preparing families ria helpful to modifying care in the area under discussion, for childbearing and childrearing, and discusses reproduc- are presented. These reviews are designed to improve stu- tive and sexual health, the role of the nurse as a genetic dents’ preparation in clinical areas so they can focus their counselor, reproductive life planning, and the concerns of care planning and apply principles to practice. the subfertile family. Nursing Diagnoses and Related Interventions: A con- Unit III presents the nursing role in caring for a pregnant sistent format highlights the nursing diagnoses and related family during pregnancy, birth and the postpartal period and interventions throughout the text. A special heading serving as a fetal advocate. A separate chapter details the role draws the students’ attention to these sections where indi- of the nurse in providing comfort during labor and birth. vidual nursing diagnoses and outcome evaluation are de- Unit IV addresses the nursing role when a woman develops tailed for the major conditions and disorders discussed. a complication of pregnancy, labor or birth, or has a compli- Tables and Displays: Numerous tables and displays cation during the postpartal period. Separate chapters address summarize important information or provide extra de- the role of the nurse when a woman has a preexisting illness, tail on topics so that a student has ready references to develops a complication during pregnancy or the postpartal this information. period, has a special need, or chooses or needs a cesarean Focus on National Health Goals: To emphasize the nurs- birth. A final chapter details care of the high risk newborn or ing role in accomplishing the health care goals of our na- a child born with a physical or developmental challenge. tion, these displays state specific ways in which maternal Unit V discusses the nursing role in health promotion and child health nursing can provide better outcomes for during childhood. The chapters in this unit cover principles both mother and child. They help the student to appreciate of growth and development and care of the child from in- the importance of national health planning and the influ- fancy through adolescence, including child health assess- ence that nurses can have in creating a healthier nation. ment and communication and health teaching with chil- Focus on Evidence-Based Practice: These displays sum- dren and families. marize research on topics related to maternal and child Unit VI presents the nursing role in supporting the health health nursing. They appear throughout the text to ac- of children and their families. The effects of illness on chil- centuate the use of evidence-based practice as the basis for dren and their families, diagnostic and therapeutic proce- nursing care. dures, medication administration, and pain management are Focus on Communication: This feature presents case ex- addressed, with respect to care of the child and family in hos- amples of less effective communication and more effective pital, home, and ambulatory settings. communication, illustrating for the student how an Unit VII examines the nursing role in restoring and main- awareness of communication can improve the patient’s taining the health of children and families when illness oc- understanding and positively impact outcomes. curs. Disorders are presented according to body systems so Focus on Family Teaching: These boxes present detailed that students have a ready orientation for locating content. health teaching information for the family, emphasizing Unit VIII discusses the nursing role in restoring and main- the importance of a partnership between nurses and taining the mental health of children and families. Separate clients in the management of health and illness. chapters discuss the role of the nurse when intimate partner Focus on Pharmacology: These boxes provide quick ref- or child abuse or mental, long-term, or fatal illness is present. erence for medications that are commonly used for the health problems described in the text. They give the drug name (brand and generic, if applicable), dosage, preg- nancy category, side effects, and nursing implications. PEDAGOGIC FEATURES Focus on Nursing Procedures: Techniques of proce- Each chapter in the text is organized to provide a complete dures specific to maternal and child health care are boxed learning experience for the student. Numerous pedagogic in an easy-to-follow two-column format, often enhanced features are included to help a student understand and in- with color figures. crease retention. Important elements include: Focus on Assessment: These visual guides provide head- to-toe assessment information for overall health status or Chapter Objectives: Learning objectives are included at specific disorders or conditions. the beginning of each chapter to identify outcomes ex- Focus on Nursing Care Planning: Multidisciplinary pected after the material in the chapter has been mastered. Care Maps: Because nurses rarely work in isolation, but Key Terms: Terms that would be new to a student are rather as a member of a health care team or unit, listed at the beginning of each chapter in a ready reference Multidisciplinary Care Maps written for specific clients are list. When the terms first appear in the text, they are included throughout the text to demonstrate the use of the shown in boldface type and then defined. Definitions ap- nursing process, provide examples of critical thinking, and pear again in the Glossary. clarify nursing care for specific client needs. Chapter-Opening Scenarios: Short scenarios appear at Multidisciplinary care maps not only demonstrate nursing the beginning of each chapter. These vignettes are designed process but also accentuate the increasingly important role to help students appreciate that nursing care is always indi- of the nurse as a coordinator of client care. vidualized and provide a taste of what is to come in the Checkpoint Questions: Throughout the text, multiple- chapter. At the end of the chapter, Critical Thinking ques- choice Checkpoint Questions appear to help readers tions related to the scenario bring the chapter full circle. check progress and comprehension. They ask readers to Nursing Process Overview: Each chapter begins with a use the knowledge just gained in the last few pages, help- review of nursing process in which specific suggestions, ing them retain this information. Answers are supplied in such as examples of nursing diagnoses and outcome crite- the accompanying CD. 15610_FM.qxd 7/24/09 1:38 AM Page xi Preface xi “What If” Questions: “What If” (critical-thinking) ques- tions also appear in each chapter in the text. These ask ANCILLARY PACKAGE readers to apply the information just acquired in an “ac- A complete learning and teaching package accompanying the tual” situation. Readers must process the information and text includes: apply it to the new situation, thus maximizing learning and emphasizing critical thinking. Suggested solutions are Free Interactive Self-Study CD-ROM: Found on the supplied in the accompanying CD. inside front cover of each book, this free CD contains Key Points: A review of important points is highlighted 300 multiple-choice NCLEX-style questions to chal- at the end of each chapter, to help students monitor their lenge the student’s comprehension and application of own comprehension. the material in the textbook. Feedback is provided for Critical Thinking Exercises: To involve a student in the each answer. decision-making realities of the clinical setting, several Instructor’s Resource DVD: The perfect complement to thought-provoking questions are posed at the end of each classroom teaching strategies, this resource contains useful chapter. These could also serve as a basis for conference or lecture points, discussion questions, and assignments for class discussion. Suggested considerations are supplied in each chapter. Also included is a computerized test bank, the accompanying CD. containing more than 1000 multiple-choice NCLEX- Critical Thinking Scenarios: An accompanying CD- style questions; an image bank containing art from the ROM contains a patient care scenario detailing a full text; and PowerPoint presentations for every chapter. health history and examination findings pertinent to the Study Guide: This companion to the text challenges the chapter content as well as 20 related multiple-choice student’s retention of key concepts and encourages critical RN-CLEX types of questions to answer for further chap- thinking and application of information to actual nursing ter review. These could also be used for classroom or situations. clinical instruction. thePoint*: Students and teachers can find additional re- References and Suggested Readings: These provide a sources to enhance learning at http://thePoint.lww.com/ student with the information needed to do more in-depth Pillitteri6e reading of the sources noted in the text, as well as other relevant articles on the topics included in the chapter. Adele Pillitteri, PhD, RN, PNP Appendices: Appendices provide a quick reference to lab- oratory values, growth charts, vital sign parameters, nutri- tion pyramids, and drugs safe for use during lactation. *thePoint is a trademark of Wolters Kluwer Health. 15610_FM.qxd 7/6/09 6:28 AM Page xii This page intentionally left blank. 15610_FM.qxd 7/6/09 6:28 AM Page xiii ❉ Acknowledgments I would like to express my sincere appreciation to Helene Caprari, Development Editor; Jean Rodenberger, Senior Acquisitions Editor; Helen Ewan, Senior Production Manager; Tom Gibbons, Senior Production Editor; Joan Wendt, Art Director; and all the members of the Production Services Group involved with this text for their assistance and guidance throughout the project. A.P. xiii 15610_FM.qxd 7/6/09 6:28 AM Page xiv This page intentionally left blank. 15610_FM.qxd 7/6/09 6:28 AM Page xv ❉ Contents Unit 1 ❉ Maternal and Child Health Nursing Practice 1 Chapter 1 A Framework for Maternal and Child Health Nursing 3 GOALS AND PHILOSOPHIES OF MATERNAL AND CHILD HEALTH NURSING 4 STANDARDS OF MATERNAL AND CHILD HEALTH NURSING PRACTICE 5 A FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING CARE 5 A CHANGING DISCIPLINE 8 ADVANCED-PRACTICE ROLES FOR NURSES IN MATERNAL AND CHILD HEALTH 21 LEGAL CONSIDERATIONS OF MATERNAL-CHILD PRACTICE 22 ETHICAL CONSIDERATIONS OF PRACTICE 23 Chapter 2 Sociocultural Aspects of Maternal and Child Health Nursing 26 Nursing Process Overview for Respecting Sociocultural Aspects of Care 28 SOCIOCULTURAL DIFFERENCES AND IMPLICATIONS FOR DIVERSITY IN MATERNAL AND CHILD HEALTH NURSING 29 Chapter 3 The Childbearing & Childrearing Family 39 Nursing Process Overview for Promotion of Family Health 40 THE FAMILY 41 FAMILY FUNCTIONS AND ROLES 45 ASSESSMENT OF FAMILY STRUCTURE AND FUNCTION 51 Chapter 4 The Childbearing & Childrearing Family in the Community 60 Nursing Process Overview for the Pregnant Woman or Child on Home Care 61 THE FAMILY AS PART OF A COMMUNITY 66 HOME CARE 67 BEGINNING HOME CARE 68 xv 15610_FM.qxd 7/6/09 6:28 AM Page xvi xvi Contents Unit 2 ❉ The Nursing Role in Preparing Families for Childbearing and Childrearing 81 Chapter 5 The Nursing Role in Reproductive and Sexual Health 83 Nursing Process Overview for Promotion of Reproductive and Sexual Health 84 REPRODUCTIVE DEVELOPMENT 86 ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM 87 MENSTRUATION 99 SEXUALITY AND SEXUAL IDENTITY 104 HUMAN SEXUAL RESPONSE 108 SEXUAL HARASSMENT 113 DISORDERS OF SEXUAL FUNCTIONING 113 Chapter 6 Assisting the Family with Reproductive Life Planning 117 Nursing Process Overview for Reproductive Health 118 METHODS OF CONTRACEPTION 119 THE COUPLE WITH A PHYSICAL OR COGNITIVE CHALLENGE 137 FUTURE TRENDS IN CONTRACEPTION 137 ELECTIVE TERMINATION OF PREGNANCY (INDUCED ABORTION) 139 Chapter 7 The Nursing Role in Genetic Assessment and Counseling 146 Nursing Process Overview for Genetic Assessment and Counseling 147 GENETIC DISORDERS 148 GENETIC COUNSELING 155 COMMON CHROMOSOMAL DISORDERS RESULTING IN PHYSICAL OR COGNITIVE DEVELOPMENTAL DISORDERS 163 Chapter 8 Nursing Care of the Subfertile Couple 168 Nursing Process Overview for the Couple With Subfertility 169 SUBFERTILITY 170 FERTILITY ASSESSMENT 174 SUBFERTILITY MANAGEMENT 178 ALTERNATIVES TO CHILDBIRTH 184 15610_FM.qxd 7/6/09 6:28 AM Page xvii Contents xvii Unit 3 ❉ The Nursing Role in Caring for Families During Normal Pregnancy, Birth, the Postpartum, and Newborn Period 187 Chapter 9 The Growing Fetus 189 Nursing Process Overview to Help Ensure Fetal Health 190 STAGES OF FETAL DEVELOPMENT 191 EMBRYONIC AND FETAL STRUCTURES 192 ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS 197 ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT 205 Chapter 10 Psychological and Physiologic Changes of Pregnancy 217 Nursing Process Overview for Healthy Adaptation to Pregnancy 218 PSYCHOLOGICAL CHANGES OF PREGNANCY 219 THE PSYCHOLOGICAL TASKS OF PREGNANCY 220 THE DIAGNOSIS OF PREGNANCY 227 PHYSIOLOGIC CHANGES OF PREGNANCY 230 Chapter 11 Assessing Fetal and Maternal Health: Prenatal Care 244 Nursing Process Overview for Prenatal Care 245 HEALTH PROMOTION DURING PREGNANCY 246 HEALTH ASSESSMENT DURING THE FIRST PRENATAL VISIT 247 SIGNS INDICATING COMPLICATIONS OF PREGNANCY 268 Chapter 12 Promoting Fetal and Maternal Health 274 Nursing Process Overview for Health Promotion of a Fetus and Mother 275 HEALTH PROMOTION DURING PREGNANCY 277 PREVENTING FETAL EXPOSURE TO TERATOGENS 288 PREPARATION FOR LABOR 296 Chapter 13 Promoting Nutritional Health During Pregnancy 299 Nursing Process Overview for Promoting Nutritional Health in a Pregnant Woman 300 RELATIONSHIP OF MATERNAL NUTRITION TO INFANT HEALTH 301 ASSESSMENT OF NUTRITIONAL HEALTH 307 PROMOTING NUTRITIONAL HEALTH DURING PREGNANCY 309 Chapter 14 Preparing a Family for Childbirth and Parenting 322 Nursing Process Overview for Childbirth and Parenting Education 323 CHILDBIRTH EDUCATION 324 THE CHILDBIRTH PLAN 326 PRECONCEPTION CLASSES 326 EXPECTANT PARENTING CLASSES 327 THE BIRTH SETTING 334 ALTERNATIVE METHODS OF BIRTH 340 15610_FM.qxd 7/6/09 6:28 AM Page xviii xviii Contents Chapter 15 Nursing Care of a Family During Labor and Birth 343 Nursing Process Overview for a Woman in Labor 344 THEORIES OF LABOR ONSET 345 SIGNS OF LABOR 345 COMPONENTS OF LABOR 346 STAGES OF LABOR 359 MATERNAL AND FETAL RESPONSES TO LABOR 362 MATERNAL AND FETAL ASSESSMENT DURING LABOR 366 FETAL HEART RATE AND UTERINE CONTRACTION RECORDS 377 CARE OF A WOMAN DURING THE FIRST STAGE OF LABOR 381 CARE OF A WOMAN DURING THE SECOND STAGE OF LABOR 384 CARE OF A WOMAN DURING THE THIRD AND FOURTH STAGES OF LABOR 391 UNIQUE CONCERNS OF A WOMAN IN LABOR 392 Chapter 16 Providing Comfort During Labor and Birth 395 Nursing Process Overview for Pain Relief During Childbirth 396 EXPERIENCE OF PAIN DURING CHILDBIRTH 397 COMFORT AND PAIN RELIEF MEASURES 399 NURSING CARE TO PROMOTE THE COMFORT OF A WOMAN DURING LABOR 409 Chapter 17 Nursing Care of a Postpartal Family 415 Nursing Process Overview for a Postpartal Woman and Family 416 PSYCHOLOGICAL CHANGES OF THE POSTPARTAL PERIOD 417 PHYSIOLOGIC CHANGES OF THE POSTPARTAL PERIOD 421 NURSING CARE OF A WOMAN AND FAMILY DURING THE FIRST 24 HOURS AFTER BIRTH 426 NURSING CARE OF A WOMAN AND FAMILY IN PREPARATION FOR DISCHARGE 438 NURSING CARE OF A WOMAN AND FAMILY AFTER DISCHARGE 441 NURSING CARE OF A POSTPARTAL WOMAN AND FAMILY WITH UNIQUE NEEDS 442 Chapter 18 Nursing Care of a Family with a Newborn 447 Nursing Process Overview for Health Promotion of the Term Newborn 448 PROFILE OF A NEWBORN 449 APPEARANCE OF A NEWBORN 458 ASSESSMENT FOR WELL-BEING 467 CARE OF A NEWBORN AT BIRTH 472 NURSING CARE OF A NEWBORN AND FAMILY IN THE POSTPARTAL PERIOD 476 ASSESSMENT OF FAMILY’S READINESS TO CARE FOR A NEWBORN AT HOME 480 Chapter 19 Nutritional Needs of a Newborn 487 Nursing Process Overview for Promoting Nutritional Health in a Newborn 488 NUTRITIONAL ALLOWANCES FOR A NEWBORN 489 BREASTFEEDING 491 FORMULA FEEDING 504 DISCHARGE PLANNING 506 15610_FM.qxd 7/6/09 6:28 AM Page xix Contents xix Unit 4 ❉ The Nursing Role in Caring for a Family During a Complicaton of Pregnancy, Birth, or the Postpartal Period 509 Chapter 20 Nursing Care of a Family Experiencing a Pregnancy Complication from a Pre-existing or Newly Acquired Illness 511 Nursing Process Overview for Care of a Woman With a Pre-existing or Newly Acquired Illness 512 IDENTIFYING A HIGH-RISK PREGNANCY 514 CARDIOVASCULAR DISORDERS AND PREGNANCY 514 HEMATOLOGIC DISORDERS AND PREGNANCY 521 RENAL AND URINARY DISORDERS AND PREGNANCY 525 RESPIRATORY DISORDERS AND PREGNANCY 527 RHEUMATIC DISORDERS AND PREGNANCY 530 GASTROINTESTINAL DISORDERS AND PREGNANCY 531 NEUROLOGIC DISORDERS AND PREGNANCY 534 MUSCULOSKELETAL DISORDERS AND PREGNANCY 535 ENDOCRINE DISORDERS AND PREGNANCY 535 CANCER AND PREGNANCY 545 MENTAL ILLNESS AND PREGNANCY 545 Chapter 21 Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 549 Nursing Process Overview for a Woman Who Develops a Complication of Pregnancy 550 BLEEDING DURING PREGNANCY 551 PRETERM LABOR 568 PRETERM RUPTURE OF MEMBRANES 574 PREGNANCY-INDUCED HYPERTENSION 575 HELLP SYNDROME 582 MULTIPLE PREGNANCY 583 HYDRAMNIOS 585 OLIGOHYDRAMNIOS 585 POST TERM PREGNANCY 585 PSEUDOCYESIS 586 ISOIMMUNIZATION (RH INCOMPATIBILITY) 586 FETAL DEATH 587 Chapter 22 Nursing Care of a Pregnant Family with Special Needs 592 Nursing Process Overview for Care of a Pregnant Woman With Special Needs 593 THE PREGNANT ADOLESCENT 595 THE PREGNANT WOMAN OVER AGE 40 601 THE PREGNANT WOMAN WHO IS PHYSICALLY OR COGNITIVELY CHALLENGED 606 A WOMAN WHO IS SUBSTANCE DEPENDENT 610 TRAUMA AND PREGNANCY 613 15610_FM.qxd 7/6/09 6:28 AM Page xx xx Contents Chapter 23 Nursing Care of a Family Experiencing a Complication of Labor or Birth 623 Nursing Process Overview for a Woman With a Labor or Birth Complication 624 COMPLICATIONS WITH THE POWER (THE FORCE OF LABOR) 625 PROBLEMS WITH THE PASSENGER 637 PROBLEMS WITH THE PASSAGE 645 ANOMALIES OF THE PLACENTA AND CORD 648 Chapter 24 Nursing Care of a Family During Cesarean Birth 652 Nursing Process Overview for a Woman Having a Cesarean Birth 653 CESAREAN BIRTH 654 NURSING CARE OF A WOMAN ANTICIPATING A CESAREAN BIRTH 656 NURSING CARE OF A WOMAN HAVING AN EMERGENT CESAREAN BIRTH 660 INTRAOPERATIVE CARE MEASURES 660 POSTPARTAL CARE MEASURES 662 Chapter 25 Nursing Care of a Family Experiencing a Postpartal Complication 674 Nursing Process Overview for a Woman Experiencing a Postpartal Complication 675 POSTPARTAL HEMORRHAGE 676 PUERPERAL INFECTION 683 THROMBOPHLEBITIS 686 MASTITIS 689 URINARY SYSTEM DISORDERS 689 CARDIOVASCULAR SYSTEM DISORDERS 693 REPRODUCTIVE SYSTEM DISORDERS 693 EMOTIONAL AND PSYCHOLOGICAL COMPLICATIONS OF THE PUERPERIUM 693 Chapter 26 Nursing Care of a Family with a High-Risk Newborn 698 Nursing Process Overview for the Family of a High-Risk Newborn 699 NEWBORN PRIORITIES IN FIRST DAYS OF LIFE 700 THE NEWBORN AT RISK BECAUSE OF ALTERED GESTATIONAL AGE OR BIRTH WEIGHT 707 ILLNESS IN THE NEWBORN 724 THE NEWBORN AT RISK BECAUSE OF MATERNAL INFECTION OR ILLNESS 736 Chapter 27 Nursing Care of the Child Born with a Physical or Developmental Challenge 743 Nursing Process Overview for Care of a Physically or Developmentally Challenged Child 744 IMMEDIATE CARE AT THE BIRTH OF AN INFANT BORN PHYSICALLY OR DEVELOPMENTALLY CHALLENGED 745 PHYSICAL AND DEVELOPMENTAL DISORDERS OF THE GASTROINTESTINAL SYSTEM 746 PHYSICAL AND DEVELOPMENTAL DISORDERS OF THE NERVOUS SYSTEM 759 PHYSICAL AND DEVELOPMENTAL DISORDERS OF THE SKELETAL SYSTEM 770 15610_FM.qxd 7/6/09 6:28 AM Page xxi Contents xxi Unit 5 ❉ The Nursing Role in Health Promotion for a Childrearing Family 781 Chapter 28 Principles of Growth and Development 783 Nursing Process Overview for Promotion of Normal Growth and Development 784 GROWTH AND DEVELOPMENT AND THE ROLE OF THE NURSE 785 PRINCIPLES OF GROWTH AND DEVELOPMENT 786 FACTORS INFLUENCING GROWTH AND DEVELOPMENT 786 THEORIES OF DEVELOPMENT 795 USING GROWTH AND DEVELOPMENT IN PRACTICE 804 Chapter 29 Nursing Care of a Family With an Infant 808 Nursing Process Overview for Healthy Development of an Infant 809 GROWTH AND DEVELOPMENT OF AN INFANT 811 HEALTH PROMOTION OF AN INFANT AND FAMILY 821 Chapter 30 Nursing Care of a Family With a Toddler 840 Nursing Process Overview for Healthy Development of a Toddler 841 GROWTH AND DEVELOPMENT OF A TODDLER 842 HEALTH PROMOTION FOR A TODDLER AND FAMILY 847 Chapter 31 Nursing Care of a Family With a Preschool Child 862 Nursing Process Overview for Healthy Development of the Preschooler 863 GROWTH AND DEVELOPMENT OF A PRESCHOOLER 864 HEALTH PROMOTION FOR A PRESCHOOLER AND FAMILY 868 Chapter 32 Nursing Care of a Family With a School-Age Child 885 Nursing Process Overview for Healthy Development of a School-Age Child 886 GROWTH AND DEVELOPMENT OF A SCHOOL-AGE CHILD 887 HEALTH PROMOTION FOR A SCHOOL-AGE CHILD AND FAMILY 895 Chapter 33 Nursing Care of a Family With an Adolescent 914 Nursing Process Overview for Healthy Development of an Adolescent 915 GROWTH AND DEVELOPMENT OF AN ADOLESCENT 916 HEALTH PROMOTION FOR AN ADOLESCENT AND FAMILY 923 15610_FM.qxd 7/6/09 6:28 AM Page xxii xxii Contents Chapter 34 Child Health Assessment 947 Nursing Process Overview for Health Assessment of the Child and Family 948 HEALTH HISTORY: ESTABLISHING A DATABASE 949 PHYSICAL ASSESSMENT 958 ASSESSING VISION, HEARING, AND SPEECH 979 ASSESSING DEVELOPMENTAL MILESTONES 989 IMMUNIZATION STATUS 992 CONCLUDING A HEALTH ASSESSMENT 999 Chapter 35 Communication and Teaching With Children and Families 1003 Nursing Process Overview for Health Teaching With Children 1004 COMMUNICATION 1005 HEALTH TEACHING IN A CHANGING HEALTH CARE ENVIRONMENT 1014 DEVELOPING AND IMPLEMENTING A TEACHING PLAN 1018 HEALTH TEACHING FOR A SURGICAL EXPERIENCE 1026 Unit 6 ❉ The Nursing Role in Supporting the Health of Ill Children and Their Families 1031 Chapter 36 Nursing Care of a Family With an Ill Child 1033 Nursing Process Overview for an Ill Child 1034 THE MEANING OF ILLNESS TO CHILDREN 1035 CARE OF THE ILL CHILD AND FAMILY IN THE HOSPITAL 1036 NURSING RESPONSIBILITIES FOR CARE OF AN ILL CHILD AND FAMILY 1048 PROMOTING NUTRITIONAL HEALTH OF AN ILL CHILD 1050 PROMOTING SAFETY FOR AN ILL CHILD 1052 PROMOTING ADEQUATE SLEEP FOR AN ILL CHILD 1053 PROMOTING ADEQUATE STIMULATION FOR AN ILL CHILD 1055 PROMOTING PLAY FOR AN ILL CHILD 1056 Chapter 37 Nursing Care of a Family When a Child Needs Diagnostic or Therapeutic Modalities 1066 Nursing Process Overview for a Child Who Needs Diagnostic or Therapeutic Procedures 1067 NURSING RESPONSIBILITIES WITH DIAGNOSTIC AND THERAPEUTIC TECHNIQUES 1068 MEASURING VITAL SIGNS 1074 REDUCING ELEVATED TEMPERATURE IN CHILDREN 1075 COMMON DIAGNOSTIC PROCEDURES 1076 COLLECTING SPECIMENS FOR ANALYSIS 1081 HOT AND COLD THERAPY 1086 NUTRITIONAL CARE 1086 ASSISTANCE WITH ELIMINATION 1092 WOUND CARE 1094 15610_FM.qxd 7/6/09 6:28 AM Page xxiii Contents xxiii Chapter 38 Nursing Care of a Family When a Child Needs Medication Administration or Intravenous Therapy 1097 Nursing Process Overview for a Child Needing Medication/Intravenous Therapy 1098 MEDICATION ADMINISTRATION 1099 INTRAVENOUS THERAPY 1107 Chapter 39 Pain Management in Children 1116 Nursing Process Overview for a Child in Pain 1117 PHYSIOLOGY OF PAIN 1118 ASSESSING TYPE AND DEGREE OF PAIN 1119 PAIN ASSESSMENT 1121 PAIN MANAGEMENT 1124 NONPHARMACOLOGIC PAIN MANAGEMENT 1125 PHARMACOLOGIC PAIN RELIEF 1129 ONGOING PAIN RELIEF 1132 Unit 7 ❉ The Nursing Role in Restoring and Maintaining the Health of Children and Families With Physiologic Disorders 1135 Chapter 40 Nursing Care of a Family When a Child Has a Respiratory Disorder 1137 Nursing Process Overview for a Child With a Respiratory Disorder 1138 ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM 1139 ASSESSING RESPIRATORY ILLNESS IN CHILDREN 1140 HEALTH PROMOTION AND RISK MANAGEMENT 1146 THERAPEUTIC TECHNIQUES USED IN THE TREATMENT OF RESPIRATORY ILLNESS IN CHILDREN 1147 DISORDERS OF THE UPPER RESPIRATORY TRACT 1158 DISORDERS OF THE LOWER RESPIRATORY TRACT 1170 Chapter 41 Nursing Care of a Family When a Child Has a Cardiovascular Disorder 1188 Nursing Process Overview for Care of a Child With a Cardiovascular Disorder 1189 THE CARDIOVASCULAR SYSTEM 1190 ASSESSMENT OF HEART DISORDERS IN CHILDREN 1190 HEALTH PROMOTION AND RISK MANAGEMENT 1195 NURSING CARE OF THE CHILD WITH A CARDIAC DISORDER 1195 CONGENITAL HEART DISORDERS 1206 ACQUIRED HEART D1ISEASE 1214 CARDIOPULMONARY ARREST 1225 15610_FM.qxd 7/6/09 6:28 AM Page xxiv xxiv Contents Chapter 42 Nursing Care of a Family When a Child Has an Immune Disorder 1230 Nursing Process Overview for a Child With an Immune Disorder 1231 THE IMMUNE SYSTEM 1232 HEALTH PROMOTION AND RISK MANAGEMENT 1235 IMMUNODEFICIENCY DISORDERS 1237 ALLERGY 1241 COMMON IMMUNE REACTIONS 1245 ATOPIC DISORDERS 1248 DRUG AND FOOD ALLERGIES 1253 STINGING INSECT HYPERSENSITIVITY 1254 CONTACT DERMATITIS 1255 Chapter 43 Nursing Care of a Family When a Child Has an Infectious Disorder 1258 Nursing Process Overview for a Child With an Infectious Disorder 1259 THE INFECTIOUS PROCESS 1260 HEALTH PROMOTION AND RISK MANAGEMENT 1262 CARING FOR THE CHILD WITH AN INFECTIOUS DISEASE 1263 VIRAL INFECTIONS 1265 BACTERIAL INFECTIONS 1275 OTHER INFECTIOUS PATHOGENS 1283 Chapter 44 Nursing Care of a Family When a Child Has a Hematologic Disorder 1289 Nursing Process Overview for a Child With a Hematologic Disorder 1290 ANATOMY AND PHYSIOLOGY OF THE HEMATOPOIETIC SYSTEM 1291 ASSESSMENT OF AND THERAPEUTIC TECHNIQUES FOR HEMATOLOGIC DISORDERS 1294 HEALTH PROMOTION AND RISK MANAGEMENT 1298 DISORDERS OF THE RED BLOOD CELLS 1298 DISORDERS OF THE WHITE BLOOD CELLS 1311 DISORDERS OF BLOOD COAGULATION 1311 Chapter 45 Nursing Care of a Family When a Child Has a Gastrointestinal Disorder 1318 Nursing Process Overview for a Child With a Gastrointestinal Disorder 1319 ANATOMY AND PHYSIOLOGY OF THE GASTROINTESTINAL SYSTEM 1320 DIAGNOSTIC AND THERAPEUTIC TECHNIQUES 1321 HEALTH PROMOTION AND RISK MANAGEMENT 1321 FLUID, ELECTROLYTE, AND ACID–BASE IMBALANCES 1322 COMMON GASTROINTESTINAL SYMPTOMS OF ILLNESS IN CHILDREN 1324 COMMON DISORDERS OF THE STOMACH AND DUODENUM 1330 HEPATIC DISORDERS 1333 INTESTINAL DISORDERS 1339 DISORDERS OF THE LOWER BOWEL 1346 DISORDERS CAUSED BY FOOD, VITAMIN, AND MINERAL DEFICIENCIES 1351 15610_FM.qxd 7/6/09 6:28 AM Page xxv Contents xxv Chapter 46 Nursing Care of a Family When a Child Has a Renal or Urinary Tract Disorder 1356 Nursing Process Overview for Care of a Child With a Renal or Urinary Tract Disorder 1357 ANATOMY AND PHYSIOLOGY OF THE KIDNEYS 1358 ASSESSMENT OF RENAL AND URINARY TRACT DYSFUNCTION 1360 THERAPEUTIC MEASURES FOR THE MANAGEMENT OF RENAL DISEASE 1363 HEALTH PROMOTION AND RISK MANAGEMENT 1366 STRUCTURAL ABNORMALITIES OF THE URINARY TRACT 1366 INFECTIONS OF THE URINARY SYSTEM AND RELATED DISORDERS 1368 DISORDERS AFFECTING NORMAL URINARY ELIMINATION 1371 KIDNEY TRANSPLANTATION 1382 Chapter 47 Nursing Care of a Family When a Child Has a Reproductive Disorder 1387 Nursing Process Overview for Care of a Child With a Reproductive Disorder 1388 ASSESSING REPRODUCTIVE DISORDERS IN CHILDREN 1389 HEALTH PROMOTION AND RISK MANAGEMENT 1391 DISORDERS CAUSED BY ALTERED REPRODUCTIVE DEVELOPMENT 1391 REPRODUCTIVE DISORDERS IN MALES 1393 REPRODUCTIVE DISORDERS IN FEMALES 1395 BREAST DISORDERS 1400 SEXUALLY TRANSMITTED INFECTIONS 1402 Chapter 48 Nursing Care of a Family When a Child Has an Endocrine or Metabolic Disorder 1413 Nursing Process Overview for Care of a Child With an Endocrine or Metabolic Disorder 1414 HEALTH PROMOTION AND RISK MANAGEMENT 1415 THE PITUITARY GLAND 1416 PITUITARY GLAND DISORDERS 1416 THE THYROID GLAND 1420 THYROID GLAND DISORDERS 1421 THE ADRENAL GLAND 1423 ADRENAL GLAND DISORDERS 1424 THE PANCREAS 1427 THE PARATHYROID GLANDS 1439 METABOLIC DISORDERS 1440 Chapter 49 Nursing Care of a Family When a Child Has a Neurologic Disorder 1445 Nursing Process Overview for Care of a Child With a Neurologic System Disorder 1446 ANATOMY AND PHYSIOLOGY OF THE NERVOUS SYSTEM 1447 ASSESSING THE CHILD WITH A NEUROLOGIC DISORDER 1449 HEALTH PROMOTION AND RISK MANAGEMENT 1454 INCREASED INTRACRANIAL PRESSURE 1454 NEURAL TUBE DISORDERS 1458 NEUROCUTANEOUS SYNDROMES 1458 CEREBRAL PALSY 1459 INFECTION 1462 INFLAMMATORY DISORDERS 1466 PAROXYSMAL DISORDERS 1467 ATAXIC DISORDERS 1476 SPINAL CORD INJURY 1476 15610_FM.qxd 7/6/09 6:28 AM Page xxvi xxvi Contents Chapter 50 Nursing Care of a Family When a Child Has a Vision or Hearing Disorder 1484 Nursing Process Overview for Care of a Child With a Vision or Hearing Disorder 1485 HEALTH PROMOTION AND RISK MANAGEMENT 1486 VISION 1488 DISORDERS THAT INTERFERE WITH VISION 1489 STRUCTURAL PROBLEMS OF THE EYE 1491 INFECTION OR INFLAMMATION OF THE EYE 1493 TRAUMATIC INJURY TO THE EYE 1496 INNER EYE CONDITIONS 1498 THE CHILD UNDERGOING EYE SURGERY 1499 THE HOSPITALIZED CHILD WITH A VISION DISORDER 1500 STRUCTURE AND FUNCTION OF THE EARS 1500 DISORDERS OF THE EAR 1502 THE HOSPITALIZED CHILD WITH A HEARING IMPAIRMENT 1507 Chapter 51 Nursing Care of a Family When a Child Has a Musculoskeletal Disorder 1510 Nursing Process Overview for Care of a Child With a Musculoskeletal Disorder 1511 THE MUSCULOSKELETAL SYSTEM 1512 ASSESSMENT OF MUSCULOSKELETAL FUNCTION 1513 HEALTH PROMOTION AND RISK MANAGEMENT 1513 THERAPEUTIC MANAGEMENT OF MUSCULOSKELETAL DISORDERS IN CHILDREN 1514 DISORDERS OF BONE DEVELOPMENT 1520 INFECTIOUS AND INFLAMMATORY DISORDERS OF THE BONES AND JOINTS 1524 DISORDERS OF SKELETAL STRUCTURE 1527 DISORDERS OF THE JOINTS AND TENDONS: COLLAGEN-VASCULAR DISEASE 1531 DISORDERS OF THE SKELETAL MUSCLES 1534 INJURIES OF THE EXTREMITIES 1536 Chapter 52 Nursing Care of a Family When a Child Has an Unintentional Injury 1543 Nursing Process Overview for Care of a Child With an Unintentional Injury 1544 HEALTH PROMOTION AND RISK MANAGEMENT 1546 HEAD TRAUMA 1546 ABDOMINAL TRAUMA 1555 DENTAL TRAUMA 1556 NEAR DROWNING 1557 POISONING 1558 FOREIGN BODY OBSTRUCTION 1564 BITES 1565 THERMAL INJURIES 1566 15610_FM.qxd 7/6/09 6:28 AM Page xxvii Contents xxvii Chapter 53 Nursing Care of a Family When a Child Has a Malignancy 1579 Nursing Process Overview for Care of a Child With a Malignancy 1580 HEALTH PROMOTION AND RISK MANAGEMENT 1581 NEOPLASIA 1581 ASSESSING CHILDREN WITH CANCER 1583 OVERVIEW OF CANCER TREATMENT MEASURES USED WITH CHILDREN 1584 THE LEUKEMIAS 1594 THE LYMPHOMAS 1597 NEOPLASMS OF THE BRAIN 1599 BONE TUMORS 1604 OTHER CHILDHOOD NEOPLASMS 1606 Unit 8 ❉ The Nursing Role in Restoring and Maintaining the Mental Health of Children and Families 1613 Chapter 54 Nursing Care of a Family When a Child Has a Cognitive or Mental Health Disorder 1615 Nursing Process Overview for Care of a Child With a Cognitive Challenge or Mental Illness 1616 HEALTH PROMOTION AND RISK MANAGEMENT 1617 CLASSIFICATION OF MENTAL HEALTH DISORDERS 1618 DEVELOPMENTAL DISORDERS 1618 ATTENTION-DEFICIT AND DISRUPTIVE BEHAVIOR DISORDERS 1623 ANXIETY DISORDERS OF CHILDHOOD OR ADOLESCENCE 1628 EATING DISORDERS 1629 TIC DISORDERS 1631 ELIMINATION DISORDERS 1632 OTHER PSYCHIATRIC DISORDERS AFFECTING CHILDREN 1632 Chapter 55 Nursing Care of a Family in Crisis: Abuse and Violence in the Family 1636 Nursing Process Overview for Care of a Family That Experiences Abuse 1637 HEALTH PROMOTION AND RISK MANAGEMENT 1638 CHILD ABUSE 1639 SEXUAL ABUSE 1648 RAPE 1650 INTIMATE PARTNER ABUSE 1653 Chapter 56 Nursing Care of a Family When a Child Has a Long-Term or Terminal Illness 1659 Nursing Process Overview for Care of a Family Coping With a Long-Term or Terminal Illness 1660 THE CHILD WITH A LONG-TERM ILLNESS 1661 THE CHILD WHO IS TERMINALLY ILL 1666 15610_FM.qxd 7/6/09 6:28 AM Page xxviii xxviii Contents Appendices ❉ A The Rights of Children and Childbearing Women 1677 B Composition of Infant Formulas (per 100 mL) 1680 C Drug Effects in Lactation 1682 D Temperature and Weight Conversion Charts 1685 E Growth Charts 1687 F Standard Laboratory Values 1696 G Pulse, Respiration, and Blood Pressure Values 1707 H Denver II 1708 I Standard Infection Precautions 1710 J Recommended Childhood and Adolescent Immunization Schedule, United States, 2009 1712 K The Food Guide Pyramid 1717 Glossary 1719 Index 1739 15610_Ch01.qxd 7/6/09 6:29 AM Page 1 Unit 1 ❉ Maternal and Child Health Nursing Practice 15610_Ch01.qxd 7/6/09 6:29 AM Page 2 This page intentionally left blank. 15610_Ch01.qxd 7/6/09 6:29 AM Page 3 Chapter A Framework for Maternal and 1 Child Health Nursing K E Y T E R M S Anna Chung is a pre- case manager maternal and child health nursing mature neonate who certified nurse-midwife mortality rate will be transported to a clinical nurse specialist neonate client advocacy regional center for nurse practitioner evidence-based practice nursing research care about 30 miles from the hospital fertility rate puerperium where she was born. Her parents, genetic nurse counselor scope of practice Melissa and Robert, are worried O B J E C T I V E S because their tiny daughter will be After mastering the contents of this chapter, you should be able to: cared for so many miles away from 1. Identify the goals and philosophy of maternal and child health nursing. home. They’re also concerned about 2. Describe the evolution, scope, standards, and professional roles for whether they will be able to pay for her nurses in maternal and child health nursing. 3. Describe family-centered care and ways that maternal and child special care. Melissa, who is 37 years health nursing could be made more family centered. old, tells you that she feels too old to 4. Define common statistical terms used in the field, such as infant and maternal mortality. leave the hospital only 2 days after 5. Identify legal and ethical issues important to maternal and child having a cesarean birth. She wonders health nursing. 6. Use critical thinking to identify areas of care that could benefit from how her first child, Micko, now 6 years additional research or application of evidence-based practice. old, will react to having an ill rather 7. Discuss the interplay of nursing process, evidence-based practice, and nursing theory as they relate to the future of maternal and child than a healthy sister. health nursing practice. This chapter discusses standards and 8. Integrate knowledge of trends in maternal and child health care with philosophies of maternal and child the nursing process to achieve quality maternal and child health nursing care. health care and how these standards and philosophies affect care. What are some health care issues evident in this scenario? What is the nursing role here? 3 15610_Ch01.qxd 7/6/09 6:29 AM Page 4 4 UNIT 1 Maternal and Child Health Nursing Practice GOALS AND PHILOSOPHIES OF BOX 1.1 ✽ Philosophy of Maternal and MATERNAL AND CHILD HEALTH NURSING Child Health Nursing Obstetrics, or the care of women during childbirth, is derived from the Greek word obstare, which means “to keep watch.” Maternal and child health nursing is family cen- Pediatrics is a word derived from the Greek word pais, meaning tered; assessment must include both family and “child.” The care of childbearing and childrearing families is a individual assessment data. major focus of nursing practice, because to have healthy adults Maternal and child health nursing is community you must have healthy children. To have healthy children, it is centered; the health of families depends on and important to promote the health of the childbearing woman influences the health of communities. and her family from the time before children are born until Maternal and child health nursing is evidence they reach adulthood. That makes both preconceptual and pre- based, because this is the means whereby criti- natal care essential contributions to the health of a woman and cal knowledge increases. fetus and to a family’s emotional preparation for childbearing A maternal and child health nurse serves as an and childrearing. As children grow, families need continued advocate to protect the rights of all family mem- health supervision and support. As children reach maturity and bers, including the fetus. plan for their own families, a new cycle begins and new support Maternal and child health nursing includes a becomes necessary. The nurse’s role in all these phases focuses high degree of independent nursing functions, on promoting healthy growth and development of the child because teaching and counseling are major and family in both health and illness (Nearns, 2009). interventions. Although the field of nursing typically divides its concerns Promoting health and disease prevention are im- for families during childbearing and childrearing into two portant nursing roles because these protect the separate entities, maternity care and child health care, the full health of the next generation. scope of nursing practice in this area is not two separate en- Maternal and child health nurses serve as im- tities but rather a continuum: maternal and child health portant resources for families during childbear- nursing (Fig. 1.1). ing and childrearing as these can be extremely The primary goal of maternal and child health nursing stressful times in a life cycle. care can be stated simply as the promotion and maintenance Personal, cultural, and religious attitudes and of optimal family health to ensure cycles of optimal child- beliefs influence the meaning and impact of bearing and childrearing. Major philosophical assumptions childbearing and childrearing on families. about maternal and child health nursing are listed in Box 1.1. Circumstances such as illness or pregnancy are The goals of maternal and child health nursing care are nec- meaningful only in the context of a total life. essarily broad because the scope of practice (the range of ser- Maternal and child health nursing is a challeng- vices and care that may be provided by a nurse based on state ing role for nurses and a major factor in keeping requirements) is so broad. The range of practice includes families well and optimally functioning. Preconceptual health care Care of women during three trimesters of pregnancy and the puerperium (the 6 weeks after childbirth, sometimes termed the fourth trimester of pregnancy) A B FIGURE 1.1 Maternal and child health nursing includes care of the pregnant woman, child, and family. (A) During a prena- tal visit, a nurse assesses that a pregnant woman’s uterus is expanding normally. (B) During a health maintenance visit, a nurse assesses a child’s growth and development. (© Barbara Proud.) 15610_Ch01.qxd 7/6/09 6:29 AM Page 5 CHAPTER 1 A Framework for Maternal and Child Health Nursing 5 Care of infants during the perinatal period (6 weeks be- STANDARDS OF MATERNAL AND fore conception to 6 weeks after birth) Care of children from birth through adolescence CHILD HEALTH NURSING PRACTICE Care in settings as varied as the birthing room, the pedi- The importance a society places on human life can best be atric intensive care unit, and the home measured by the concern it places on its most vulnerable mem- In all settings and types of care, keeping the family at the bers—its elderly, disadvantaged, and youngest citizens. To center of care or considering the family as the primary unit promote consistency and ensure quality nursing care and out- of care is an essential goal. This is because the level of a fam- comes in these areas, specialty organizations have developed ily’s functioning affects the health status of its members guidelines for care in their specific areas of nursing practice. In (Vonderheid, Norr, & Handler, 2007). If a family’s level of maternal-child health, standards have been developed by the functioning is low, the emotional, physical, and social health Division of Maternal-Child Health Nursing Practice of the and potential of individuals in that family can be adversely American Nurses Association in collaboration with the Society affected. A healthy family, on the other hand, establishes an of Pediatric Nurses. These standards are shown in Box 1.3. environment conducive to growth and health-promoting be- The Association of Women’s Health, Obstetric, and haviors that sustain family members during crises. Similarly, Neonatal Nurses (AWHONN) has developed similar stan- the health of an individual and his or her ability to function dards for the nursing care of women and newborns. These strongly influence the health of family members and overall are summarized in Box 1.4. Notice how both these practice family functioning. For these reasons, a family-centered ap- directives speak to family-centered care. proach enables nurses to better understand individuals and their effect on others and, in turn, to provide holistic care. Box 1.2 provides a summary of key measures for the delivery A FRAMEWORK FOR MATERNAL AND of family-centered maternal and child health care. CHILD HEALTH NURSING CARE Maternal and child health nursing can be visualized within a framework in which nurses, using nursing process, nursing BOX 1.2 ✽ Common Measures to Ensure theory, and evidence-based practice, care for families during Family-Centered Maternal and Child Health Care childbearing and childrearing years through four phases of health care: Principles Health promotion The family is the basic unit of society. Health maintenance Families come in many different forms and sizes Health restoration and represent racial, ethnic, cultural, and socio- Health rehabilitation economic diversity. Examples of these phases of health care as they relate to Children grow both individually and as part of a maternal and child health are shown in Table 1.1. family. The Nursing Process Nursing Interventions Consider the family as a whole as well as its in- Nursing care, at its best, is designed and implemented in a dividual members. thorough manner, using an organized series of steps, to ensure Assess families for strengths as well as for spe- quality and consistency of care (Carpenito, 2007). The nurs- cific needs or challenges. ing process, a form of problem solving based on the scientific Respect diversity in families as a unique quality method, serves as the basis for assessing, making a nursing of that family. diagnosis, planning, organizing, and evaluating care. That the Share or initiate information on health planning nursing process is applicable to all health care settings, from with family members so that care is family the prenatal clinic to the pediatric intensive care unit, is proof oriented. that the method is broad enough to serve as the basis for Encourage family bonding through rooming-in in nursing care. both maternal and child health hospital settings. Because nurses rarely work in isolation but rather as a Encourage families to give care to a newborn or member of a health care team or unit, multidisciplinary care ill child. maps are included throughout the text to demonstrate the use Family members affect other members; individ- of the nursing process for selected clients, provide examples of ual members affect the total family group. critical thinking, and clarify nursing care for specific client Encourage family and sibling visits in the hospi- needs. These also serve to accentuate the increasingly impor- tal to promote family contacts. tant role of the nurse as a coordinator of client care and mem- Participate in early hospital discharge programs ber of a collaborative team. to reunite families as soon as possible. Include developmental stimulation in nursing care. Evidence-Based Practice Encourage families to reach out to their commu- nity so that family members are not isolate