NFDN 2005 Midterm Review PDF

Preschooler / school age Admission/Hospitalizations/End-of-life care? ​ For preschoolers, hospitalization may be easier if they have previous experience with separation through preschool or kindergarten ​ School-age children can generally handle separation from parents better if it...

Preschooler / school age Admission/Hospitalizations/End-of-life care? ​ For preschoolers, hospitalization may be easier if they have previous experience with separation through preschool or kindergarten ​ School-age children can generally handle separation from parents better if it's not prolonged ​ During hospitalization, children should understand it's not a punishment for bad behavior ​ The daily routine of pediatric units facilitates parent rooming-in and provides consistent nurses with flexible schedules Prep for procedures? ​ Children should be forewarned about unpleasant experiences in age-appropriate terms ​ For young children, preparation should occur only a few days before hospitalization, while adolescents can be prepared weeks in advance. ​ Nurses should use non threatening words when explaining procedures. ​ Distractions like blowing bubbles, looking through kaleidoscopes, and playing with pop-up toys can help reduce anxiety and pain during procedures Play: ​ Play is an essential part of nursing care plans for children. ​ Hospitals often have playrooms supervised by child-life specialists or play therapists. ​ The playroom should be considered a safe haven from painful treatments. ​ Types of play activities include: ​ Art activities and computer programs. ​ Nursery rhymes, stories, nonsense games, songs, and puppet shows. ​ Therapeutic play to encourage growth, development, and expression of feelings 1.​ Parents as Primary Caregivers ​ Parents should be included in the decision-making process and informed of benefits and risks of therapy ​ Family-centered care acknowledges the expertise of family members ​ Parents need support from hospital personnel to make informed decisions ​ Discharge preparation includes: ​ Teaching parents about potential behavioral issues post-hospitalization. ​ Providing guidance on handling regression, aggression, and nightmares ​ Instructions for wound care, diet, exercise, and rest. 2.​ Special Considerations ​ Preparation and explanations should be provided immediately before procedures to avoid unnecessary worry ​ Parents are encouraged to assist with care as much as possible ​ Daily routines should be flexible to meet children's developmental needs. ​ Documentation should include who accompanied the child, discharge time, condition, vital signs, medications, and instructions given to parents. End of life: -​ Preschool children respond to questions about death by relying on their experience and by turning to fantasy. -​ They may believe death is reversible or that they are in some way responsible. -​ They have no understanding of the universality and -​ inevitability of death, does not develop realistic of death till age 9 or 10. Adolescents 1.​ Care of the Adolescent Population ​ Healthcare teaching should cover various aspects including nutrition, dental care, personal care, substance use, risk-taking behavior, and money management 487 ​ Primary challenges include: ​ Adjusting to rapid physical changes ​ Maintaining privacy ​ Coping with stresses and pressures ​ Maintaining open communication ​ Developing positive lifestyle choices 488 ​ Healthcare providers must: ​ Ensure confidentiality and respect ​ Provide privacy ​ Use a sense of humor to establish rapport ​ Guide parents in listening and understanding their adolescents 487 2.​ Puberty ​ Sexual Development: ​ Early adolescents show increased sexual awareness and interest ​ Sexual exploration and masturbation are common ​ Romantic relationships initially lack emotional depth 479 ​ Physical Changes: ​ During early adolescence (11-14 years), there's often: ​ Heightened concern about body image ​ Anxiety about physical appearance ​ Increased awareness of body sensations 505 ​ Support Needs:  ​ Parents should help children understand emerging emotions and feelings brought about by puberty 389 3.​ Independence ​ Development of Autonomy: ​ Adolescents need practice in making decisions ​ Parents should respect decisions even if mistakes are made ​ Creating an atmosphere of understanding is crucial 477 ​ Responsibility Development: ​ Adolescents should be encouraged to take on new responsibilities ​ Financial management can be taught through allowances ​ Even routine jobs can be made inspiring when connected to longer-term objectives 479 4.​ Education ​ Academic Considerations: ​ Graduation from high school is a major step toward self-actualization 487 ​ Late adolescents (18-20 years) focus primarily on education, career, and lifestyle choices 505 ​ Support Systems: ​ School attendance and performance should be monitored ​ Parents should encourage discussion of school concerns ​ Homework should be the child's responsibility with minimal parental assistance 459 5.​ Influences ​ Peer Relationships: ​ Peer groups help adolescents separate psychologically from family ​ Cliques provide opportunities to belong and develop close relationships 488 ​ Early adolescents tend to socialize with same-sex peers ​ Late adolescents become less vulnerable to peer influence 478 ​ Parental Influence: ​ Parenting requires major adaptations ​ Negotiation is more successful than authoritarian approaches ​ Issues of privacy and trust are common ​ Conflict often occurs as adolescents seek more adult liberties 481 ​ Cultural Considerations: ​ In Indigenous cultures, adolescents (11-18 years) are considered young adults ​ During this stage, they begin to understand their responsibilities to:  ​ Family ​ Community ​ Nation infant 1.​ Assessment ​ Initial assessment after birth should be conducted in a warm, non-stimulating environment 513 ​ Key assessment components include: ​ Position and flexion ​ Color ​ Respiratory rate and effort ​ Level of consciousness 513 ​ The Apgar score is used at 1 and 5 minutes after birth to evaluate: ​ Heart rate ​ Breathing ​ Muscle tone ​ Reflexes ​ Skin color 346 2.​ Anxiety Management ​ Approach infants calmly, slowly and at eye level with parent present when possible 502 ​ Key strategies include: ​ Maintain consistent caregivers ​ Provide open visiting hours ​ Ensure prompt meeting of physical and emotional needs ​ Offer soothing support and gentle touch when parents aren't available 502 ​ Support parents by: ​ Being available to listen and answer questions ​ Maintaining child's contact with family ​ Involving family in care when appropriate 493 3.​ Immunization Schedule  ​ Most routine immunizations start at 2 months of age due to maternal passive immunity 814 ​ Key considerations: ​ Follow provincial guidelines for specific schedules 818 ​ Document all immunizations accurately 818 ​ Obtain informed consent before administration 818 ​ Pain reduction during immunization: ​ Use vapocoolant sprays or EMLA cream ​ Employ proper injection technique ​ Consider combination vaccines to reduce number of injections 818 4.​ Pain Assessment ​ Important considerations: ​ Untreated pain can have long-term effects ​ Pain pathways are well developed by 24 weeks gestation ​ Some newborns may be too weak to show visible responses 321 ​ Pain Assessment Methods: ​ Monitor behavioral responses and physiological changes 321 ​ Observe for: ​ Facial expressions ​ Crying ​ Movement patterns ​ Changes in vital signs 322 ​ Pain Management Strategies: ​ Non-pharmacological methods: ​ Skin-to-skin contact ​ Breastfeeding ​ Oral sucrose (0.1-2mL of minimum 20% solution) ​ Non-nutritive sucking 495 ​ Additional comfort measures: ​ Touch ​ Massage ​ Rocking ​ Holding ​ Maintaining low noise and light levels 322 5.​ Family Involvement ​ Include parents in pain assessment 492 ​ Educate parents about: ​ Pain assessment techniques  ​ Management strategies ​ Feeding protocols ​ Incision care (if applicable) Toddlers: 1.​ Assessments ​ Development and behavior assessments should include: ​ Recording home habits as basis for daily routines 503 ​ Evaluating family relationships and support systems 498 ​ Assessing communication skills, personality, and adaptability 498 ​ Monitoring developmental milestones and growth patterns 376 ​ Key assessment components include: ​ Cultural beliefs and values that may affect care 498 ​ Previous experiences and coping mechanisms 498 ​ Developmental level and abilities 498 2.​ Communication ​ Essential communication strategies include: ​ Using a soft voice and quiet approach 498 ​ Getting down to the child's eye level 430 ​ Maintaining consistency in caregivers 498 ​ Using familiar words from home, especially for toileting 503 ​ Parent communication considerations: ​ Encourage parents to participate in care decisions 498 ​ Maintain open communication between staff and family 498 ​ Use concrete terms rather than abstract time references 503 3.​ Pain Assessment ​ Pain evaluation methods include: ​ Observing behavioral indicators like crying and anxiety 493 ​ Recognizing that crying may be caused by fear rather than pain 493 ​ Using appropriate pain assessment tools for preverbal children 493 ​ Pain management approaches:  ​ Implementing distraction techniques like blowing bubbles 503 ​ Using kaleidoscopes and pop-up toys to reduce anxiety 503 ​ Providing comfort measures after procedures 500 4.​ Admission/Hospitalization/End-of-Life Care ​ During admission: ​ Orient child and parent to the unit and playroom ​ Explain routines usually followed on the unit ​ Suggest bringing familiar items from home ​ Hospitalization considerations: ​ Allow parents to room in when possible ​ Maintain familiar routines and schedules ​ Provide emotional support and reassurance 5.​ Views on Being Sick, Hospitalized, Surgery ​ Understanding toddler perspectives: ​ Fear of bodily harm, especially during invasive procedures ​ Need for clear, simple explanations about procedures ​ Importance of showing exactly which body part will be involved in surgery 6.​ Hospitalization ​ Key aspects of hospital care: ​ Maintain consistent routines ​ Allow familiar toys and comfort items ​ Provide opportunities for mobility when possible ​ Avoid attempting changes in established habits during hospitalization 7.​ Tantrums ​ Management strategies: ​ Use time-out and limit setting ​ Implement clear communication ​ Provide frequent rewards for positive behavior ​ Avoid corporal punishment as it's ineffective 8.​ Play ​ Therapeutic value of play: ​ Essential part of every pediatric nursing care plan ​ Helps relieve stress and provide enjoyment ​ Should be included in treatment plans for all ages ​ Play guidelines: ​ Avoid giving treatments in playrooms ​ Encourage use of safe medical equipment in play ​ Provide age-appropriate toys and activities  ​ Include therapeutic play to aid recovery ​ Specific play recommendations: ​ Encourage playroom visits with caregivers ​ Allow play with safe medical equipment like bandages and stethoscopes ​ Use art activities for creative expression ​ Incorporate computer programs for problem-solving games Post-hospitalization considerations: ​ Prepare parents for potential behavioral changes after discharge ​ Expect behaviors such as: ​ Clinging to parents ​ Regression in bowel and bladder control ​ Possible aggression and manipulation ​ Nightmares General: 1.​ Admission/Hospitalizations/End-of-life Care ​ Admission should be done in a way that meets the emotional needs of both child and family ​ Key elements include: ​ Ideally touring the pediatric unit before admission when possible ​ Meeting staff who will care for the child ​ Use age-appropriate explanations and maintain a warm, friendly atmosphere ​ Addressing fears and concerns ​ Family-centered care principles include: ​ Allowing parents to room-in ​ Providing consistent nursing staff ​ Maintaining flexible schedules for growing children ​ End-of-life care focuses on: ​ Focus on comprehensive care including hospital and follow-up community care  ​ Coordinate with support groups and community resources 491 ​ Implement palliative care guidelines when appropriate 2.​ Care of Pediatric Clients Post-Operation ​ Key considerations include: ​ Notifying parents and allowing visits in recovery room ​ Using age-appropriate safety precautions ​ Implementing proper positioning ​ Preoperative preparation involves: ​ Show children the specific body part where surgery will occur ​ Provide age-appropriate explanations immediately before procedures ​ Use distractions like bubbles or toys to reduce anxiety ​ Emotional and psychosocial preparation ​ Parents need education about: ​ Monitor for behavioral changes and regression ​ Implement appropriate pain management strategies ​ Provide guidance to parents about expected behaviors and coping strategies. 3.​ Care of Tubes ​ Nurses must be familiar with: ​ Proper techniques for gastrostomy tube feeding ​ Monitoring for complications ​ Teaching families proper care techniques ​ Safety measures include: ​ Regular assessment of tube placement ​ Proper documentation ​ Prevention of complications 4.​ Safe Medication Administration ​ Key Guidelines: ​ Calculate and confirm weight-based dosing before each administration ​ Use proper patient identification methods including ID bracelet scanning ​ Document both positive and negative medication responses. ​ Safety Protocols: ​ Check for medication interactions and allergies before administration. ​ Use appropriate reference materials for pediatric dosing. ​ Follow proper documentation procedures. ​ Understanding absorption and metabolism differences in children 5.​ Normal and Abnormal Growth and Development ​ Growth and development principles:  ​ Follows orderly and sequential patterns ​ Proceeds from simple to complex behaviors ​ Shows individual variation in rate ​ Development theories include: ​ Erikson's psychosocial stages ​ Piaget's cognitive development ​ Freud's personality development ​ Assessment includes: ​ Regular monitoring of developmental milestones ​ Tracking growth patterns ​ Evaluating physical and social development 6.​ Ensuring Safety Across Pediatric Population ​ Hospital Safety Measures: ​ Implement prevention strategies for: ​ Adverse drug events ​ Catheter-associated infections ​ Central line infections ​ Serious falls ​ IV infiltration 509 ​ Unit-Specific Safety: ​ Keep crib sides up and locked 510 ​ Post special consideration signs above beds 506 ​ Maintain proper identification procedures 7.​ Care for Pediatric Clients in Restraints ​ Guidelines emphasize: ​ Using restraints only when necessary ​ Regular monitoring ​ Documentation of necessity ​ Important considerations include: ​ Proper application techniques ​ Regular assessment ​ Family education 8.​ Abuse Prevention and Recognition ​ Nurses must: ​ Be alert to signs of abuse ​ Follow proper reporting procedures ​ Provide appropriate support and documentation ​ Care approaches include:  ​ Cultural sensitivity ​ Family-centered care ​ Appropriate referrals to support services The pediatric nurse must maintain a comprehensive understanding of these aspects while providing care that is: ​ Age-appropriate ​ Family-centered ​ Cultural sensitivity ​ Evidence-based. Regular evaluation and updates to care plans ensure optimal outcomes for pediatric patients and their families 376. The nurse's role extends beyond direct care to include education, advocacy, and support for both patients and their families 505.