Introduction to Child Health and Pediatric Nursing Flashcards
Exam 1
Historically, how was health measured?
Measured by morbidity and mortality
Historically, what was health?
Absence of disease
Currently, how is health defined?
Health promotion
Disease Prevention
Wellness
What is the World Health Organization (WHO) definition of health?
“A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”
How were children viewed prior to the late 18th century?
Children were viewed as commodities or property
Prior to the 18th century, what was the role of children?
Their role was to increase population and help with workload
Prior to the 18th century, what was common for children?
High rates of child mortality were common
At the end of the 19th century, what happened with illness?
Better understanding of cause of illnesses
At the end of the 19th century, what new public health efforts occurred?
- Milk pasteurization
- Compulsory vaccination programs
At the end of the 19th century, what was established for children?
Public schools were established
At the end of the 19th century, how did the court view children?
Court viewed children as minors (not property!)
In the 19th and early 20th century, what improvements occurred?
Urban public health improvements
Growth of public health initiatives
Growing knowledge
What kind of urban public health improvements occurred in the 19th and early 20th centuries?
Improved sanitation,
treated municipal drinking water, and hygiene awareness
What kind of knowledge developed in the 19th and early 20th centuries?
Nutrition, sanitation, bacteriology, pharmacology, and psychology
At the end of the 20th century, what occurred?
New antibiotics and vaccines
Increased survival rates
Increase in chronic versus acute illness
Biotechnology and genetic research
What is the focus of national and international organizations to protect child rights?
Violence and abuse
Child labor and soldiering
Juvenile justice
Child immigrants and orphaned children
Abandoned or homeless children
Evolution of Pediatric Nursing
Timeline slide- study if you have time
Overall Goals of Healthy People 2030- what do they want to ELIMINATE?
Eliminate preventable disease, disability, and injury and premature death
Eliminate disparities and attain health literacy to improve the health of all groups
Overall Goals of Healthy People 2030- what do they want to ACHIEVE?
Achieve health equity
Engage leadership, the public and key constituents to take action and develop policies that will improve the health of all
Overall Goals of Healthy People 2030- what do they want to create?
Create physical, economic, and social environments that promote good health
Overall Goals of Healthy People 2030- what do they want to PROMOTE?
Promote healthy development and behaviors across every stage of life (specific goals for each stage)
Mortality
Number of individuals who have died over a specific period
(can be overall or from specific cause)
How is mortality presented?
Presented in rates per unit of population (usually 1,000 or more)
What is infant mortality often used for?
Infant mortality often used as indirect measure of the general health of a population
Morbidity
Measure of prevalence of disease or degree of disability in a population at a particular time
Examples of morbidity?
(e.g., days lost from school due to a particular problem)
How is morbidity presented?
Presented as a rate per unit of population
How is the infant and neonatal mortality trending from 1960 to 2016? Why?
Trending downward
Because of education
What is the top major reason for hospitalization in children 1 to 17 years of age
Respiratory
Causes of death in children by age group: Age 0 to 1
Developmental, genetic conditions present at birth
Premature birth
SIDS
Causes of death in children by age group: Age 1 to 4 years
Accidents (unintentional injuries)
Developmental, genetic conditions present at birth
Homicide
Causes of death in children by age group: Age 5 to 14 years
Accidents (unintentional injuries)
Cancer
Suicide
What is the number 1 cause of death in peds in the US?
unintentional injuries and gun violence
What is unintentional injury?
Unintentional injuries like choking, not knowing where the child is developmentally
What is the philosophy of pediatric nursing?
To promote and assist the child in maintaining optimal levels of health
Philosophy of pediatric nursing is to promote and assist the child in maintaining optimal levels of health how?
Focusing on the family
Providing atraumatic therapeutic care
Using evidence-based practices
Philosophy of nursing: To promote and assist the child in maintaining optimal levels of health, how should nurses focus on the family?
Providing family centered, culturally competent care
Philosophy of nursing: To promote and assist the child in maintaining optimal levels of health, how should nurses providing atraumatic therapeutic care?
Minimizing physical and psychological stress for children and their parents
Philosophy of nursing: To promote and assist the child in maintaining optimal levels of health, how should nurses use evidence based practices?
Using research findings to establish a plan of care
Characteristics of Pediatric Care?
Continuous
Comprehensive
Coordinated
Family centered
Compassionate
Culturally competent
What is the role of the nurse in relation to morbidity and mortality in children?
Educating families and communities
Role of the nurse in relation to morbidity and mortality in children is to educate families and communities about?
Developmentally appropriate child safety and preventative measures
Utility of vaccinations in preventing childhood illnesses/morbidity and benefits of preventative care
Symptoms requiring health care visits
What is the goal of nurses in educating families and communities?
Raise awareness of and provide guidance and counseling to prevent unnecessary deaths/illnesses in children
Pediatric Nursing: Scope and Standards of Nursing- what is it?
Defines guiding principles in pediatric nursing practice
Position statement about standards of practice and professional performance of pediatric nurses
Pediatric Nursing: Scope and Standards of Nursing- has been adopted by?
Jointly adopted by National Association of Pediatric Nurse Practitioners
Society of Pediatric Nurses
American Nurse’s Association Scope
Standards of Pediatric Nursing Practice
Standards of Practice: Nursing Process:
Assessment
Nursing Diagnosis
Planning and Expected outcomes
Implementation
Evaluation
Standards of Professional Practice include?
Quality of practice
Professional practice evaluation
Education
Collegiality, communication and collaboration
Ethics, research, evidenced-based practice, and clinical scholarship
Resource utilization, environmental health, advocacy,and leadership
To balance ethical components for families of different cultures and religions, what should you identify?
Identify the problem within the family’s cultural context
To balance ethical components for families of different cultures and religions, what should you gather?
Gather information about the problem and the culture
To balance ethical components for families of different cultures and religions, what should you compare?
Weigh risks against benefits
To balance ethical components for families of different cultures and religions how should you choose a solution(s)?
Choose solution based upon culturally competent care
To balance ethical components for families of different cultures and religions how should you implement solutions?
Implement solution based within family values
To balance ethical components for families of different cultures and religions what should you evaluate?
Evaluate outcome of implementation
Key Elements of Informed Consent: How should the decision maker be?
The decision maker (person who consents) must be of legal age in that state, with full civil rights and be competent
Key Elements of Informed Consent: How should the information be presented?
Information in the consent form must be simple, concise, appropriate to the level of education and language of the decision maker
Key Elements of Informed Consent: How should the decision to participate be?
Decision to participate must be voluntary, without coercion, force, or influence of duress
What must also be present in order to have informed consent?
Have a witness to the process of obtaining informed consent
What must the witness do in order to have informed consent?
Have that witness sign the consent form
Special considerations related to informed consent?
Child not living with parent (biologic or adoptive)
Mature or emancipated minors
Parental consent after divorce
Consent for organ donation
Consent for medical experimentation
Psychiatric and reproductive health services (may be a different age of consent than for other health care services)
What does pediatric assent affirm?
Affirms child’s participation in the decision making process about health care (child does not make final decision)
What does pediatric assent help?
Helps the child understand his or her health condition as developmentally appropriate for the child?
What does pediatric assent inform the child of?
Informs the child of the treatment planned and discuss what he or she should expect
What does pediatric assent make sure of?
Make sure he or she is not being unduly influenced to make a decision one way or another
What does pediatric assent ascertain?
Ascertains the child’s willingness to participate in the treatment or research
What established the concept of Advance Directives?
Patient Self-Determination Act of 1990 established the concept
What does an advance directive do?
Determine and communicate the child’s and family’s wishes should life-sustaining care become necessary
ADvance directive: What role do parents play?
Parents are generally the surrogate decision makers for children
They need to take into consideration the views of the child when possible
What do health care providers do (having to do with advance directives)?
Health care providers assist families in developing and implementing advance directives
Related acronyms having to do with advance directives?
Related acronyms are:
AND (Allow Natural Death) and
DNAR (Do Not Attempt Resuscitation)
HIPPA
Privacy
Exceptions to HIPPA?
Know the exceptions to confidentiality (e.g., suspicion of child abuse; reporting infections to health agencies; child threatens harm to self or others)
Genetic influences on child health?
Sex and Gender
Race
Genetically linked diseases
Temperament
A child’s temperament has a corresponding influence on what?
The child’s temperament has a corresponding influence on those around the child (positive or negative)
Temperament Theory:What is temperament?
Describes how a child interacts with the environment
How does child’s temperament influence parenting?
Parents react to the child based upon the child’s temperament
How are infants characterized?
Infants are characterized as “easy,” “difficult or challenging,” or “slow to warm up”
Not strict categories—a child may be a combination of these types
Parameters of Temperament include?
Activity level
Rhythmicity
Approach and withdrawal
Adaptability
Threshold of responsiveness
Intensity of reaction
Quality of mood
Distractibility
Attention span and persistence
Heath Status and Lifestyle include?
Health at birth, presence of chronic illness
Distribution of disease varies with age
Nutrition
Lifestyle choices
Environmental exposure
Stress and coping
Access and barriers to healthcare
Lifestyle Influences on Child Health occur when?
Affects children early on via their mother’s behaviors (in utero, as infants and young children) and directly (older children by their own behaviors)
What parent’s lifestyle choices influence child health?
Patterns of eating
Exercise
Use of tobacco
Drugs
Alcohol
Methods of coping with stress
Biologic Influences on Health
Genetics
In utero exposure to teratogens
Postpartum illness (mother cannot care for child)
Nutrition
Exposure to hazardous substances
Maturation
Exposure to stressful events
Types of stressors affecting children:
Social (starting school, new babysitter)
Family stress (conflict in the home, divorce, new baby)
Societal (poverty, lack of basic needs)
Physical (illness, trauma, normal growth and development)
Types of stressors affecting children: Social
(starting school, new babysitter)
Types of stressors affecting children: Family stress
(conflict in the home, divorce, new baby)
Types of stressors affecting children: Societal
(poverty, lack of basic needs)
Types of stressors affecting children: Physical
(illness, trauma, normal growth and development)
How Children Cope With Stress: Behaviors vary by what?
Behaviors suggestive of stressful feelings may vary by developmental stage
How Children Cope With Stress: How is stressful feelings expressed?
May be expressed as somatic symptoms
How Children Cope With Stress: How does prior experience to stress effect stress and response?
Prior experience with stress may drive ability to respond positively to stress
Coping of stress is influenced by?
Coping is influenced by temperament and developmental stage
What enables an effective coping?
Developing a sense of resiliency enables effective coping
Protective Factors Promoting Resiliency: Two types
- Internal
- External
Protective Factors Promoting Resiliency: Internal- is having the ability for what?
Having ability to take control, be proactive and having responsibility for own decisions
Protective Factors Promoting Resiliency: Internal- is understanding what?
Understanding and accepting own limits and abilities
Protective Factors Promoting Resiliency: Internal- is what?
Being goal-directed and knowing when to continue or stop
Protective Factors Promoting Resiliency: External is having what?
Having caring relationships
Having a positive learning environment and positive influences in the community
Barriers to Health Care
Financial
Ethnic
Sociocultural
Health care delivery system
Financial barriers to health care?
lack of insurance, cost of medications
Ethnic Barriers to health care?
Ethnic (e.g., cultural expectations encourage obesity in children)
Sociocultural barriers to healthcare?
Sociocultural (e.g., language or cultural barriers)
Healthcare delivery system barriers to health care?
Health care delivery system (e.g., fragmented care)
What is considered the basic social unit?
Family is considered the basic social unit
The Role of Family in Child Health
Provides physical and emotional care for the child as well as to convey rules of appropriate social interaction
According to the US census bureau, how is family defined?
Defined by U.S. Census Bureau as a group of two or more persons related by birth, marriage, or adoption and living together
How is the family structure?
Traditional nuclear family is no longer considered the only family structure—family structures and roles can be highly variable!
Examples of types of family structures?
Adolescent families
Grandparent-as-parents
Foster families
Same-sex families
Blended families
Four Major Parenting Styles:
Authoritarian
Authoritative
Permissive
Rejecting–neglecting
Discipline
is teaching and rewarding desirable behavior and decreasing or eliminating undesirable behavior.
It is an ongoing process.
Punishment
is a negative consequence applied for undesirable behavior.
It is a finite process.
Discipline Strategies- what should you maintain?
Maintain a positive, supportive, nurturing caregiver–child relationship
Discipline Strategies- what should you use?
Use positive reinforcement to increase desirable behaviors
Discipline Strategies- what should you do for negative behaviors?
Remove positive reinforcements for negative behaviors
Discipline Strategies- when should you use negative consequences?
Use negative consequences (punishment) to reduce or eliminate undesirable behaviors
Distinguishing Factors of Ethnic Groups
Customs
Characteristics
Language
Family structures
Food preferences
Moral codes
Health care practices
Beliefs and Practices of Cultural Groups That Impact Health Care: Cultural groups have well defined roles for
Roles of family members including children
Roles and responsibilities for extended family members
Models of health, disease, and causes of disease
Expression of pain and causes of pain
Role of foods that promote health or cure illnesses
Role of spirituality
Elements of a Child’s Community affect what?
Affects many aspects of a child’s health, development, and general welfare
Elements of a Child’s Community consist of what?
Consists of the family, school, neighborhood, youth organizations, and other peer groups
Type of Violence Affecting Child Health
Violent crimes
Suicide
School violence (bullying)
Violence in the home (Domestic violence–to self or as witness to abuse)
Major Components of Society Influencing Child Health
Changes in social roles
Socioeconomic status
Poverty
Homelessness
The media (television, Internet, social media)
Expanding global nature of society can affect children at home as well as travelers
UNICEF and WHO Identified Major Problems for Global Child Health which include:
Acute respiratory infections, such as pneumonia
Malnutrition, including micronutrient deficiency
Diarrhea related to lack of clean water and sanitation
Vaccine-preventable diseases such as measles
Malaria
Preterm birth complications and birth asphyxia
Poor health care of pregnant and nursing mothers
Principles of Atraumatic Care- what should be prevented?
Prevent or minimize physical stressors (distraction) including pain, discomfort, immobility, sleep deprivation, inability to eat or drink and changes in elimination.
Prevent or minimize parent-child separation
Principles of Atraumatic Care- what should be promoted?
Promote family centered care, treating the family as the patient.
Promote a sense of control
Goals of Child and Family Education- three things to improve?
Improve the child and family’s health literacy
Improve health outcomes and promote healthy lifestyles
Improve compliance with care and treatment plan
Goals of Child and Family Education- two things to encourage?
Encourage communication with physicians or nurse practitioners
Encourage involvement of child and family in care and decision making about care
Goals of Child and Family Education- what to promote?
Promote a sense of autonomy and control
