Lecture 1+ Historical/legal/ethical considerations; immunizations Flashcards
Cognitive development influences response to pain. What age group is most concerned with the fear of losing control during a painful experience?
Adolescents. [Adolescents usually approach pain with self-control. They are concerned with remaining composed and feel embarrassed and ashamed of losing control. Toddlers and preschoolers react to pain primarily as a physical, concrete experience. Preschoolers may try to escape a procedure with verbal statements such as “go away.” Young school-age children may view pain as punishment for wrongdoing. This age group fears bodily harm.]
A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, “I am fine.” How should the nurse interpret this situation?
Children in this age group often do not request support even though they need and want it. [The school-age child’s visible composure, calmness, and acceptance often mask an inner longing for support. Children of this age have a more passive approach to pain and an indirect request for support. It is especially important to be aware of nonverbal cues such as facial expression, silence, and lack of activity. Usually when someone identifies the unspoken messages, the child will readily accept support.]
The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care?
Ensuring that the mother has time away from the infant. [The mother needs sufficient rest and nutrition so she can be effective as a caregiver. While the infant is hospitalized, the care is the responsibility of the nursing staff. The mother should be made comfortable with the care the staff provides in her absence.]
A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose?
Lets the child express thoughts and feelings through pictures rather than words. [The art supplies allow the child to draw images that come into the mind. This can help the child develop symbols and then verbalize reactions to illness and hospitalization. The child benefits by being able to express feelings nonverbally.]
The nurse is notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. What roommate should be best to select?
An 8-year-old boy with a fractured femur. [The boys are similar in age. The child with nephrotic syndrome most likely will be on immunosuppressive agents and susceptible to infection. The child with a fractured femur is not infectious. A girl should not be a good roommate for a school-age boy.]
A 6-year-old is being discharged home, which is 90 miles from the hospital, after an outpatient hernia repair. In addition to explicit discharge instructions, what should the nurse provide?
Prescribed pain medication before discharge. [The nurse should anticipate that the child will begin experiencing pain on the trip home. By providing a dose of oral analgesia, the nurse can ensure the child remains comfortable during the trip.]
The nurse should expect a toddler to cope with the stress of a short period of separation from parents by displaying what?
Regression. [Children in the toddler stage demonstrate goal-directed behaviors when separated from parents for short periods. They may demonstrate displeasure on the parents’ return or departure by having temper tantrums; refusing to comply with the usual routines of mealtime, bedtime, or toileting; or regressing to more primitive levels of development. Detachment would be seen with a prolonged absence of parents, not a short one.]
The nurse is instructing student nurses about the stress of hospitalization for children from middle infancy throughout the preschool years. What major stress should the nurse relate to the students?
Separation anxiety. [The major stress from middle infancy throughout the preschool years, especially for children ages 6 to 30 months, is separation anxiety.]
A parent needs to leave a hospitalized toddler for a short period of time. What action should the nurse suggest to the parent to ease the separation for the toddler?
Leave a favorite article from home with the child. [Because young children associate such inanimate objects with significant people, they gain comfort and reassurance from these possessions. They make the association that if the parents left this, the parents will surely return.]
Pertussis vaccination should begin at which age?
2 months. [The acellular pertussis vaccination is recommended beginning at age 6 weeks, and is usually given at the 2-month well-child visit.]
Illness and vaccinations
Serious illness is a contraindication to receiving vaccines. A mild illness with or without fever is not a contraindication.
The first vaccine a child receives
Hepatitis B - first of three doses is given at birth.
Briefly discuss the treatment of children during colonial times.
Children in colonial times were viewed as “little adults” as early as the age of five, and were sold for cheap labor. If they were judged to be dishonest or subordinate, children were imprisoned, deported, or publicly executed. Childhood mortality was high due to a failure to effectively treat disease.
What are some reasons that children were not valued by society?
The two major reasons why earlier society did not protect or provide for children were (1) children had a much shorter life span; and (2) society knew nothing about the developmental processes of children. Children were also viewed as innately “evil” and it was believed that only through corporal punishment that the “good” could be brought out in a child.
Briefly discuss what is meant by “holistic care of the child”.
Holistic care of children takes into account the physical, intellectual and psychosocial responses of children in health promotion and health maintenance. Pediatric nursing care now involves children and their families and the consideration of the changing family structure.
Discuss the role of developmental theorists on society’s view and treatment of children.
Developmental theorists advanced the notion that childhood was a unique part of the lifespan marked by specific age-related behaviors and developmental milestones. This counteracted the earlier views of children as society gained an understanding of the importance of childhood development.
What are some advances in health care since the 1900s that have contributed to improved nursing care of children?
The 20th century saw an improved understanding of the disease process that called attention to the vulnerability of children to disease. Increasing knowledge of childhood physiology, more treatment options, the introduction of penicillin, vaccines against communicable diseases, corticosteroids, and anticonvulsants led to improved care of children in the clinical setting. Research into child development during hospitalization led to increased family visitation and the parent’s involvement in care for hospitalized children.
Discuss what is meant be being an advocate for the patient and family. What factors should the nurse take into consideration when setting goals and planning care with the child and family members?
As an advocate, the nurse assists the child and family in making informed choices and acting in the child’s best interest. When setting goals and planning, the nurse ensures that families are aware of all available health services and adequately informed of treatments and procedures. The nurse endeavors to provide atraumatic care to the child, prevent injury and disease, assess knowledge and provide teaching as needed, and coordinate care with other healthcare professionals.
Describe what is meant by “atraumatic care”.
Atraumatic care is the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and their families in the healthcare system.
Why is it important for nurses to have an understanding of nutrition when providing anticipatory guidance to children and families?
Nutrition is an essential component of disease prevention and health promotion due to its role in child growth and development and overall health. By having an understanding of nutrition, nurses can provide education on childhood nutrition and anticipate problems that may arise due to inadequate nutrition.
What procedures require that a separate informed consent be signed by the parent or guardian of a minor?
Major surgery; minor surgery (e.g., cutdown, biopsy, dental extraction, suturing a laceration, removal of a cyst, closed reduction of a fracture); diagnostic tests with an element of risk (e.g., bronchoscopy, angiography, lumbar puncture, cardiac catheterization, bone marrow aspiration); medical treatments with an element of risk (e.g., blood transfusion, thoracentesis or paracentesis, radiotherapy).
If the parents of a child are divorced, who can provide informed consent?
If the parents are divorced, consent usually rests with the parent who has legal custody.
Define “emancipated minor.” Explain what that means for obtaining informed consent. Are there any instances when an adolescent who is not emancipated can receive medical treatment without informed consent from a parent/guardian?
An emancipated minor is one who is legally under the age of majority but is recognized as having the legal capacity of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independent living, or military service. These children have the ability to give informed consent without the involvement of a parent or guardian. An adolescent who is not emancipated can receive medical treatment without informed consent from a parent or guardian when: They need urgent medical or surgical treatment and a parent is not readily available to give consent, or when they are seeking treatment for a “medically emancipated” condition such as sexually transmitted infections, mental health services, alcohol and drug addiction, pregnancy, and contraceptive advice (including abortion in some states).
Define assent. When should it be obtained? Is it ever legally required?
Assent means the child or adolescent has been informed about the proposed treatment, procedure, or research and is willing to permit a health care provider to perform it. It should be obtained from children aged 7 or older in addition to parental consent. Assent is not a legal requirement, but an ethical one to protect the rights of children. It demonstrates respect for the child and involves him or her in the decision making process.
