Introduction to Pediatric Introduction to Pediatric NursingNursing

Who is the “patient” ?Who is the “patient” ? 6 year old female admitted to the hospital 6 year old female admitted to the hospital

with a diagnosis of pneumoniawith a diagnosis of pneumonia Currently in 1Currently in 1stst grade grade Lives at home with Mother, Father, and 2 Lives at home with Mother, Father, and 2

year old siblingyear old sibling Both parents work full time outside the homeBoth parents work full time outside the home Grandparents live in near by town and assist Grandparents live in near by town and assist

with child carewith child care

Answer:Answer:

Pediatric Nursing is:Pediatric Nursing is: A parent-nurse partnershipA parent-nurse partnership

Nurse’s goal is to promote a Nurse’s goal is to promote a therapeutic relationship between therapeutic relationship between parent and childparent and child

Accomplished by family-centered careAccomplished by family-centered care

Definitions of Growth and Definitions of Growth and DevelopmentDevelopment

GrowthGrowth Increase in physical size of a whole or any Increase in physical size of a whole or any

of its parts, or an increase in number and of its parts, or an increase in number and size of cells: Growth can be measured size of cells: Growth can be measured

DevelopmentDevelopment A continuous, orderly series of conditions A continuous, orderly series of conditions

that leads to activities, new motives for that leads to activities, new motives for activities, and patterns of behavioractivities, and patterns of behavior

Stages of Growth and Stages of Growth and DevelopmentDevelopment

NeonateNeonate: first 28 days of : first 28 days of lifelife

InfancyInfancy: birth to 1 year: birth to 1 yearToddlerToddler: 1 to 3 years: 1 to 3 yearsPreschoolerPreschooler: 3 to 6 years: 3 to 6 yearsSchool-agerSchool-ager: 6 to 10 years: 6 to 10 yearsPrepubertalPrepubertal: 10 to 13 years: 10 to 13 yearsAdolescentAdolescent: 13 to 18 + : 13 to 18 +

yearsyears

Biologic Determinants of Biologic Determinants of Growth in InfancyGrowth in Infancy

HeightHeight: stable : stable measurement of measurement of growth (double birth growth (double birth height at 2 years)height at 2 years)

WeightWeight: birth weight : birth weight triples by end of 1triples by end of 1stst yearyear

Pace of GrowthPace of Growth A rapid pace from birth to 1 ½-2 yearsA rapid pace from birth to 1 ½-2 years A slower pace from 2 years to pubertyA slower pace from 2 years to puberty A rapid pace from puberty to A rapid pace from puberty to

approximately 15 yearsapproximately 15 years A sharp decline from 16 years to A sharp decline from 16 years to

approximately 24 years when full adult approximately 24 years when full adult size is reachedsize is reached

Factors Influencing Growth Factors Influencing Growth and Developmentand Development

GeneticsGenetics EnvironmentEnvironment CultureCulture NutritionNutrition Health statusHealth status FamilyFamily Parental attitudesParental attitudes Child-rearing philosophiesChild-rearing philosophies

Psychosocial, Intellectual, and Psychosocial, Intellectual, and Moral Development Moral Development

Theorists Associated Theorists Associated with Developmentwith Development

Piaget:Piaget: Periods of cognitive Periods of cognitive developmentdevelopment

Erikson:Erikson: Stages of psychosocial Stages of psychosocial developmentdevelopment

Kohlberg:Stages of moral developmentKohlberg:Stages of moral development Freud:Freud: Stages of psychosexual Stages of psychosexual

developmentdevelopment

Psychosocial Development Psychosocial Development (Erikson)(Erikson)

Trust vs. Mistrust: Trust vs. Mistrust: (birth to 1 year)(birth to 1 year) Provide consistent, loving careProvide consistent, loving careAutonomy vs. Shame & DoubtAutonomy vs. Shame & Doubt: (1-3 yrs): (1-3 yrs) Allow for self care, imitationAllow for self care, imitationInitiative vs. Guilt: Initiative vs. Guilt: (3-6 yrs)(3-6 yrs) Encourage to explore environment with Encourage to explore environment with

senses, promote imaginationsenses, promote imagination

Psychosocial Development (Erikson)Psychosocial Development (Erikson)

Industry vs. Inferiority: Industry vs. Inferiority: (6-12 yrs)(6-12 yrs) Want to be workers & producers, like to Want to be workers & producers, like to

compete and cooperatecompete and cooperate

Identity vs. Role Confusion: Identity vs. Role Confusion: (12-18 yrs)(12-18 yrs) Peers, society big influencePeers, society big influence Forms identity and establishment Forms identity and establishment

of autonomyof autonomy

Intellectual Development (Piaget)Intellectual Development (Piaget)

Sensorimotor (birth to 2)Sensorimotor (birth to 2)learn cause & effectlearn cause & effect

Preoperational (2 to 7)Preoperational (2 to 7)Thinking is concreteThinking is concrete““egocentrism”egocentrism”

Intellectual Development (Piaget)Intellectual Development (Piaget)

Concrete Operational (7 to 11)Concrete Operational (7 to 11) logical & coherent thoughtlogical & coherent thought

can distinguish fact from fantasycan distinguish fact from fantasy

Formal Operations (11 to 15)Formal Operations (11 to 15)Acquisition of abstract reasoning leading toAcquisition of abstract reasoning leading to Analytical thinkingAnalytical thinking Problem solvingProblem solving Planning for the futurePlanning for the future

Important Tasks Important Tasks of Toddlerhoodof Toddlerhood

Recognition of self as a separate Recognition of self as a separate person, with own willperson, with own will

Control of impulses and acquisition of Control of impulses and acquisition of socially acceptable ways to socially acceptable ways to communicate wants and needscommunicate wants and needs

Control of eliminationControl of elimination Toleration of separation from the Toleration of separation from the

parentparent

Purpose of PlayPurpose of Play Sensorimotor Sensorimotor

developmentdevelopment Intellectual Intellectual

developmentdevelopment SocializationSocialization CreativityCreativity Self-awarenessSelf-awareness Therapeutic valueTherapeutic value Moral valueMoral value

Types of PlayTypes of Play SolitarySolitary ParallelParallel AssociativeAssociative CooperativeCooperative OnlookerOnlooker DramaticDramatic FamiliarizationFamiliarization

Communicating with childrenCommunicating with children

InfancyInfancyo Respond to Respond to

physical contactphysical contacto Gentle voiceGentle voiceo Sing-song Sing-song

qualityqualityo High pitchedHigh pitchedo Need to be held, Need to be held,

cuddledcuddled

Early Childhood < 5 yrsEarly Childhood < 5 yrs

egocentric, interpret words literallyegocentric, interpret words literally

tell them what “they” can dotell them what “they” can do let them touch equipmentlet them touch equipment nonverbal messages should be clearnonverbal messages should be clear maintain eye levelmaintain eye level use quiet, calm voiceuse quiet, calm voice be specific, use simple words, short be specific, use simple words, short

sentences, sentences, be honestbe honest

School AgeSchool Age want to know why want to know why

an object existsan object exists how it workshow it works why it is being why it is being

done to themdone to them concerned about concerned about

body integritybody integrity

AdolescentsAdolescents• give undivided give undivided

attentionattention• listen, be open-listen, be open-

mindedminded• avoid criticizingavoid criticizing• make make

expectations clearexpectations clear

Physical & Developmental Physical & Developmental AssessmentAssessment

Physical Exam GuidelinesPhysical Exam Guidelines Non-threatening environmentNon-threatening environment Place frightening equipment out of Place frightening equipment out of

sightsight Provide privacyProvide privacy Provide time for play (stuffed animals, Provide time for play (stuffed animals,

dolls)dolls) Observe for behaviors re: child’s Observe for behaviors re: child’s

readiness to cooperatereadiness to cooperate

Age-specific approaches to Age-specific approaches to examexam

InfantInfant: auscultate heart, lungs first (head to : auscultate heart, lungs first (head to toe NOT always appropriate)toe NOT always appropriate)

ToddlerToddler: inspect body area through play, : inspect body area through play, introduce equipment slowlyintroduce equipment slowly

PreschoolPreschool: if cooperative: proceed head to : if cooperative: proceed head to toe, if not: same as toddlertoe, if not: same as toddler

School-ageSchool-age: head to toe, genitalia last, : head to toe, genitalia last, respect privacyrespect privacy

AdolescentAdolescent: same as school-age: same as school-age

Pediatric Physical Exam: Key Pediatric Physical Exam: Key PointsPoints

Growth measurementsGrowth measurements Physiologic measurements Physiologic measurements General appearance (hygiene, posture, General appearance (hygiene, posture,

behavior)behavior) Lungs/ HeartLungs/ Heart Skin (color, texture, moisture, turgor)Skin (color, texture, moisture, turgor) Lymph nodes (tender, large, warm may Lymph nodes (tender, large, warm may

indicate infection)indicate infection) Eyes, ears, nose, throatEyes, ears, nose, throat Abdomen/GenitaliaAbdomen/Genitalia

Denver Developmental Denver Developmental Screening Test (DDST-II)Screening Test (DDST-II)

Evaluates development for children 0-6 in four Evaluates development for children 0-6 in four areasareas Personal-socialPersonal-social Fine-motorFine-motor LanguageLanguage Gross motorGross motor

Child’s mood must be typical for results to Child’s mood must be typical for results to be valid (results may be altered if child is be valid (results may be altered if child is not feeling well, sedated)not feeling well, sedated)

Denver Developmental Denver Developmental Screening Test (DDST-II)Screening Test (DDST-II)

Provides a clinical impression on Provides a clinical impression on child’s overall developmentchild’s overall development

Not a predictor of future Not a predictor of future development, not an IQ testdevelopment, not an IQ test

Used for noting problems, Used for noting problems, monitoring, and to base a referral for monitoring, and to base a referral for additional developmental testingadditional developmental testing

Nursing Interventions based on Nursing Interventions based on Developmental LevelDevelopmental Level

Infants (0-12m) Use soft voice, sing-song, talk to Infants (0-12m) Use soft voice, sing-song, talk to and describe procedures as they are doneand describe procedures as they are done

Toddlers (1-2 yr) Separation anxiety peaks, seeing Toddlers (1-2 yr) Separation anxiety peaks, seeing the nurse as a stranger increased anxiety: establish the nurse as a stranger increased anxiety: establish trust firsttrust firstPreparation for a procedure should begin Preparation for a procedure should begin immediately before the eventimmediately before the event

Preschool (3-5 yr) Explain procedures according to Preschool (3-5 yr) Explain procedures according to senses (what child will feel, see, hear) Imagination senses (what child will feel, see, hear) Imagination is active...may see procedures as a consequence for is active...may see procedures as a consequence for misbehaviormisbehavior

Nursing Interventions based on Nursing Interventions based on Developmental LevelDevelopmental Level

School-age (6-11 yr) Use books, pictures to School-age (6-11 yr) Use books, pictures to explain procedures, developmentally ready explain procedures, developmentally ready for detailed explanations. Organizing and for detailed explanations. Organizing and collecting is an enjoyed activity, peers collecting is an enjoyed activity, peers become more important become more important

Adolescents (12 & up) Value privacy, group Adolescents (12 & up) Value privacy, group identification is important, may have an identification is important, may have an need for independence. Can understand need for independence. Can understand adult concepts and can be prepared for a adult concepts and can be prepared for a procedure up to a week in advanceprocedure up to a week in advance

Discipline (Limit Setting)Discipline (Limit Setting) Reinforcement of desired behaviors is Reinforcement of desired behaviors is

most effectivemost effective Consequences for negative behaviorsConsequences for negative behaviors

Teaching parents how to discipline avoids Teaching parents how to discipline avoids problems related to incorrect useproblems related to incorrect use

Appropriate limit settingAppropriate limit setting ConsistencyConsistency Consequences should be told in advanceConsequences should be told in advance Include truthful explanation of why behavior is Include truthful explanation of why behavior is

unacceptableunacceptable Physical punishment is the least effectivePhysical punishment is the least effective

Guidelines for Discipline Guidelines for Discipline and the Toddlerand the Toddler

Discipline must be consistent, Discipline must be consistent, immediate, realistic, age-appropriate, immediate, realistic, age-appropriate, and related to the incidentand related to the incident

Clearly explain limits and give time for Clearly explain limits and give time for toddlers to respondtoddlers to respond

Avoid arguments and extensive Avoid arguments and extensive explanationsexplanations

Avoid withdrawing love as punishmentAvoid withdrawing love as punishment Separate toddler from behaviorSeparate toddler from behavior Praise toddler for good behaviorPraise toddler for good behavior

NutritionNutrition

Infancy (0-6 months)Infancy (0-6 months) Breastmilk most desirableBreastmilk most desirable Fe fortified formula alternative.Fe fortified formula alternative.No whole milk until 1 yoa b/cNo whole milk until 1 yoa b/c:: Altered ability to be digestedAltered ability to be digested Increased risk of contaminationIncreased risk of contamination Lack of components needed for Lack of components needed for

appropriate growthappropriate growth

No solids before 4-6 mos b/cNo solids before 4-6 mos b/c:: Not compatible with GI tractNot compatible with GI tract Exposure to food antigens that Exposure to food antigens that

may produce a food-protein allergymay produce a food-protein allergy Extrusion reflex still present Extrusion reflex still present

(pushes food out of mouth)(pushes food out of mouth)

Infancy (6-12 months)Infancy (6-12 months) Breastmilk or formula remains the primary Breastmilk or formula remains the primary

source of nutrition. source of nutrition. Addition of solids b/cAddition of solids b/c:: GI tract is mature to handle complex GI tract is mature to handle complex

nutrients & is less sensitive to allergenic nutrients & is less sensitive to allergenic foods. foods.

Extrusion reflex has disappeared.Extrusion reflex has disappeared. Swallowing is more coordinated.Swallowing is more coordinated. Head control is well developed, voluntary Head control is well developed, voluntary

grasping begins.grasping begins.

Infancy (6-12 months)Infancy (6-12 months) 4- 6 mos infant cereal mixed with 4- 6 mos infant cereal mixed with

formula or Breast milkformula or Breast milk 6 mos can introduce crackers as a 6 mos can introduce crackers as a

teething food.teething food. 6 mos fruit juice to sub for one milk 6 mos fruit juice to sub for one milk

feedingfeeding Baby food (fruits first then vegs)Baby food (fruits first then vegs) *** introduce one at a time at 4-7 day *** introduce one at a time at 4-7 day

intervalsintervals

Infancy (6-12 months)Infancy (6-12 months) By 8-9 months junior foods & By 8-9 months junior foods &

finger foods.finger foods. By 1-year well-cooked table foods By 1-year well-cooked table foods

are served.are served.

ToddlerhoodToddlerhood From 12-18 mos rate of growth slows.From 12-18 mos rate of growth slows. At 18 mos decreased nutritional need, At 18 mos decreased nutritional need,

appetite declines, picky eaters appetite declines, picky eaters At 18 mos may be able to adeptly use At 18 mos may be able to adeptly use

spoon, prefer fingersspoon, prefer fingers Do not force food.Do not force food.

ToddlerhoodToddlerhood Mealtime should be pleasant.Mealtime should be pleasant. What is eaten is more important What is eaten is more important

than how much is eaten. than how much is eaten. General serving size: ¼ to 1/3 of General serving size: ¼ to 1/3 of

the adult portion.the adult portion. May have a hard time sitting May have a hard time sitting

through an entire meal.through an entire meal.

Preschool YearsPreschool Years Needs are similar to toddler.Needs are similar to toddler. Average daily intake: 1800 calories.Average daily intake: 1800 calories. By age 5 they are more agreeable By age 5 they are more agreeable

to try new foods; are ready to to try new foods; are ready to socialize during meals.socialize during meals.

½ of an adult’s portion½ of an adult’s portion

School-age YearsSchool-age Years Likes & dislikes are established.Likes & dislikes are established. Important for parents to choose foods Important for parents to choose foods

that promotes growth.that promotes growth. Eat away from home.Eat away from home. Important to teach Food Pyramid Guide Important to teach Food Pyramid Guide

for nutrition instruction.for nutrition instruction. Encourage the child to make good Encourage the child to make good

choiceschoices..

AdolescenceAdolescence Caloric & protein requirements are Caloric & protein requirements are

higher than almost any time in life.higher than almost any time in life. Eating habits easily influenced by Eating habits easily influenced by

peers.peers. Fad diets, high caloric foods low in Fad diets, high caloric foods low in

nutritional value.nutritional value.

Dietary Guidelines for Dietary Guidelines for Children older than 2 YearsChildren older than 2 Years

Aim for fitnessAim for fitness ̶̶ Healthy weight Healthy weight ̶̶ Daily physical activityDaily physical activity

Build a healthy baseBuild a healthy base ̶̶ Use pyramid to guide food choicesUse pyramid to guide food choices ̶̶ Eat a variety of grains, fruits, and Eat a variety of grains, fruits, and vegetablesvegetables ̶̶ Keep food safe to eatKeep food safe to eat

Choose sensiblyChoose sensibly ̶̶ Foods low in fat, cholesterol, sugar, and Foods low in fat, cholesterol, sugar, and saltsalt

Care of the Hospitalized Care of the Hospitalized ChildChild

““Atraumatic Care”Atraumatic Care”

use of interventions that eliminate use of interventions that eliminate or minimize psychological and or minimize psychological and physical distress that is physical distress that is experienced by children and their experienced by children and their families in the health care systemfamilies in the health care system

Promotion of normal Promotion of normal developmentdevelopment

InfantsInfants: oral-motor development: oral-motor development ToddlersToddlers: encourage mobility & : encourage mobility &

exploration, language developmentexploration, language development PreschoolersPreschoolers: assistance with self-care: assistance with self-care School-agedSchool-aged: socialization, provision of : socialization, provision of

games & tasks for masterygames & tasks for mastery AdolescentsAdolescents: increased independence : increased independence

in managing own carein managing own care

Stressors of HospitalizationStressors of Hospitalization

1.1. Separation AnxietySeparation Anxiety2.2. Loss of ControlLoss of Control3.3. Bodily Injury & PainBodily Injury & Pain

1. Separation Anxiety1. Separation Anxiety(Universal fear of toddler)(Universal fear of toddler)

ProtestProtest: loud, demanding cries, rejects : loud, demanding cries, rejects comfort measurescomfort measures

DespairDespair: wailing cry, rejects parents, lies on : wailing cry, rejects parents, lies on abdomen, flat facial expression, weight loss, abdomen, flat facial expression, weight loss, insomnia, loss of developmental skillsinsomnia, loss of developmental skills

Denial or DetachmentDenial or Detachment: silent expressionless : silent expressionless child, deterioration of developmental child, deterioration of developmental milestones, may have trouble forming close milestones, may have trouble forming close relationshipsrelationships

Nursing DiagnosisNursing DiagnosisAnxiety r/t separation from parents during Anxiety r/t separation from parents during

hospitalization.hospitalization.GoalGoal: child will exhibit minimal evidence of : child will exhibit minimal evidence of

separation anxiety during hospitalization.separation anxiety during hospitalization.Outcome criteriaOutcome criteria: observe child’s positive : observe child’s positive

interactions with staff members & adherence interactions with staff members & adherence to hospital routine, appropriate for age & to hospital routine, appropriate for age & stage of development.stage of development.

Nursing InterventionsNursing Interventions Limit admissionsLimit admissions Limit hospital stayLimit hospital stay Reduce painReduce pain Adequately prepare childAdequately prepare child Open visiting (include siblings)Open visiting (include siblings) Primary nursingPrimary nursing Use of playUse of play Hospital bed = “safe area”Hospital bed = “safe area” Increase controlIncrease control

2. Loss of Control2. Loss of Control InfantsInfants: need consistent care: need consistent care ToddlersToddlers: maintain consistent routine: maintain consistent routine PreschoolersPreschoolers: need adequate : need adequate

preparation to unfamiliar experiences, preparation to unfamiliar experiences, fear bodily injuryfear bodily injury

School-agedSchool-aged: fear loss of control, : fear loss of control, boredomboredom

AdolescentsAdolescents: separation from peers: separation from peers

Interventions: PLAY!Interventions: PLAY! Provides diversion, brings about Provides diversion, brings about

relaxation.relaxation. Helps child feel more secure in strange Helps child feel more secure in strange

environment.environment. Helps lessen stress of separation.Helps lessen stress of separation. Means for release of tension & fears.Means for release of tension & fears. Means for accomplishing therapeutic Means for accomplishing therapeutic

goals.goals. Allows making choices & being in Allows making choices & being in

control.control.

3. Bodily Injury and Pain3. Bodily Injury and PainInfantsInfants: facial expression: facial expressionToddlersToddlers: grimace, clench teeth, restless: grimace, clench teeth, restlessPreschoolersPreschoolers: can locate pain, use face scale, : can locate pain, use face scale,

fear bodily injury & mutilation, literalfear bodily injury & mutilation, literalSchool-agedSchool-aged: fear disability & death, pain is : fear disability & death, pain is

punishment, “magical quality” of germspunishment, “magical quality” of germsAdolescentsAdolescents: use same pain scale as adults: use same pain scale as adults

Pediatric Pain AssessmentPediatric Pain Assessment““Pain is whatever the child experiencing it Pain is whatever the child experiencing it

says it is”.says it is”.

Children are under-medicated Children are under-medicated because of these because of these MYTHS:MYTHS:

infants don’t feel paininfants don’t feel pain children tolerate pain better than adultschildren tolerate pain better than adults children cannot tell you where it hurtschildren cannot tell you where it hurts children always tell the truth about painchildren always tell the truth about pain children become accustomed to painful children become accustomed to painful

proceduresprocedures parents do not want to be involved in child’s parents do not want to be involved in child’s

pain controlpain control narcotics are more dangerous for childrennarcotics are more dangerous for children

Assess the child using Assess the child using QUESTT:QUESTT:

QQuestion the child.uestion the child. UUse pain rating scales.se pain rating scales. EEvaluate behavior & physiologic changes.valuate behavior & physiologic changes. SSecure the parents’ involvementecure the parents’ involvement TTake into consideration: cause of pain.ake into consideration: cause of pain. TTake action & evaluate results.ake action & evaluate results.

Hospitalization for all pediatric Hospitalization for all pediatric patientspatients

GOALS:GOALS:Child will be prepared.Child will be prepared.Child will experience little or no Child will experience little or no

separation.separation.Child will maintain sense of Child will maintain sense of

control.control.Child will exhibit decreased fear of Child will exhibit decreased fear of

bodily injury.bodily injury.

While the nurse is administering the Denver While the nurse is administering the Denver Developmental Screening test to an infant, a Developmental Screening test to an infant, a mother expresses concern that her baby is mother expresses concern that her baby is not doing well. Which response is most not doing well. Which response is most appropriate for the nurse to make?appropriate for the nurse to make?

1.1. Why are you so worried? Have you been Why are you so worried? Have you been having problems at home too?having problems at home too?

2.2. Please let me finish this test before you start Please let me finish this test before you start worrying, Maybe the baby will do better on worrying, Maybe the baby will do better on the rest of the testthe rest of the test

3.3. You really sound worried. Please keep in You really sound worried. Please keep in mind that no baby is expected to do all the mind that no baby is expected to do all the things on this testthings on this test

4.4. Unfortunately, your concerns seem to be Unfortunately, your concerns seem to be valid. I will write up a consult with the child valid. I will write up a consult with the child development specialist development specialist

The RN observes a nursing student entering a The RN observes a nursing student entering a toddler’s room to check vital signs and toddler’s room to check vital signs and begins to take the child’s temperature begins to take the child’s temperature first. The RN should:first. The RN should:

1.1. Suggest the student start with the pulseSuggest the student start with the pulse2.2. Suggest the student start with the BPSuggest the student start with the BP3.3. Suggest the student start with respirationsSuggest the student start with respirations4.4. Say nothing, this action is appropriateSay nothing, this action is appropriate

The nurse should counsel parents of a The nurse should counsel parents of a preschooler that the best way for them to preschooler that the best way for them to assist their child to complete the core assist their child to complete the core developmental task of the preschooler is developmental task of the preschooler is to:to:

1.1. Have the preschooler watch the parents do Have the preschooler watch the parents do choreschores

2.2. Answer their preschooler’s questions Answer their preschooler’s questions simply but truthfullysimply but truthfully

3.3. Minimize the preschooler’s fear of the dark Minimize the preschooler’s fear of the dark and monstersand monsters

4.4. Insist on clear fluent speechInsist on clear fluent speech

A toddler who is to be hospitalized brings a dirty, A toddler who is to be hospitalized brings a dirty, ragged Barney stuffed animal with him. The ragged Barney stuffed animal with him. The nurse’s most appropriate action is:nurse’s most appropriate action is:

1.1. Ask the toddler’s parents to find an identical new Ask the toddler’s parents to find an identical new Barney stuffed animalBarney stuffed animal

2.2. Remove Barney while the child is sleeping and tell Remove Barney while the child is sleeping and tell the child when he wakes that Barney is lostthe child when he wakes that Barney is lost

3.3. Allow the toddler to keep the Barney stuffed Allow the toddler to keep the Barney stuffed animalanimal

4.4. Distract the toddler by taking him to the playroom Distract the toddler by taking him to the playroom and letting him select another stuffed animaland letting him select another stuffed animal

Answer: # 3 Allow the toddler to Answer: # 3 Allow the toddler to keep the Barney stuffed animalkeep the Barney stuffed animal

Rationale: Toddlers often have security Rationale: Toddlers often have security objects such as a stuffed animal that help objects such as a stuffed animal that help them feel safe and secure. them feel safe and secure.

There is no harm to the child as he has been There is no harm to the child as he has been living with the toy in this condition for living with the toy in this condition for some time.some time.

Removing the toy would cause Removing the toy would cause psychological stress, nor should the psychological stress, nor should the parents attempt to replace itparents attempt to replace it

The mother of a preschooler expresses disappointment The mother of a preschooler expresses disappointment when her child’s weight has increased only 4 when her child’s weight has increased only 4 pounds since the child’s physical 1 year ago. The pounds since the child’s physical 1 year ago. The nurse should advise this mother that:nurse should advise this mother that:

1.1. A weight gain of 4-6 pounds/year is normal for a A weight gain of 4-6 pounds/year is normal for a preschoolerpreschooler

2.2. The poor weight gain may be a result of poor The poor weight gain may be a result of poor nutritionnutrition

3.3. The poor weight gain may indicate a more serious The poor weight gain may indicate a more serious problemproblem

4.4. The weight gain is not ideal but may be nothing to The weight gain is not ideal but may be nothing to worry about worry about

Answer: # 1 A weight gain of 4-6 Answer: # 1 A weight gain of 4-6 pounds/year is normal for a pounds/year is normal for a

preschoolerpreschooler

Rationale: A preschooler normally Rationale: A preschooler normally gains 4-6 pounds a year. The nurse gains 4-6 pounds a year. The nurse should reassure the mother that the should reassure the mother that the weight gain is within normal limitsweight gain is within normal limits

The nurse should suggest that the best way for The nurse should suggest that the best way for a toddler’s parents to assist their child to a toddler’s parents to assist their child to complete the core developmental task of complete the core developmental task of the toddler years is to:the toddler years is to:

1.1. Allow the toddler to make simple decisionsAllow the toddler to make simple decisions2.2. Allow the toddler to “help”Allow the toddler to “help”3.3. Assign the toddler simple tasks or errandsAssign the toddler simple tasks or errands4.4. Teach the toddler car and street safety Teach the toddler car and street safety

rulesrules

The nurse should be aware that which The nurse should be aware that which description is description is uncharacteristicuncharacteristic of the play of the play practices of children in the school-age practices of children in the school-age years?years?

1.1. Boys and girls seek each other to playBoys and girls seek each other to play2.2. Both sexes like to collect thingsBoth sexes like to collect things3.3. School age children like to play with same School age children like to play with same

sex childrensex children4.4. School age children like competitive gamesSchool age children like competitive games