overview of child health nursing

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Overview of Child Health Nursing

Child Health Nursing

Focuses on protecting children from

illness and injury

Assists children to obtain optimal levels of wellness

Primary roles of the Pediatric Nurse

Care provider

ducator

Advocate

Pediatric Health !tatistics

"nfant #ortality

o

Number of deaths per

$%%% live births during $

st

year of life&


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o

"nfant mortality rate is an indicator of how healthy the nation is&

o

'his rate is used to compare national health care to previousyears and to other

countries&

o

'here has been a great decrease in the number of deaths overthe past century&

"n $(()* +&( per $%% live births&

Childhood #ortality

For children older than one year* death rates have always been lessthan those for

infants&

"n later adolescence* there is a sharp rise in deaths&

"njuries, the leading -iller in childhood

"njuries cause more death and disabilities in children than anydiseases&

!ome e.amples include/

o

#otor vehicle accidents are the leading cause of death inchildren over $ year of

age&

o


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#ajority of deaths are due to no use of seatbelts&

0rowning is 1

nd

leading cause of death in boys $2$3, both se.es $4213years old& 0rowning is the 5

rd

leading cause of death for girls $2$3&

6urns are the 1

nd

leading cause of death from injury in girls and the 5

rd

in boys from $2$3 years old&

Childhood #orbidity 7"llness8

An illness or injury that limits activity* re9uires medical attention orhospitali:ation*

or results in a chronic condition&

.amples/

o

Congenital heart defects

o

Asthma

o

Cerebral Palsy

o

Cystic Fibrosis


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Concerned with helping to decrease these statistics as children missschool and

other activities when ill&

Advanced Practice roles for nurses in Child health nursing

Family nurse practitioner

Neonatal nurse practitioner

Pediatric nurse practitioner

Nurse midwife

;rowth and 0evelopment

;rowth / used to show an increase in

physical si:e

or a signi


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0evelopment / >sed to denote an increase in

s-ill or ability to


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CN!* Cardiac develops 9uic-ly&

ungs are typically the last to develop&

0evelopment is

Cephalicaudal

*

which is the 5

rd

principle of ; @ 0& DHeadto toeE&

0evelopment goes from

pro.imal to distal*

which is the 3

th

principle&

.ample/ 0evelopment proceeds from gross to re


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;ender

Health

"ntelligence

'emperament

"nborn in all of us

A way of reacting to the world around us

eaction Patterns/

Activity level

o

evel of activity diBers widely among children

hythmicity

o

Have a regular rhythm is physiologic terms

Approach

o


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Child?s response to a new situation

Adaptability

o

"s the child able to adapt to new situationsG

"ntensity of reaction

0istractibility

Attention span and persistence

#ood 9uality

Categories of temperament

'he DasyE Child

o

asy to care for if they have predictable rhythmicity* approachand easily adapt to

new situations* have a mild to moderateintensity of reaction* and an overall positive

mood 9uality&

o

3%24% of children fall into this category

'he D0iIcultE child

o


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Children are DdiIcultE if irregular in habits* have negative mood9uality* and

withdraw from new situations

o

$% of children


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As a child normally develops somewhat predictably in growth andphysical

development* he also matures emotionally* intellectually* andspiritually along

certain paths&

eview/

ri-son?s theory of Psychosocial development

Piaget?s theory of cognitive development

Johlberg?s theory of #oral development

Text Mode Text version of the exam

1. The nurse is caring for a male client with a chest tube. If the chest drainage system isaccidentally disconnected, what should the nurse plan to do?

A. lace the end of the chest tube in a container of sterile saline.


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!. Apply an occlusive dressing and notify the physician.

". "lamp the chest tube immediately.

#. $ecure the chest tube with tape.

%. A male elderly client is admitted to an acute care facility with influen&a. The nurse monitorsthe client closely for complications. 'hat is the most common complication of influen&a?

A. $epticemia

!. neumonia

". (eningitis

#. ulmonary edema

). A female client has a tracheostomy but doesn*t re+uire continuous mechanical ventilation.

'hen weaning the client from the tracheostomy tube, the nurse initially should plug the openingin the tube for

A. 1- to / seconds.

!. - to %/ minutes.

". )/ to 0/ minutes.

#. 0- to / minutes.

0. ina, a home health nurse is visiting a home care client with advanced lung cancer. 2ponassessing the client, the nurse discovers whee&ing, bradycardia, and a respiratory rate of 1/

breaths3minute. These signs are associated with which condition?

A. 4ypoxia

!. #elirium

". 4yperventilation

#. $emiconsciousness

-. A male client with uillain5!arr6 syndrome develops respiratory acidosis as a result of

reduced alveolar ventilation. 'hich combination of arterial blood gas 7A!8 values confirms

respiratory acidosis?

A. p4, -./9 a":% )/ mm 4g


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!. p4, ;.0/9 a":% )- mm 4g

". p4, ;.)-9 a":% 0/ mm 4g

#. p4, ;.%-9 a":% -/ mm 4g

. A female client with interstitial lung disease is prescribed prednisone 7#eltasone8 to controlinflammation. #uring client teaching, the nurse stresses the importance of ta. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial

oxygen saturation of >>. 'hich mode of oxygen delivery would most li


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A. Immediately before a meal

!. At least % hours after a meal

". 'hen bronchospasms occur

#. 'hen secretions have mobili&ed

1/. :n arrival at the intensive care unit, a critically ill female client suffers respiratory arrest andis placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client*s

arterial oxygen saturation 7$a:%8 noninvasively. 'hich vital sign abnormality may alter pulse

oximetry values?

A. ever

!. Tachypnea

". Tachycardia

#. 4ypotension

11. The nurse is caring for a male client who recently underwent a tracheostomy. The first

priority when caring for a client with a tracheostomy is

A. helping him communicate.

!.


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!. residual volume.

". vital capacity.

#. dead5space volume.

10. A male client with pneumonia develops respiratory failure and has a partial pressure ofarterial oxygen of -- mm 4g. 4e*s placed on mechanical ventilation with a fraction of inspired

oxygen 7I:%8 of /.B. The nursing goal should be to reduce the I:% to no greater than

A. /.%1

!. /.)-

". /.-

#. /.;

1-. @urse (ic


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". ;.-/ to ;./

#. ;.-- to ;.-

1>. !efore weaning a male client from a ventilator, which assessment parameter is most

important for the nurse to review?

A. luid inta


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". 2se of cooling blan


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!. % to - mcg3ml

". - to 1/ mcg3ml

#. 1/ to %/ mcg3ml

%. A male client is to receive I.. vancomycin 7ancocin8. 'hen preparing to administer thisdrug, the nurse should . At 11 p.m., a male client is admitted to the emergency department. 4e has a respiratory rateof 00 breaths3minute. 4e*s anxious, and whee&es are audible. The client is immediately given

oxygen by face mas< and methylprednisolone 7#epo5medrol8 I.. At 11)/ p.m., the client*s

arterial blood oxygen saturation is > and he*s still whee&ing. The nurse should plan toadminister

A. alpra&olam 7Janax8.

!. propranolol 7Inderal8

". morphine.

#. albuterol 7roventil8.

%B. ulmonary disease 7":#8, which nursing action best promotes ade+uate gas exchange?

A. Cncouraging the client to drin< three glasses of fluid daily


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!. Heeping the client in semi5owler*s position

". 2sing a high5flow enturi mas< to deliver oxygen as prescribed

#. Administering a sedative as prescribed

)/. @urse Foana is teaching a client with emphysema how to perform pursed5lip breathing. Theclient as


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mental confusion characteri&ed by disorientation to time and place. 4yperventilation

7respiratory rate greater than that metabolically necessary for gas exchange8 is mar


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1%. Answer C. "ontrolled coughing helps maintain a patent airway by helping to mobili&e

and remove secretions. A moderate fluid inta to /.%1.

1-. Answer B. A positive reaction means the client has been exposed to T!9 it isn*t

conclusive of the presence of active disease. A positive reaction consists of palpable

swelling and induration of - to 1- mm. It can be read 0> to ;% hours after the inDection. In

clients with positive reactions, further studies are usually done to rule out active disease.In immunosuppressed clients, a negative reaction doesn*t exclude the presence of active

disease.

1. Answer A.In a client with emphysema, albuterol is used as a bronchodilator. Arespiratory rate of %% breaths3minute indicates that the drug has achieved its therapeutic

effect because fewer respirations are re+uired to achieve oxygenation. Albuterol has no

effect on pupil reaction or urine output. It may cause a change in the heart rate, but this isan adverse, not therapeutic, effect.

1;. Answer B.A p4 less than ;.)- is indicative of acidosis9 a p4 above ;.0- indicates

al. Answer B. !efore weaning a client from mechanical ventilation, it*s most important to

have baseline A! levels. #uring the weaning process, A! levels will be chec


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%/. Answer C. The most significant and direct indicator of the effectiveness of oxygen

therapy is the a:% value. !ased on the a:% value, the nurse may adDust the type of

oxygen delivery 7cannula, venturi mas


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respirations8 don*t cause excessive ":% loss. (yasthenia gravis and narcotic overdose

suppress the respiratory drive, causing ":% retention, not ":% loss9 this may lead to

respiratory acidosis, not al. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by

whee&es and a subnormal arterial oxygen saturation level. The client*s greatest need isbronchodilation, which can be accomplished by administering bronchodilators. Albuterol

is a beta% adrenergic agonist, which causes dilation of the bronchioles. It*s given bynebuli&ation or metered5dose inhalation and may be given as often as every )/ to /

minutes until relief is accomplished. Alpra&olam is an anxiolytic and central nervous

system depressant, which could suppress the client*s breathing. ropranolol iscontraindicated in a client who*s whee&ing because it*s a beta% adrenergic antagonist.

(orphine is a respiratory center depressant and is contraindicated in this situation.

%B. Answer C. The client with ":# retains carbon dioxide, which inhibits stimulation of

breathing by the medullary center in the brain. As a result, low oxygen levels in the blood

stimulate respiration, and administering unspecified, unmonitored amounts of oxygenmay depress ventilation. To promote ade+uate gas exchange, the nurse should use a

enturi mas< to deliver a specified, controlled amount of oxygen consistently andaccurately. #rin

overview of child health nursing

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