Embed Size (px)
Citation preview
Introduction to Introduction to Pediatric NursingPediatric Nursing
Who is the patient?Who is the patient?
6 year old female admitted to the 6 year old female admitted to the hospital with a diagnosis of pneumoniahospital with a diagnosis of pneumonia
Currently in 1Currently in 1stst grade grade Lives at home with Mother, Father, and Lives at home with Mother, Father, and
2 year old sibling2 year old sibling Both parents work full time outside the Both parents work full time outside the
homehome Grandparents live in near by town and Grandparents live in near by town and
assist with child careassist with child care
Answer:Answer:
Pediatric Nursing is:Pediatric Nursing is:
A parent-nurse partnershipA parent-nurse partnership
Nurse’s goals are:Nurse’s goals are:– to promote a therapeutic relationship to promote a therapeutic relationship
between parent and childbetween parent and child– Accomplished by family-centered careAccomplished by family-centered care– To promote continued growth and To promote continued growth and
developmentdevelopment
Definitions of Grwoth Definitions of Grwoth and Developmentand Development GrowthGrowth
– Increase in physical size of a whole or Increase in physical size of a whole or any of its parts, or an increase in any of its parts, or an increase in number and size of cells: Growth can number and size of cells: Growth can be measured be measured
DevelopmentDevelopment– A continuous, orderly series of A continuous, orderly series of
conditions that leads to activities, conditions that leads to activities, new motives for activities, and new motives for activities, and patterns of behaviorpatterns of behavior
Stages of Growth and Stages of Growth and DevelopmentDevelopmentNeonateNeonate: first 28 days of life: first 28 days of lifeInfancyInfancy: 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 + years: 13 to 18 + years
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
– 4-6 lb/year4-6 lb/year 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 approximately 24 years when full adult size is reachedadult size is reached
Psychosocial & Intellectual Psychosocial & Intellectual DevelopmentDevelopment
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 Kohlberg: Stages of moral
developmentdevelopment Freud:Freud: Stages of psychosexual Stages of psychosexual
developmentdevelopment
Promote Psychosocial Promote Psychosocial Development (Erikson)Development (Erikson)
Trust vs. Mistrust: Trust vs. Mistrust: (birth to 1 year)(birth to 1 year) Establishes a sense of trust when basic Establishes a sense of trust when basic
needs areneeds are Nurses should provide consistent, loving carerovide consistent, loving careAutonomy vs. Shame & DoubtAutonomy vs. Shame & Doubt: (1-3 yrs): (1-3 yrs) Increasingly independent in many spheres of life Nurses should allow for self care &
imitation
Initiative vs. Guilt: Initiative vs. Guilt: (3-6 yrs)(3-6 yrs) Learns to initiate play activities. Nurses should encourage to explore
environment with senses, promote imagination
Industry vs. Inferiority: Industry vs. Inferiority: (6-12 yrs)(6-12 yrs) Learns self worth as a workers & producers Learns self worth as a workers & producers Allow children to compete and cooperateAllow children to compete and cooperate
Psychosocial Development Psychosocial Development (Erikson)(Erikson)
Identity vs. Role Confusion: Identity vs. Role Confusion: (12-18 yrs)(12-18 yrs) Forms identity and establishment Forms identity and establishment
of autonomy from parentsof autonomy from parents Peers, society big influencePeers, society big influence Encourage peer visitation, texting, Encourage peer visitation, texting,
phone callsphone calls
Intellectual Development Intellectual Development (Piaget)(Piaget)
Sensorimotor (birth to 2)Sensorimotor (birth to 2) learns from movement and sensory input.learns from movement and sensory input. learns cause & effectlearns cause & effect
Preoperational (2 to 7)Preoperational (2 to 7) Increasing curiosity and explorative behavior.Increasing curiosity and explorative behavior. Thinking is concreteThinking is concrete EgocentrismEgocentrism
Intellectual Development Intellectual Development (Piaget)(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 to Formal Operations (11 to 15 to adulthood)adulthood)Acquisition of abstract reasoning leading toAcquisition of abstract reasoning leading toAnalytical thinkingAnalytical thinkingProblem solvingProblem solvingPlanning for the futurePlanning for the future
Factors Influencing Factors Influencing Growth and Growth and DevelopmentDevelopment GeneticsGenetics EnvironmentEnvironment CultureCulture NutritionNutrition Health statusHealth status FamilyFamily Parental attitudesParental attitudes Child-rearing philosophiesChild-rearing philosophies
PlayPlay
Purpose of PlayPurpose of Play
Sensorimotor developmentSensorimotor development Intellectual developmentIntellectual development 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 Communicating with ChildrenChildren
InfancyInfancy
o Respond to physical contactRespond to physical contacto Gentle voiceGentle voiceo Sing-song qualitySing-song qualityo High pitchedHigh pitchedo Need to be held, cuddledNeed to be held, cuddled
Early Childhood < 7 Early Childhood < 7 yrsyrsegocentric, 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, be honestsentences, be 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 attentiongive undivided attention• listen, be open-mindedlisten, be open-minded• avoid criticizingavoid criticizing• make expectations clearmake expectations clear
Physical & Developmental Physical & Developmental AssessmentAssessment
Physical Exam Physical Exam GuidelinesGuidelines Non-threatening environmentNon-threatening environment Place frightening equipment out of sightPlace frightening equipment out of sight 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 Begin with the least intrusive Begin with the least intrusive
examination (observation)examination (observation)
Age-specific approaches to Age-specific approaches to examexam
InfantInfant: auscultate heart, lungs first (head : auscultate heart, lungs first (head to toe NOT always appropriate)to 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 : if cooperative: proceed head to toe, if not: same as toddlerto toe, 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 Pediatric Physical Exam: Key PointsExam: Key Points Growth measurementsGrowth measurements
Height, weight, Head circumference (<2 yrs)Height, weight, Head circumference (<2 yrs) 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-Screening Test (DDST-II)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 Child’s mood must be typical for results to be valid (results may be altered if to be valid (results may be altered if child is not feeling well, sedated)child is not feeling well, sedated)
Denver Developmental Denver Developmental Screening Test (DDST-Screening Test (DDST-II)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 monitoring, and to base a referral for additional developmental for additional developmental testingtesting
Nursing Interventions Nursing Interventions based on Developmental based on Developmental LevelLevel Infants (0-12m) Use soft voice, sing-song, Infants (0-12m) Use soft voice, sing-song,
talk to and describe procedures as they are talk to and describe procedures as they are donedone
Toddlers (1-2 yr) Separation anxiety peaks, Toddlers (1-2 yr) Separation anxiety peaks, seeing the nurse as a stranger increased seeing the nurse as a stranger increased anxiety: establish trust firstanxiety: establish trust 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 Preschool (3-5 yr) Explain procedures according to senses (what child will feel, see, according to senses (what child will feel, see, hear) Imagination is active...may see hear) Imagination is active...may see procedures as a consequence for procedures as a consequence for misbehaviormisbehavior
Nursing Interventions Nursing Interventions based on Developmental based on Developmental LevelLevel School-age (6-11 yr) Use books, pictures School-age (6-11 yr) Use books, pictures
to explain procedures, developmentally to explain procedures, developmentally ready for detailed explanations. ready for detailed explanations. Organizing and collecting is an enjoyed Organizing and collecting is an enjoyed activity, peers become more important activity, peers become more important
Adolescents (12 & up) Value privacy, Adolescents (12 & up) Value privacy, group identification is important, may group identification is important, may have an need for independence. Can have an need for independence. Can understand adult concepts and can be understand adult concepts and can be prepared for a procedure up to a week in prepared for a procedure up to a week in advanceadvance
Discipline (Limit Discipline (Limit Setting)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
Limit Setting and the Limit Setting and the ToddlerToddler
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 monthsInfancy 0-6 months
Breastmilk most desirableBreastmilk most desirable Fe fortified formula alternative.Fe fortified formula alternative.No whole milk until 1 yr b/cNo whole milk until 1 yr 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 may produce a food-protein allergyallergy
Extrusion reflex still present Extrusion reflex still present (pushes food out of mouth)(pushes food out of mouth)
Infancy 6-12 monthsInfancy 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 monthsInfancy 6-12 months
4- 6 mos infant cereal mixed with formula 4- 6 mos infant cereal mixed with formula or Breast milk (Rice, then oatmeal, barley)or Breast milk (Rice, then oatmeal, barley)
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 (pureed fruits and vegetables)Baby food (pureed fruits and vegetables) *** introduce one at a time at 4-7 day *** introduce one at a time at 4-7 day
intervalsintervals No Strawberries, eggs, peanutsNo Strawberries, eggs, peanuts
Infancy 6-12 monthsInfancy 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 By 1-year well-cooked table foods are served.foods are served.
ToddlerhoodToddlerhood
From 12-18 mos rate of growth From 12-18 mos rate of growth slows.slows.
At 18 mos decreased nutritional At 18 mos decreased nutritional need, appetite declines, picky need, appetite declines, picky eaters eaters
At 18 mos may be able to adeptly At 18 mos may be able to adeptly use spoon, prefer fingersuse spoon, 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.
PreschoolPreschool
Needs are similar to toddler.Needs are similar to toddler. Average daily intake: 1800 Average daily intake: 1800
calories.calories. By age 5 they are more By age 5 they are more
agreeable to try new foods; are agreeable to try new foods; are ready to socialize during meals.ready to 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 Important for parents to choose
foods that promotes growth.foods that promotes growth. Eat away from home.Eat away from home. Important to teach Food Pyramid Important to teach Food Pyramid
Guide for nutrition instruction.Guide for nutrition instruction. Encourage the child to make good Encourage the child to make good
choiceschoices..
AdolescenceAdolescence
Caloric & protein requirements Caloric & protein requirements are higher than almost any time are higher than almost any time in life.in life.
Eating habits easily influenced Eating habits easily influenced by peers.by peers.
Fad diets, high caloric foods Fad diets, high caloric foods low in nutritional value.low in nutritional value.
Care of the Care of the Hospitalized ChildHospitalized Child
““Atraumatic Care”Atraumatic Care”
Use of interventions that Use of interventions that eliminate or minimize eliminate or minimize psychological and physical psychological and physical distress that is experienced by distress that is experienced by children and their families in the children and their families in the health care systemhealth 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 in : increased independence in
managing own caremanaging own care
Stressors of HospitalizationStressors of Hospitalization
1.1. Separation AnxietySeparation Anxiety
2.2. Loss of ControlLoss of Control
3.3. Bodily Injury & PainBodily Injury & Pain
1. Separation Anxiety1. Separation Anxiety (Universal fear of toddler)(Universal fear of toddler) ProtestProtest: loud, demanding cries, rejects comfort : loud, demanding cries, rejects comfort
measuresmeasures
DespairDespair: lies on abdomen, flat facial expression, : lies on abdomen, flat facial expression, weight loss, insomnia, loss of developmental weight loss, insomnia, loss of developmental skillsskills
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 Diagnosis
Anxiety 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 & interactions with staff members & adherence to hospital routine, appropriate adherence to hospital routine, appropriate for age & stage of development.for age & stage of development.
Nursing InterventionsNursing Interventions Limit admissionsLimit admissions Limit hospital stayLimit hospital stay Reduce painReduce pain Adequately prepare child for proceduresAdequately prepare child for procedures 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
Children loose control over their:Children loose control over their:– RoutineRoutine– BodyBody– Basic decisionsBasic decisions– Loss of school, boredomLoss of school, boredom– Ability to socializeAbility to socialize
InterventionsInterventions
InfantsInfants: Provide consistent care: Provide consistent care ToddlersToddlers: maintain consistent routine: maintain consistent routine Toddlers often have security objects such as Toddlers often have security objects such as
a stuffed animal that help them feel safe and a stuffed animal that help them feel safe and securesecure
PreschoolersPreschoolers: need adequate preparation to : need adequate preparation to unfamiliar experiences, fear bodily injuryunfamiliar experiences, fear bodily injury
School-agedSchool-aged: provide schoolwork, social: provide schoolwork, social AdolescentsAdolescents: same as schoolage, privacy: same as schoolage, privacy
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 control.Allows making choices & being in control.
3. Bodily Injury3. Bodily Injury
Procedures are uncomfortableProcedures are uncomfortable
Disease processes are painfulDisease processes are painful
Postoperative pain can be very Postoperative pain can be very severesevere
Assess for PainAssess for Pain
InfantsInfants: watch facial expression, FLACC : watch facial expression, FLACC ToddlersToddlers: grimace, clench teeth, restless: grimace, clench teeth, restlessPreschoolersPreschoolers: can locate pain, use face : can locate pain, use face
scale, fear bodily injury & mutilation, scale, fear bodily injury & mutilation, literalliteral
School-agedSchool-aged: fear disability & death, pain : fear disability & death, pain is punishment, “magical quality” of is punishment, “magical quality” of germs, can use faces scalegerms, can use faces scale
AdolescentsAdolescents: use same pain scale as : use same pain scale as adultsadults
Pediatric Pain Pediatric Pain AssessmentAssessment
Pain is whatever the child experiencing it Pain is whatever the child experiencing it says it is”.says it is”.
Children are under-Children are under-medicated because of medicated because of these 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 parents do not want to be involved in
child’s pain controlchild’s pain control narcotics are more dangerous for narcotics are more dangerous for
childrenchildren
InterventionsInterventions
Nurses have an ethical obligation Nurses have an ethical obligation to relieve a child’s sufferingto relieve a child’s suffering
In addition adequate pain relief In addition adequate pain relief leads toleads to– earlier mobilizationearlier mobilization– shortened hospital staysshortened hospital stays– reduced costs.reduced costs.
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 valuate behavior & physiologic
changes.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.
InterventionsInterventions
Medicate for PainMedicate for Pain
Non Pharmacological TherapyNon Pharmacological Therapy– Cutaneous StimulationCutaneous Stimulation– DistractionDistraction– Guided ImageryGuided Imagery– Hot or Cold applicationHot or Cold application– Relaxation Relaxation
Hospitalization for all Hospitalization for all pediatric patientspediatric patients
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 Child will exhibit decreased fear
of bodily injury.of bodily injury.
Practice Questions!Practice Questions!
While the nurse is administering the While the nurse is administering the Denver Developmental Screening test to an Denver Developmental Screening test to an infant, a mother expresses concern that her infant, a mother expresses concern that her baby is not doing well. Which response is baby is not doing well. Which response is most appropriate for the nurse to make?most 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 Please let me finish this test before you start worrying, Maybe the baby will do start worrying, Maybe the baby will do better on the rest of the testbetter on the 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 The RN observes a nursing student entering a toddler’s room to check vital entering a toddler’s room to check vital signs and begins to take the child’s signs and begins to take the child’s temperature first. The RN should:temperature first. The RN should:
1.1. Suggest the student start with the pulseSuggest the student start with the pulse
2.2. Suggest the student start with the BPSuggest the student start with the BP
3.3. Suggest the student start with Suggest the student start with respirationsrespirations
4.4. Say nothing, this action is appropriateSay nothing, this action is appropriate
The nurse should teach parents of a The nurse should teach 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 to:developmental task of the preschooler is to:
1.1. Encourage the child to remove and put on Encourage the child to remove and put on own clothesown clothes
2.2. Knock on door before entering the child’s Knock on door before entering the child’s bedroombedroom
3.3. Plan for playtime and offer a variety of Plan for playtime and offer a variety of materials from which to choose.materials from which to choose.
4.4. Sing to, rock, and hold the child Sing to, rock, and hold the child consistentlyconsistently
A toddler who is to be hospitalized brings a A toddler who is to be hospitalized brings a dirty, ragged Barney stuffed animal with him. dirty, ragged Barney stuffed animal with him. The nurse’s most appropriate action is:The nurse’s most appropriate action is:
1.1. Ask the toddler’s parents to find an identical Ask the toddler’s parents to find an identical new Barney stuffed animalnew Barney stuffed animal
2.2. Remove Barney while the child is sleeping and Remove Barney while the child is sleeping and tell the child when he wakes that Barney is losttell the 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 Distract the toddler by taking him to the playroom and letting him select another stuffed playroom and letting him select another stuffed animalanimal
The mother of a preschooler The mother of a preschooler expresses disappointment when her expresses disappointment when her child’s weight has increased only 4 child’s weight has increased only 4 pounds since the child’s physical 1 pounds since the child’s physical 1 year ago. The nurse should advise this year ago. The nurse should advise this mother that:mother that:
1.1. A weight gain of 4-6 pounds/year is A weight gain of 4-6 pounds/year is normal for a preschoolernormal for a preschooler
2.2. The poor weight gain may be a result The poor weight gain may be a result of poor nutritionof poor nutrition
3.3. The poor weight gain may indicate a The poor weight gain may indicate a more serious problemmore serious problem
4.4. The weight gain is not ideal but may The weight gain is not ideal but may be nothing to worry about be nothing to worry about
The nurse should suggest that the best The nurse should suggest that the best way for a toddler’s parents to assist their way for a toddler’s parents to assist their child to complete the core developmental child to complete the core developmental task of the toddler years is to:task of 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” with choresAllow the toddler to “help” with chores3.3. 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 is preparing to change a The nurse is preparing to change a toddler’s wound for the first time. toddler’s wound for the first time. Prior to the dressing change the Prior to the dressing change the nurse uses a gauze as a “blanket” nurse uses a gauze as a “blanket” for the child’s action figure. This is for the child’s action figure. This is known as:known as:
1.1. Dramatic playDramatic play
2.2. FamiliarizationFamiliarization
3.3. Cooperative playCooperative play
4.4. Onlooker actionsOnlooker actions
A mother of a toddler is frustrated A mother of a toddler is frustrated and states “ I can’t get this child to and states “ I can’t get this child to eat!”. The nurse should help by eat!”. The nurse should help by reviewing the portion size for reviewing the portion size for toddlers is _____ of an adult’s portion.toddlers is _____ of an adult’s portion.
1. ¼2. 2/3
3. ½4. ¾
