NURSING 220Chapter 30 Basic Pediatric Nursing Care.
Chapter 30 Basic Pediatric Nursing
• 15. Discuss administration of pediatric medications.
Care Objectives
• 16. Discuss hazards and accident prevention in the pediatric population.
• 1. Identify events that were significant to the health care of children in
the United States in the 20th century. Key Terms
• 2. Discuss the works of Abraham Jacobi and Lillian Wald. anterior fontanelle (fŏn-tă-NĔL, p. 957)
anticipatory guidance (p. 937)
birth defects (congenital anomalies) (kŏn-JĔN-ĭ-tăl ă-NŎM-ă-lēz, p. 933)
• 3. Describe the purposes and outcomes of the White House body surface area (BSA) (p. 965)
Conferences on Children between 1909 and the 1980s. children with special needs (p. 934)
cognitive impairment (p. 936)
• 4. Discuss the personal characteristics and professional skills of en face position (ăhn FĂS, p. 941)
a successful pediatric nurse. family-centered care (p. 934)
morbidity (mŏr-BĬD-ĭ-tē, p. 968)
• 5. Identify key elements of family-centered care. mortality (mŏr-TĂL-ĭ-tē, p. 931)
primary (deciduous) teeth (dĕ-SĬD-ū-ŭs, p. 942)
vastus lateralis muscle (VĂS-tŭs lăt-ŭr-Ă-lĭs, p. 966)
• 6. Describe areas in which the pediatric nurse uses principles of
weaning (p. 945)
growth and development. http://evolve.elsevier.com/Cooper/foundationsadult/
• 7. Discuss how to use the head-to-toe method for the physical History of Child Care: Then and Now
assessment of a child.
In today's society, children are recognized as individuals with unique medical
• 8. Describe metabolism in the child and its relationship with nutrition. needs that are different than those of adults. The care of children, however, has not
always been viewed as involving an important stage of life. For centuries, children
• 9. List general strategies to consider when talking with children. were considered miniature adults.
In colonial America, children had to assume adult responsibilities as soon as they
• 10. Describe the three categories of child abuse. were capable. The value of children was related directly to the work they could
perform. Infant and childhood mortality (or death) rates were high. Epidemic
diseases were common, and there was no control over or treatment for such
• 11. Outline several approaches for making the hospitalization of children
diseases as smallpox, diphtheria, measles, dysentery, mumps, chickenpox, yellow
a positive experience for them and their families. fever, cholera, or whooping cough. Farm accidents and burns from open
fireplaces and gunpowder also contributed to high mortality rates.
• 12. Discuss pain management in infants and children. Industrialization in America resulted in a population shift from rural to urban
settings, where people lived in overcrowded and unsanitary conditions. Oftentimes,
• 13. Explain the needs of parents during their child's hospitalization. unsanitary conditions were caused by lack of knowledge about how disease occurs.
For instance, milk was not refrigerated and contained hundreds of millions of
• 14. Discuss common pediatric procedures. bacteria, which contributed to the development of diarrhea and tuberculosis.
Children were treated as adults and worked in factories 12 to 14 hours a day. They
1
,NURSING 220Chapter 30 Basic Pediatric Nursing Care.
had no legal rights, and there were no work laws. Family life was sacrificed, and on Children was called in 1930 to study the economic effects of the Great
the real issue was survival. Depression on the health and well-being of children. Thereafter, a conference was
Children's health care needs were not considered to be different from those of held at the beginning of each decade until the 1980s. These conferences have been
adults until 1860, when Abraham Jacobi, a New York physician referred to as the responsible over the years for many changes in child health and welfare, including
“father of pediatrics,” first lectured to medical students on the special diseases and funding for essential programs, legislation, and shifting the focus from treatment of
health problems of children. With several other physicians, Dr. Jacobi pioneered diseases to preventive health care. Attendees were professionals who worked with
the scientific and clinical investigation of childhood diseases. One outstanding children, representatives of federal and state agencies and volunteer organizations,
achievement during Dr. Jacobi's era was the establishment of “milk stations,” and members of various citizen groups. Although the group did not have
where infants were weighed and mothers were taught how to prepare milk before legislative powers, together its members raised the consciousness of public
giving it to their babies. Mothers also had access to nurses who taught them the officials and private citizens regarding the status of children and families.
benefits of fresh air, clean water, and adequate clothing and how to satisfy the The United States did not recover from the Great Depression for many years. In the
recreational needs of children. The crusade for pure milk resulted in improved interim, the Children's Bureau was able to propose legislation to assist children.
sanitation, the pasteurization of milk, and increased interest in infant care. Despite Some of the most remarkable pieces of legislation were those authorized by the
a remarkable decline in infant mortality rate, 20% of children still died before their Social Security Act of 1937, which was signed by President Franklin D. Roosevelt.
second birthday, and 50% died before age 21. The health care needs of children were incorporated into the provisions of Title V,
During the late 1800s, increasing concern developed for the social welfare of Maternal and Child Health Services, which among other accomplishments
children, especially those who were homeless or employed as factory laborers. recognized for the first time the needs of disabled children. Another important
Reformer Lillian Wald (1867–1940) founded the Henry Street Settlement in New milestone was the Women, Infants, and Children (WIC) program, which opened
York City, which provided nursing services, social work, and an organized its first distribution site in 1974. WIC offers assistance with food and nutrition
program of social, cultural, and educational activities. She is regarded as the counseling for low-income pregnant, breastfeeding, and non-breastfeeding
founder of public health or community nursing, and her work had far-reaching postpartum women and infants and children under the age of 5 years.
effects on child health and nursing. Today the Office of Child Development, established in 1967, oversees children's
As medical and scientific advances revealed more causes of disease, emphasis programs. It houses the Children's Bureau and the Bureau of Child Development
came to be placed on isolation and asepsis. In the early 1900s, children with Services, which operates such programs as Head Start. The Secretary of Health and
contagious disease were isolated from adult patients. Parents were prohibited from Human Services is the cabinet officer responsible for all of their activities. In
visiting because of the possibility of transmitting disease to and from home. The December 1987, the United States Congress and President Ronald Reagan created
works of Spitz (1945) and Robertson (1990) on institutionalized children helped the National Commission on Children to serve as a forum on behalf of the children
health care professionals recognize how isolation and maternal deprivation
affected children. The growing interest in the psychological health of children
resulted in changes for hospitalized children, such as rooming in, of the nation. In May 1991, after years of intensive investigation and
prehospitalization, parent education, and hospital schooling. deliberation, the 34-member commission concluded that the United States was
Influenced by social reformers such as Lillian Wald, national leaders began to take failing many of its children. For example, the proportion of children who were not
action to improve children's living conditions. In 1909, President Theodore adequately immunized for preventable childhood diseases had increased
Roosevelt called the first White House Conference on Children. The conference dramatically since the early 1980s. Lack of immunization resulted in 26,500 cases
focused on such issues as child labor, dependent children, and infant care. In 1912, of measles and 60 deaths from measles in 1990. The commission's final report
the U.S. Children's Bureau was established as a direct result of that conference. Its listed numerous recommendations for addressing pressing children's issues, such
charge was to investigate all aspects of child care, including infant mortality, child as the need to ensure income security, improve health, increase educational
labor laws, conditions of social agencies, and the country's birthrate. achievement, prepare adolescents for adulthood, strengthen and support families,
The second White House Conference on Children convened in 1919, after World and protect vulnerable children and their families.
War I. This conference addressed the socioeconomic situation of mothers and Children are the focus of many of our century's reform initiatives, and solutions
children and resulted in the first federally supported health programs for mothers are sure to emphasize collaboration between various disciplines. For example,
and children. The Great Depression of 1929 paralyzed the United States and violence, once considered solely a criminal justice problem, is now acknowledged
resulted in devastating social and economic conditions. A White House Conference as a preventable public health problem. The most effective solutions for this and
2
,NURSING 220Chapter 30 Basic Pediatric Nursing Care.
other multifaceted problems require the expertise of health care professionals, and pediatric patients
law enforcement and criminal justice officials, social workers, economists, and
educators.
Pediatric Nursing
The nursing of infants and children is consistent with the revised definition of
nursing proposed by the Social Policy Task Force of the American Nurses
Association (ANA) in 2003. The definition states that “nursing is the prevention of
illness, the alleviation of suffering, and the protection, promotion, and restoration
of health in the care of individuals, families, groups, communities, and
populations” (ANA, 2003). This definition incorporates the four essential features
of nursing practice:
• 1.Attention to the full range of human experiences and responses to health
and illness without restriction to a problem-focused orientation
• 2.Integration of objective data with knowledge gained from an
understanding of the patient or the group's subjective experience
• 3.Application of scientific knowledge to the processes of diagnosis
and treatment
• 4.Provision of a caring relationship that facilitates health and healing
The purpose of pediatric nursing is to promote the highest possible state of health
in each child by: (1) preventing disease or injury; (2) assisting children, including
those with a permanent disability or health problem, to achieve and maintain an
optimal level of health and development; and (3) treating or rehabilitating
children who have deviations from an optimal state of health.
Characteristics of a Pediatric Nurse
Pediatric nursing is different from other clinical specialties. First, the nurse must
enjoy working with children of all ages. Second, when a child has a health
problem, the child, the family, and the disease become a nursing concern; none
can be separated from the other two. Pediatric nursing is family-centered nursing
in its truest sense. It is important for the family to be totally involved and have a
feeling of control over the decision making concerning their child's health care.
The nurse must be able to provide care to the child while also identifying family
stressors and providing care for other members of the family. Working with
3
, NURSING 220Chapter 30 Basic Pediatric Nursing Care.
requires the nurse to have specialized skills, including excellent assessment injuries or disabilities are now surviving. These are children who never would have
skills, the ability to establish trust, teaching ability, and the ability to serve as a
patient advocate.
By watching children play or perform certain tasks, the nurse must be able to
assess their developmental ages. In addition, not all birth defects (congenital
anomalies) (any abnormality present at birth, particularly a structural one, that is
possible to inherit genetically, acquire during gestation, or acquire during the
parturition [process of giving birth]) are diagnosed in the neonatal period.
Sometimes the nurse identifies a problem as a result of the nursing assessment.
When children are very ill, minor changes in their physical status sometimes
result in a variety of complications; therefore, any changes must be noted as early
as possible.
Often the nurse is involved in supporting a child through a difficult procedure or
serious illness. Such an endeavor not only includes preparation for the event but
also requires a level of trust that permits children to express their fear,
apprehension, and anxiety. To establish a trusting relationship, the nurse should
convey respect to children, talk with them at a level they are able to understand,
and, most importantly, be honest.
Teaching is ongoing in pediatrics and can take many forms. Innumerable
opportunities are available to help children and parents adapt to a chronic illness
or disorder but require a nurse's knowledge of community resources or volunteer
agencies.
The nurse needs to be aware of the indirect teaching that occurs through
example. A pediatric nurse serves as a role model for children by demonstrating
appropriate health promotion and prevention behaviors, such as maintaining
good nutrition, a healthy lifestyle, and personal hygiene, and for parents by
exhibiting age- appropriate responses to children.
Another role the nurse fills is that of child and family advocate, whether the
situation involves ethical decision making or has more to do with the quality of
care given. Sometimes this takes the form of coordinating the activities of a
health team and collaborating with members of different disciplines to provide a
child with the expert care that is necessary.
The ability to communicate effectively with a child is essential. However, to
enjoy and continue working in pediatrics, what the nurse needs most is the
ability to recognize and appreciate the uniqueness that each child or adolescent
brings to the nurse-patient relationship. It is that special quality—uniqueness—
that anyone who provides care for children is called on to understand, respect,
and cherish.
Children with Special Needs
Medical advances over the past two decades have resulted in significant changes
in the pediatric population. Fragile or premature infants and children with severe
4
Chapter 30 Basic Pediatric Nursing
• 15. Discuss administration of pediatric medications.
Care Objectives
• 16. Discuss hazards and accident prevention in the pediatric population.
• 1. Identify events that were significant to the health care of children in
the United States in the 20th century. Key Terms
• 2. Discuss the works of Abraham Jacobi and Lillian Wald. anterior fontanelle (fŏn-tă-NĔL, p. 957)
anticipatory guidance (p. 937)
birth defects (congenital anomalies) (kŏn-JĔN-ĭ-tăl ă-NŎM-ă-lēz, p. 933)
• 3. Describe the purposes and outcomes of the White House body surface area (BSA) (p. 965)
Conferences on Children between 1909 and the 1980s. children with special needs (p. 934)
cognitive impairment (p. 936)
• 4. Discuss the personal characteristics and professional skills of en face position (ăhn FĂS, p. 941)
a successful pediatric nurse. family-centered care (p. 934)
morbidity (mŏr-BĬD-ĭ-tē, p. 968)
• 5. Identify key elements of family-centered care. mortality (mŏr-TĂL-ĭ-tē, p. 931)
primary (deciduous) teeth (dĕ-SĬD-ū-ŭs, p. 942)
vastus lateralis muscle (VĂS-tŭs lăt-ŭr-Ă-lĭs, p. 966)
• 6. Describe areas in which the pediatric nurse uses principles of
weaning (p. 945)
growth and development. http://evolve.elsevier.com/Cooper/foundationsadult/
• 7. Discuss how to use the head-to-toe method for the physical History of Child Care: Then and Now
assessment of a child.
In today's society, children are recognized as individuals with unique medical
• 8. Describe metabolism in the child and its relationship with nutrition. needs that are different than those of adults. The care of children, however, has not
always been viewed as involving an important stage of life. For centuries, children
• 9. List general strategies to consider when talking with children. were considered miniature adults.
In colonial America, children had to assume adult responsibilities as soon as they
• 10. Describe the three categories of child abuse. were capable. The value of children was related directly to the work they could
perform. Infant and childhood mortality (or death) rates were high. Epidemic
diseases were common, and there was no control over or treatment for such
• 11. Outline several approaches for making the hospitalization of children
diseases as smallpox, diphtheria, measles, dysentery, mumps, chickenpox, yellow
a positive experience for them and their families. fever, cholera, or whooping cough. Farm accidents and burns from open
fireplaces and gunpowder also contributed to high mortality rates.
• 12. Discuss pain management in infants and children. Industrialization in America resulted in a population shift from rural to urban
settings, where people lived in overcrowded and unsanitary conditions. Oftentimes,
• 13. Explain the needs of parents during their child's hospitalization. unsanitary conditions were caused by lack of knowledge about how disease occurs.
For instance, milk was not refrigerated and contained hundreds of millions of
• 14. Discuss common pediatric procedures. bacteria, which contributed to the development of diarrhea and tuberculosis.
Children were treated as adults and worked in factories 12 to 14 hours a day. They
1
,NURSING 220Chapter 30 Basic Pediatric Nursing Care.
had no legal rights, and there were no work laws. Family life was sacrificed, and on Children was called in 1930 to study the economic effects of the Great
the real issue was survival. Depression on the health and well-being of children. Thereafter, a conference was
Children's health care needs were not considered to be different from those of held at the beginning of each decade until the 1980s. These conferences have been
adults until 1860, when Abraham Jacobi, a New York physician referred to as the responsible over the years for many changes in child health and welfare, including
“father of pediatrics,” first lectured to medical students on the special diseases and funding for essential programs, legislation, and shifting the focus from treatment of
health problems of children. With several other physicians, Dr. Jacobi pioneered diseases to preventive health care. Attendees were professionals who worked with
the scientific and clinical investigation of childhood diseases. One outstanding children, representatives of federal and state agencies and volunteer organizations,
achievement during Dr. Jacobi's era was the establishment of “milk stations,” and members of various citizen groups. Although the group did not have
where infants were weighed and mothers were taught how to prepare milk before legislative powers, together its members raised the consciousness of public
giving it to their babies. Mothers also had access to nurses who taught them the officials and private citizens regarding the status of children and families.
benefits of fresh air, clean water, and adequate clothing and how to satisfy the The United States did not recover from the Great Depression for many years. In the
recreational needs of children. The crusade for pure milk resulted in improved interim, the Children's Bureau was able to propose legislation to assist children.
sanitation, the pasteurization of milk, and increased interest in infant care. Despite Some of the most remarkable pieces of legislation were those authorized by the
a remarkable decline in infant mortality rate, 20% of children still died before their Social Security Act of 1937, which was signed by President Franklin D. Roosevelt.
second birthday, and 50% died before age 21. The health care needs of children were incorporated into the provisions of Title V,
During the late 1800s, increasing concern developed for the social welfare of Maternal and Child Health Services, which among other accomplishments
children, especially those who were homeless or employed as factory laborers. recognized for the first time the needs of disabled children. Another important
Reformer Lillian Wald (1867–1940) founded the Henry Street Settlement in New milestone was the Women, Infants, and Children (WIC) program, which opened
York City, which provided nursing services, social work, and an organized its first distribution site in 1974. WIC offers assistance with food and nutrition
program of social, cultural, and educational activities. She is regarded as the counseling for low-income pregnant, breastfeeding, and non-breastfeeding
founder of public health or community nursing, and her work had far-reaching postpartum women and infants and children under the age of 5 years.
effects on child health and nursing. Today the Office of Child Development, established in 1967, oversees children's
As medical and scientific advances revealed more causes of disease, emphasis programs. It houses the Children's Bureau and the Bureau of Child Development
came to be placed on isolation and asepsis. In the early 1900s, children with Services, which operates such programs as Head Start. The Secretary of Health and
contagious disease were isolated from adult patients. Parents were prohibited from Human Services is the cabinet officer responsible for all of their activities. In
visiting because of the possibility of transmitting disease to and from home. The December 1987, the United States Congress and President Ronald Reagan created
works of Spitz (1945) and Robertson (1990) on institutionalized children helped the National Commission on Children to serve as a forum on behalf of the children
health care professionals recognize how isolation and maternal deprivation
affected children. The growing interest in the psychological health of children
resulted in changes for hospitalized children, such as rooming in, of the nation. In May 1991, after years of intensive investigation and
prehospitalization, parent education, and hospital schooling. deliberation, the 34-member commission concluded that the United States was
Influenced by social reformers such as Lillian Wald, national leaders began to take failing many of its children. For example, the proportion of children who were not
action to improve children's living conditions. In 1909, President Theodore adequately immunized for preventable childhood diseases had increased
Roosevelt called the first White House Conference on Children. The conference dramatically since the early 1980s. Lack of immunization resulted in 26,500 cases
focused on such issues as child labor, dependent children, and infant care. In 1912, of measles and 60 deaths from measles in 1990. The commission's final report
the U.S. Children's Bureau was established as a direct result of that conference. Its listed numerous recommendations for addressing pressing children's issues, such
charge was to investigate all aspects of child care, including infant mortality, child as the need to ensure income security, improve health, increase educational
labor laws, conditions of social agencies, and the country's birthrate. achievement, prepare adolescents for adulthood, strengthen and support families,
The second White House Conference on Children convened in 1919, after World and protect vulnerable children and their families.
War I. This conference addressed the socioeconomic situation of mothers and Children are the focus of many of our century's reform initiatives, and solutions
children and resulted in the first federally supported health programs for mothers are sure to emphasize collaboration between various disciplines. For example,
and children. The Great Depression of 1929 paralyzed the United States and violence, once considered solely a criminal justice problem, is now acknowledged
resulted in devastating social and economic conditions. A White House Conference as a preventable public health problem. The most effective solutions for this and
2
,NURSING 220Chapter 30 Basic Pediatric Nursing Care.
other multifaceted problems require the expertise of health care professionals, and pediatric patients
law enforcement and criminal justice officials, social workers, economists, and
educators.
Pediatric Nursing
The nursing of infants and children is consistent with the revised definition of
nursing proposed by the Social Policy Task Force of the American Nurses
Association (ANA) in 2003. The definition states that “nursing is the prevention of
illness, the alleviation of suffering, and the protection, promotion, and restoration
of health in the care of individuals, families, groups, communities, and
populations” (ANA, 2003). This definition incorporates the four essential features
of nursing practice:
• 1.Attention to the full range of human experiences and responses to health
and illness without restriction to a problem-focused orientation
• 2.Integration of objective data with knowledge gained from an
understanding of the patient or the group's subjective experience
• 3.Application of scientific knowledge to the processes of diagnosis
and treatment
• 4.Provision of a caring relationship that facilitates health and healing
The purpose of pediatric nursing is to promote the highest possible state of health
in each child by: (1) preventing disease or injury; (2) assisting children, including
those with a permanent disability or health problem, to achieve and maintain an
optimal level of health and development; and (3) treating or rehabilitating
children who have deviations from an optimal state of health.
Characteristics of a Pediatric Nurse
Pediatric nursing is different from other clinical specialties. First, the nurse must
enjoy working with children of all ages. Second, when a child has a health
problem, the child, the family, and the disease become a nursing concern; none
can be separated from the other two. Pediatric nursing is family-centered nursing
in its truest sense. It is important for the family to be totally involved and have a
feeling of control over the decision making concerning their child's health care.
The nurse must be able to provide care to the child while also identifying family
stressors and providing care for other members of the family. Working with
3
, NURSING 220Chapter 30 Basic Pediatric Nursing Care.
requires the nurse to have specialized skills, including excellent assessment injuries or disabilities are now surviving. These are children who never would have
skills, the ability to establish trust, teaching ability, and the ability to serve as a
patient advocate.
By watching children play or perform certain tasks, the nurse must be able to
assess their developmental ages. In addition, not all birth defects (congenital
anomalies) (any abnormality present at birth, particularly a structural one, that is
possible to inherit genetically, acquire during gestation, or acquire during the
parturition [process of giving birth]) are diagnosed in the neonatal period.
Sometimes the nurse identifies a problem as a result of the nursing assessment.
When children are very ill, minor changes in their physical status sometimes
result in a variety of complications; therefore, any changes must be noted as early
as possible.
Often the nurse is involved in supporting a child through a difficult procedure or
serious illness. Such an endeavor not only includes preparation for the event but
also requires a level of trust that permits children to express their fear,
apprehension, and anxiety. To establish a trusting relationship, the nurse should
convey respect to children, talk with them at a level they are able to understand,
and, most importantly, be honest.
Teaching is ongoing in pediatrics and can take many forms. Innumerable
opportunities are available to help children and parents adapt to a chronic illness
or disorder but require a nurse's knowledge of community resources or volunteer
agencies.
The nurse needs to be aware of the indirect teaching that occurs through
example. A pediatric nurse serves as a role model for children by demonstrating
appropriate health promotion and prevention behaviors, such as maintaining
good nutrition, a healthy lifestyle, and personal hygiene, and for parents by
exhibiting age- appropriate responses to children.
Another role the nurse fills is that of child and family advocate, whether the
situation involves ethical decision making or has more to do with the quality of
care given. Sometimes this takes the form of coordinating the activities of a
health team and collaborating with members of different disciplines to provide a
child with the expert care that is necessary.
The ability to communicate effectively with a child is essential. However, to
enjoy and continue working in pediatrics, what the nurse needs most is the
ability to recognize and appreciate the uniqueness that each child or adolescent
brings to the nurse-patient relationship. It is that special quality—uniqueness—
that anyone who provides care for children is called on to understand, respect,
and cherish.
Children with Special Needs
Medical advances over the past two decades have resulted in significant changes
in the pediatric population. Fragile or premature infants and children with severe
4
