VERSION 1
NR 328 PEDS EXAM 1 STUDY GUIDE
INTRO TO PEDIATRICS/FAMILY/CHRONIC ILLNESSES:
● Describe atraumatic care
o Eliminating or minimizing the pain and/or psychological stress of receiving care
▪ 3 Principles:
● Prevent or minimize child’s separation from family
o Allowing parents present during a code; performing an assessment while child is
in parent’s arms
● Promote a sense of control
o Give them choices, choices we can live with; meds before or after bath, before or
after meals; how they take meds—syringe or PO; where and how to do an
intervention, not if an intervention should be done
● Prevent or minimize bodily injury and pain
o Do labs now or in morning, combining sticks
● Identify the essential elements of the transition to parenting
o Parental age
▪ 18-35 “ideal” age
● 30-44 yrs is on the increase
● 20-29 yrs is on the decrease
o Father involvement
▪ Or another involved adult; another man; non-biological father; same-sex relationships
o Parenting education
▪ How prepared were the parents? Baby classes? Books?
▪ Education level? High school or college education?
o Support systems
▪ Internal resources
● Internal ability to adapt to change easily. Can they cope well to a chaotic environment?
● Experience with other children?
● Stress level before the child was there?
● Kiddos temperament? High needs child?
● Marriage or relationship quality?
▪ Coping strategies
● Coping mechanisms
● Antidepressant drugs
o Other factors
● Describe the role that effective discipline plays in a child’s development
o Discipline needs to be developmentally appropriate not necessarily ‘age’ appropriate
o TIMING
o COMMITMENT
o PLANNING
o Children want/need limits set for them even in hospital setting
o Children need encouragement and modeled appropriate behavior whether child is ill or not
o Need CONSISTENCY between caregivers
o Before child reaches 4,5 and 6 years of age when a child may experience embarrassment—child should
be disciplined in PRIVATE
o FLEXIBILITY/PLANNING—need a plan but plan may not be right for particular incidence; plan may not
be right for every child
o BEHAVIOR ORIENTATION—behavior is bad, not the child
o TERMINATION—when the crime has been done and the punishment paid, DO NOT continue to bring it
up. It’s over and done with
● Stages of divorce
o Acute Phase
1
, ▪ Make the decision
▪ Legal steps
o Transitional Phase
▪ Unfamiliar roles and relationships
▪ Many changes
● Living arrangements
● Decreased standard of living
o Stabilizing Phase
▪ Reestablish a functioning family unit
● Effects of divorce—listen to podcast again
o Infancy: change in sleeping and eating patterns, irritable
o Early preschool (2-3): frightened, confused, fear of abandonment, aggressive behaviors
o Later preschool (3-5): blames themselves, fear of abandonment, aggressive towards others
o Early school age (5-6): depression, loss of appetite, increase anxiety
o Middle school age (6-8): strong sense of panic, angry at one or both of parents
o Later school age (9-12): have a better understanding of what is happening, embarrassed, intense angry
or revenge against one parent
o Adolescents (12-18): recognize what’s going on,
made be pleased,
● Discuss major stressors of hospitalized children
o Diagnosis
▪ Parental adjustments
● Denial/Shock
● Anger
● Bargaining
● Depression
● Acceptance
o Developmental milestones—parents may return to
any of the stages at any time
▪ When a ill child turns 1 but isn’t walking; or
when a child turns 8 and is only ever going to
have a cognitive level of the age of 4; when a child should be starting school and has to attend a
special school; adolescents—a child should be gaining more independence but the child is still
very dependent on parent’ when child eventually passes
o Start of schooling
o Reaching the ultimate attainment
o Adolescence
o Future placement
o Death of the child
● Explain the nurse’s role in minimizing these stressors
● Nurses can build a relationship with a child, communicate effectively, playing, incentives, rewards,
positive talk, support, counseling, encouragement
● Discuss the impact of chronic illness on the child
o Siblings: promote healthy relationship, avoid comparisons, teach the well sibling how to interact with the
sick child, involve the well sibling in the patient care
o Factors that increase the risk for negative effects:
▪ Responsibility for care giving
▪ Differential treatment by parents
▪ Limitations in family resources and recreational time
o Ways to support siblings:
▪ Promote healthy sibling relationships
▪ Help siblings cope
▪ Involve siblings
● Discuss how a chronic condition can affect child development
o A child with a chronic condition most likely lives differently than a child without a chronic condition. Their
daily life may include doctor visits, therapy, pain, ect. Many kids with chronic conditions may have social
anxiety due to them not interacting as much as other children their age. Chronic conditions affect social
development and its recommended that children join support groups or get involved in social activities
● Identify the patterns of coping of the family with a child with a chronic illness
o Involve family and siblings in the plan of care for the ill child
2
,● List nursing goals in chronic illness and discuss age-related strategies to promote growth and
development and psychosocial adaptation.
o Nursing goals in chronic illness: Children will have a positive outlook, children will act and be
developed age appropriately.
o Age related strategies to promote growth and development: Join social/support groups, journaling,
encouraging day care and attending school and school related activities, playing sports that doesn't
interfere with the overall health of the child.
● Discuss pain assessment of children
● Behavioral pain measures are generally used from infancy to 4 years of age. This more time consuming
due to that an observer watches and observes a child’s behaviors, such as: sounds associated with pain, changes
in facial expression, and body movements that express discomfort. An observer must understand the different
behaviors. Ex: F.L.A.C.C .pain assessment scale. (pg. 152)
● The COMFORT pain assessment scale is recommended in critical care settings on patients that are
unconscious or on ventilators. (pg. 152)
● A self-report pain scale is generally used for patients over 5 years of age. This is the Wong and Baker
pain assessment scale
● For children 8 years of age and older, a numeric scale can be used.
● Neonate’s pain assessment is a combination of behavioral and physiologic signs to determine pain level.
The CRIES pain assessment scale is most common.
● Develop a nursing care plan for the child in pain
o Pain and suffering
▪ Pain management is the HIGHEST priority
▪ Regular schedule for pain medications with orders for breath-through pain
▪ Children will ask if dying hurts? We don’t know—be honest and tell them if you’re in pain tell me
and we will help alleviate your pain
o Dying alone (child) or not being present when child dies (Parent)
▪ Help child have death they desire
▪ They may want/need someone at the bedside—will hold on until that person is at the bedside
o Actual death itself
▪ Home death
▪ Hospital death
● Discuss non-pharmacologic and pharmacologic management of pain in children
● Genetics
o Chromosomal abnormalities
▪ Numeric and structural changes in normal pattern
▪ 25% of all genetic disorders
▪ 46 chromosomes; 23 pairs
o Single-gene defects
▪ Caused by mutation of a single gene
▪ CF or hemophilia
o Complex (multifactorial) disorders
▪ Individual has a certain genetic predisposition
o Causes:
▪ Radiation
▪ Autoimmune disease
▪ Viruses
▪ Parental age
● Chromosomal abnormalities
o Autosomal
▪ Non-sex chromosomes
▪ Usually have some kind of mental deficiencies
▪ Down’s Syndrome
o Sex Chromosomes:
▪ No or less severe mental deficiencies
▪ X or Y defects
▪ Turner’s/Klinefelter’s
● Describe the major historical and societal changes that have had an impact on children’s health care.
3
, Discuss the role of the pediatric nurse in acute care, outpatient, rehabilitative and community settings,
and society
o Nurses support families in their natural caregiving and decision-making roles by building on their unique
strengths and acknowledging their expertise in caring for their child both within and outside the hospital
setting. The nurse considers the needs of all family members in relation to the care of the child.
Other Roles
Therapeutic relationships
Family advocate
Disease Prevention/Health Promotion
Teacher
Counselor
Coordination/Collaboration
Research
Describe hereditary influences on health promotion of the child and family.
o We can now screen for many of these diseases and attempt to fix the problem or prepare the family.
Discuss therapeutic management of genetic disease.
o Therapy for genetic disease is currently aimed at correcting the phenotypic expression of gene
abnormalities, and therefore the major goal of therapy is modification of the internal or external
environment to correct or minimize the effects of the genetic defect.
Describe the role of nurses in genetic counseling.
o The professional practice domains include applying/integrating genetic knowledge into nursing
assessment; identifying and referring clients who may benefit from genetic information or services;
identifying genetics resources and services to meet clients' needs; and providing care and support before,
during, and after providing genetic information and/or services. Often a nurse is the first one to recognize
the need for genetic evaluation by identifying an inherited disorder in a family history or by noting
physical, cognitive, or behavioral abnormalities when performing a nursing assessment
GROWTH and DEVELOPMENT:
● List the principles of growth and development and give examples of each
o Growth—getting bigger, increase in number and size of cells
o Development—gradual advancement from a lower to more advanced stage of complexity—psychosocial,
mental, etc.
o Stages of Development: (4)
▪ Infancy
● Birth to 12 months
▪ Early Childhood
● 1-6 years
● Toddlerhood (1-2)
● Preschool (3-4)
● Early school (5-6)
▪ Middle Childhood
● 6-12 years
● Tweeners (10-12) prepubescent stages
▪ Later Childhood
● 11-12; 13+
● adolescents
o Patterns
▪ Directional trends
● Typically grow and develop in a specific
● Grow head to toe—cephalocaudal; head to toe
● Proximodistal—develop core/midline first
● Differentiation—general to specific; simple to complex
▪ Sequential trends
● An order in development
● Crawl before you walk
▪ Developmental pace
● Individualized
▪ Sensitive periods
4
NR 328 PEDS EXAM 1 STUDY GUIDE
INTRO TO PEDIATRICS/FAMILY/CHRONIC ILLNESSES:
● Describe atraumatic care
o Eliminating or minimizing the pain and/or psychological stress of receiving care
▪ 3 Principles:
● Prevent or minimize child’s separation from family
o Allowing parents present during a code; performing an assessment while child is
in parent’s arms
● Promote a sense of control
o Give them choices, choices we can live with; meds before or after bath, before or
after meals; how they take meds—syringe or PO; where and how to do an
intervention, not if an intervention should be done
● Prevent or minimize bodily injury and pain
o Do labs now or in morning, combining sticks
● Identify the essential elements of the transition to parenting
o Parental age
▪ 18-35 “ideal” age
● 30-44 yrs is on the increase
● 20-29 yrs is on the decrease
o Father involvement
▪ Or another involved adult; another man; non-biological father; same-sex relationships
o Parenting education
▪ How prepared were the parents? Baby classes? Books?
▪ Education level? High school or college education?
o Support systems
▪ Internal resources
● Internal ability to adapt to change easily. Can they cope well to a chaotic environment?
● Experience with other children?
● Stress level before the child was there?
● Kiddos temperament? High needs child?
● Marriage or relationship quality?
▪ Coping strategies
● Coping mechanisms
● Antidepressant drugs
o Other factors
● Describe the role that effective discipline plays in a child’s development
o Discipline needs to be developmentally appropriate not necessarily ‘age’ appropriate
o TIMING
o COMMITMENT
o PLANNING
o Children want/need limits set for them even in hospital setting
o Children need encouragement and modeled appropriate behavior whether child is ill or not
o Need CONSISTENCY between caregivers
o Before child reaches 4,5 and 6 years of age when a child may experience embarrassment—child should
be disciplined in PRIVATE
o FLEXIBILITY/PLANNING—need a plan but plan may not be right for particular incidence; plan may not
be right for every child
o BEHAVIOR ORIENTATION—behavior is bad, not the child
o TERMINATION—when the crime has been done and the punishment paid, DO NOT continue to bring it
up. It’s over and done with
● Stages of divorce
o Acute Phase
1
, ▪ Make the decision
▪ Legal steps
o Transitional Phase
▪ Unfamiliar roles and relationships
▪ Many changes
● Living arrangements
● Decreased standard of living
o Stabilizing Phase
▪ Reestablish a functioning family unit
● Effects of divorce—listen to podcast again
o Infancy: change in sleeping and eating patterns, irritable
o Early preschool (2-3): frightened, confused, fear of abandonment, aggressive behaviors
o Later preschool (3-5): blames themselves, fear of abandonment, aggressive towards others
o Early school age (5-6): depression, loss of appetite, increase anxiety
o Middle school age (6-8): strong sense of panic, angry at one or both of parents
o Later school age (9-12): have a better understanding of what is happening, embarrassed, intense angry
or revenge against one parent
o Adolescents (12-18): recognize what’s going on,
made be pleased,
● Discuss major stressors of hospitalized children
o Diagnosis
▪ Parental adjustments
● Denial/Shock
● Anger
● Bargaining
● Depression
● Acceptance
o Developmental milestones—parents may return to
any of the stages at any time
▪ When a ill child turns 1 but isn’t walking; or
when a child turns 8 and is only ever going to
have a cognitive level of the age of 4; when a child should be starting school and has to attend a
special school; adolescents—a child should be gaining more independence but the child is still
very dependent on parent’ when child eventually passes
o Start of schooling
o Reaching the ultimate attainment
o Adolescence
o Future placement
o Death of the child
● Explain the nurse’s role in minimizing these stressors
● Nurses can build a relationship with a child, communicate effectively, playing, incentives, rewards,
positive talk, support, counseling, encouragement
● Discuss the impact of chronic illness on the child
o Siblings: promote healthy relationship, avoid comparisons, teach the well sibling how to interact with the
sick child, involve the well sibling in the patient care
o Factors that increase the risk for negative effects:
▪ Responsibility for care giving
▪ Differential treatment by parents
▪ Limitations in family resources and recreational time
o Ways to support siblings:
▪ Promote healthy sibling relationships
▪ Help siblings cope
▪ Involve siblings
● Discuss how a chronic condition can affect child development
o A child with a chronic condition most likely lives differently than a child without a chronic condition. Their
daily life may include doctor visits, therapy, pain, ect. Many kids with chronic conditions may have social
anxiety due to them not interacting as much as other children their age. Chronic conditions affect social
development and its recommended that children join support groups or get involved in social activities
● Identify the patterns of coping of the family with a child with a chronic illness
o Involve family and siblings in the plan of care for the ill child
2
,● List nursing goals in chronic illness and discuss age-related strategies to promote growth and
development and psychosocial adaptation.
o Nursing goals in chronic illness: Children will have a positive outlook, children will act and be
developed age appropriately.
o Age related strategies to promote growth and development: Join social/support groups, journaling,
encouraging day care and attending school and school related activities, playing sports that doesn't
interfere with the overall health of the child.
● Discuss pain assessment of children
● Behavioral pain measures are generally used from infancy to 4 years of age. This more time consuming
due to that an observer watches and observes a child’s behaviors, such as: sounds associated with pain, changes
in facial expression, and body movements that express discomfort. An observer must understand the different
behaviors. Ex: F.L.A.C.C .pain assessment scale. (pg. 152)
● The COMFORT pain assessment scale is recommended in critical care settings on patients that are
unconscious or on ventilators. (pg. 152)
● A self-report pain scale is generally used for patients over 5 years of age. This is the Wong and Baker
pain assessment scale
● For children 8 years of age and older, a numeric scale can be used.
● Neonate’s pain assessment is a combination of behavioral and physiologic signs to determine pain level.
The CRIES pain assessment scale is most common.
● Develop a nursing care plan for the child in pain
o Pain and suffering
▪ Pain management is the HIGHEST priority
▪ Regular schedule for pain medications with orders for breath-through pain
▪ Children will ask if dying hurts? We don’t know—be honest and tell them if you’re in pain tell me
and we will help alleviate your pain
o Dying alone (child) or not being present when child dies (Parent)
▪ Help child have death they desire
▪ They may want/need someone at the bedside—will hold on until that person is at the bedside
o Actual death itself
▪ Home death
▪ Hospital death
● Discuss non-pharmacologic and pharmacologic management of pain in children
● Genetics
o Chromosomal abnormalities
▪ Numeric and structural changes in normal pattern
▪ 25% of all genetic disorders
▪ 46 chromosomes; 23 pairs
o Single-gene defects
▪ Caused by mutation of a single gene
▪ CF or hemophilia
o Complex (multifactorial) disorders
▪ Individual has a certain genetic predisposition
o Causes:
▪ Radiation
▪ Autoimmune disease
▪ Viruses
▪ Parental age
● Chromosomal abnormalities
o Autosomal
▪ Non-sex chromosomes
▪ Usually have some kind of mental deficiencies
▪ Down’s Syndrome
o Sex Chromosomes:
▪ No or less severe mental deficiencies
▪ X or Y defects
▪ Turner’s/Klinefelter’s
● Describe the major historical and societal changes that have had an impact on children’s health care.
3
, Discuss the role of the pediatric nurse in acute care, outpatient, rehabilitative and community settings,
and society
o Nurses support families in their natural caregiving and decision-making roles by building on their unique
strengths and acknowledging their expertise in caring for their child both within and outside the hospital
setting. The nurse considers the needs of all family members in relation to the care of the child.
Other Roles
Therapeutic relationships
Family advocate
Disease Prevention/Health Promotion
Teacher
Counselor
Coordination/Collaboration
Research
Describe hereditary influences on health promotion of the child and family.
o We can now screen for many of these diseases and attempt to fix the problem or prepare the family.
Discuss therapeutic management of genetic disease.
o Therapy for genetic disease is currently aimed at correcting the phenotypic expression of gene
abnormalities, and therefore the major goal of therapy is modification of the internal or external
environment to correct or minimize the effects of the genetic defect.
Describe the role of nurses in genetic counseling.
o The professional practice domains include applying/integrating genetic knowledge into nursing
assessment; identifying and referring clients who may benefit from genetic information or services;
identifying genetics resources and services to meet clients' needs; and providing care and support before,
during, and after providing genetic information and/or services. Often a nurse is the first one to recognize
the need for genetic evaluation by identifying an inherited disorder in a family history or by noting
physical, cognitive, or behavioral abnormalities when performing a nursing assessment
GROWTH and DEVELOPMENT:
● List the principles of growth and development and give examples of each
o Growth—getting bigger, increase in number and size of cells
o Development—gradual advancement from a lower to more advanced stage of complexity—psychosocial,
mental, etc.
o Stages of Development: (4)
▪ Infancy
● Birth to 12 months
▪ Early Childhood
● 1-6 years
● Toddlerhood (1-2)
● Preschool (3-4)
● Early school (5-6)
▪ Middle Childhood
● 6-12 years
● Tweeners (10-12) prepubescent stages
▪ Later Childhood
● 11-12; 13+
● adolescents
o Patterns
▪ Directional trends
● Typically grow and develop in a specific
● Grow head to toe—cephalocaudal; head to toe
● Proximodistal—develop core/midline first
● Differentiation—general to specific; simple to complex
▪ Sequential trends
● An order in development
● Crawl before you walk
▪ Developmental pace
● Individualized
▪ Sensitive periods
4
