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Maternal-Child Nursing McKinney 4th Edition Test Bank

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Maternal-Child Nursing McKinney 4th Edition Test Bank

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Ideal for accelerated maternity and pediatrics courses, Maternal-Child Nursing, 4th Edition is filled with user-friendly features to help you quickly master essential concepts and skills. It offers completely updated content that’s easy to read and understand. Plus, active learning tools give you the chance to practice applying your knowledge and make learning fun!

 

Table of Content:

  1. Front Matter
  2. Contributors
  3. Reviewers
  4. Preface
  5. Concepts
  6. Features
  7. Objectives
  8. Nursing Process
  9. Critical Thinking Exercises
  10. Evidence-Based Practice
  11. Critical Alerts
  12. Want to Know
  13. Health Promotion
  14. Clinical Reference Pages
  15. Pathophysiology
  16. Procedures
  17. Drug Guides
  18. Key Concepts
  19. Ancillaries
  20. For Students
  21. For Instructors
  22. Acknowledgments
  23. Interactive Review – Maternal-Child Nursing Care
  24. Introduction to Maternal-Child Health Nursing
  25. Interactive Review – Introduction to Maternal-Child Nursing
  26. Chapter 1 Foundations of Maternity, Women’s Health, and Child Health Nursing
  27. Learning Objectives
  28. Historical Perspectives
  29. Maternity Nursing
  30. “Granny” Midwives
  31. Emergence of Medical Management
  32. Government Involvement in Maternal-Infant Care
  33. TABLE 1-1 FEDERAL PROJECTS FOR MATERNAL-CHILD CARE
  34. Impact of Consumer Demands on Health Care
  35. Development of Family-Centered Maternity Care
  36. Current Settings for Childbirth
  37. Traditional Hospital Setting
  38. Labor, Delivery, and Recovery Rooms
  39. FIG 1-1 A typical labor, delivery, and recovery room. Home-like furnishings (A) can be adapted quickly to reveal needed technical equipment (B).
  40. Labor, Delivery, Recovery, and Postpartum Rooms
  41. Birth Centers
  42. Home Births
  43. Nursing of Children
  44. Historical Perspectives
  45. Societal Changes
  46. Hygiene and Hospitalization
  47. Development of Family-Centered Child Care
  48. Current Trends in Child Health Care
  49. Cost Containment
  50. Diagnosis-Related Groups
  51. Managed care ExemplarManaged care organizations ExemplarManaged Care
  52. Capitated Care
  53. Effects of Cost Containment
  54. Case management ExemplarNurse case management ExemplarCase Management
  55. Evidence-Based Nursing Care
  56. Outcomes Management
  57. Nurse Sensitive Indicators
  58. Variances
  59. Clinical Pathways
  60. Home care models ExemplarHome Care
  61. Community Care
  62. Access to Care
  63. Public Health Insurance Programs
  64. FIG 1-2 Uninsured Children by Poverty Status, Household Income, Age, Race and Hispanic Origin, and Nativity, 2009. Federal surveys now give respondents the option of reporting more than one race. This figure shows data using the race-alone concept. For example, Asian refers to people who reported Asian and no other race.
  65. Preventative health activities ExemplarPreventive Health
  66. Health Care Assistance Programs
  67. Statistics on Maternal, Infant, and Child Health
  68. Maternal and Infant Mortality
  69. Maternal Mortality
  70. FIG 1-3 Infant mortality rates, 1950-2007
  71. Infant Mortality
  72. Racial Disparity for Mortality
  73. TABLE 1-2 INFANT MORTALITY DATA FOR SELECTED COUNTRIES (BASED ON 2007 DATA)
  74. International Infant Mortality
  75. TABLE 1-3 LEADING CAUSES OF DEATH AMONG CHILDREN AGES 1 TO 14 YEARS: DEATH RATES PER 100,000
  76. Adolescent Births
  77. Childhood Mortality
  78. Morbidity
  79. Ethics ExemplarEthical Perspectives on Maternity, Women’s Health, and Child Nursing
  80. Ethics and Bioethics
  81. Ethical Dilemmas
  82. Ethical Principles
  83. BOX 1-1 ETHICAL PRINCIPLES
  84. Solving Ethical Dilemmas
  85. Ethical Concerns in Reproduction
  86. Elective Pregnancy Termination
  87. Belief that Induced Abortion is a Private Choice
  88. BOX 1-2 SUPREME COURT DECISIONS ON ABORTION SINCE ROE V. WADE
  89. Belief that Elective Pregnancy Termination is Taking a Life
  90. Implications for Nurses
  91. Fetal Injury
  92. Ethical Concerns in Child Health Nursing
  93. Cessation of Treatment
  94. Terminating Life Support
  95. Social Issues
  96. Poverty
  97. Homelessness
  98. FIG 1-4 The cycle of poverty.
  99. Prenatal Care in the United States
  100. Government Programs for Health Care: Medicaid
  101. Distribution of health care ExemplarAllocation of Health Care Resources
  102. Care versus Cure
  103. Health Care Rationing
  104. Violence
  105. Legal Issues
  106. Safeguards for Health Care
  107. Scope of practice education requirements ExemplarNurse Practice Acts
  108. Standards of Care
  109. Agency Policies
  110. Accountability
  111. Malpractice
  112. NURSING QUALITY ALERT: Elements of Negligence
  113. Prevention of Malpractice Claims
  114. Informed consent ExemplarInformed Consent
  115. NURSING QUALITY ALERT: Requirements of Informed Consent
  116. Competence
  117. Full Disclosure
  118. Understanding of Information
  119. Voluntary Consent
  120. Refusal of Care
  121. Adoption
  122. Documentation
  123. Discharge teaching ExemplarDocumenting Discharge Teaching
  124. Disclosure of medical errors ExemplarDocumenting Incidents
  125. The Nurse as an Advocate
  126. Maintaining Expertise
  127. Current Trends and Their Legal and Ethical Implications
  128. Use of Unlicensed Assistive Personnel
  129. Concerns about Early Discharge
  130. Dealing with Early Discharge
  131. KEY CONCEPTS
  132. References and Readings
  133. Chapter 2 The Nurse’s Role in Maternity, Women’s Health, and Pediatric Nursing
  134. Learning Objectives
  135. The Role of the Professional Nurse
  136. BOX 2-1 ANA CODE OF ETHICS FOR NURSES
  137. Care Provider
  138. FIG 2-1 In the prenatal clinic, the nurse teaches a woman one-on-one.
  139. Teacher
  140. Factors Influencing Learning
  141. Principles of Teaching and Learning
  142. Collaborator
  143. Researcher
  144. Advocate
  145. Manager of Care
  146. Advanced Preparation for Maternity and Pediatric Nurses
  147. Certified Nurse-Midwives
  148. Nurse Practitioners
  149. Clinical Nurse Specialists
  150. Clinical Nurse Leaders
  151. Implications of Changing Roles for Nurses
  152. Therapeutic Communication
  153. Guidelines for Therapeutic Communication
  154. Therapeutic Communication Techniques
  155. Critical Thinking
  156. The Purpose of Critical Thinking
  157. Steps in Critical Thinking
  158. A Recognizing Assumptions
  159. B Examining Biases
  160. C Analyzing the Need for Closure
  161. D Data management Exemplar Managing Data
  162. Collecting Data
  163. Validating Data
  164. Organizing and Analyzing Data
  165. E Evaluating Other Factors
  166. The Nursing Process in Maternity and Pediatric Care
  167. BOX 2-2 COMMUNICATION TECHNIQUES
  168. TABLE 2-1 BEHAVIORS THAT BLOCK COMMUNICATION
  169. Assessment
  170. Screening Assessment
  171. Focused Assessment
  172. Nursing Diagnosis
  173. BOX 2-3 DEVELOPING INDIVIDUALIZED NURSING CARE THROUGH THE NURSING PROCESS
  174. Assessment
  175. Analysis
  176. Planning
  177. Implementing Nursing Interventions
  178. Evaluation
  179. Planning
  180. Setting Priorities
  181. Establishing Goals and Expected Outcomes
  182. Implementation
  183. Evaluation
  184. Complementary and Alternative Medicine
  185. Research studies ExemplarNursing Research and Evidence-Based Practice
  186. KEY CONCEPTS
  187. References and Readings
  188. Chapter 3 The Childbearing and Child-Rearing Family
  189. Learning Objectives
  190. Family-Centered Care
  191. Family Structure
  192. FIG 3-1 Traditional, two-parent families typically have the resources to prepare for childbirth and the needs of infants.
  193. Types of Families
  194. Traditional Families
  195. Nontraditional Families
  196. Single-Parent Families
  197. Blended Families
  198. Adoptive Families
  199. Multigenerational Families
  200. FIG 3-2 A nurse caring for a child needs to know the child’s family structure and the identity of the child’s primary caregiver. This background becomes the context in which the nurse provides care. If family support is a concern, the nurse can provide information about local community resources. For example, in some communities, after-school programs and “warm lines” can help children with schoolwork and alleviate loneliness and fear.
  201. Same-Sex Parent Families
  202. Communal Families
  203. Characteristics of Healthy Families
  204. Factors that Interfere with Family Functioning
  205. High-Risk Families
  206. Marital Conflict and Divorce
  207. Adolescent Parenting
  208. Violence
  209. Substance Abuse
  210. Child with Special Needs
  211. Healthy Versus Dysfunctional Families
  212. Coping with Stress
  213. Coping Strategies
  214. BOX 3-1 COPING STRATEGIES OF FAMILIES
  215. Internal Coping Strategies
  216. Relationship Strategies
  217. Cognitive Strategies
  218. Communication Strategies
  219. External Coping Strategies
  220. Community Strategy: Maintaining Active Linkages with the Community
  221. Social Support Strategies
  222. Spiritual Strategies
  223. Cultural Influences on Maternity and Pediatric Nursing
  224. FIG 3-3 Visible and hidden layers of culture are like the visible and submerged parts of an iceberg. Many cultural differences are hidden below the surface.
  225. Implications of Cultural Diversity for Nurses
  226. Western Cultural Beliefs
  227. TABLE 3-1 RELIGIOUS BELIEFS AFFECTING HEALTH CARE
  228. Cultural Influences on the Care of People from Specific Groups
  229. Asians and Pacific Islanders
  230. Hispanics
  231. African-Americans
  232. American Indians and Alaska Natives
  233. Middle Easterners
  234. Cross-Cultural Health Beliefs
  235. Traditional Methods of Preventing Illness
  236. Traditional Practices to Maintain Health
  237. Traditional Practices to Restore Health
  238. Cultural Assessment
  239. Parenting
  240. Parenting Styles
  241. Parent-Child Relationship Factors
  242. Parental Characteristics
  243. Characteristics of the Child
  244. Temperament and Parental Expectations
  245. BOX 3-2 CHARACTERISTICS OF TEMPERAMENT IN CHILDREN
  246. Discipline
  247. BOX 3-3 EFFECTIVE DISCIPLINE FOR POSITIVE SOCIALIZATION AND SELF-ESTEEM
  248. Dealing with Misbehavior
  249. Redirection
  250. Reasoning
  251. Time-Out
  252. Consequences
  253. Behavior Modification
  254. SAFETY ALERT: Avoiding the Use of Corporal Punishment as Discipline
  255. Corporal Punishment
  256. Nursing Process and the Family
  257. Family Assessment
  258. Nursing Diagnosis and Planning
  259. Intervention and Evaluation
  260. CRITICAL THINKING EXERCISE 3-1
  261. KEY CONCEPTS
  262. References and Readings
  263. Chapter 4 Communicating with Children and Families
  264. Learning Objectives
  265. Components of Effective Communication
  266. Touch
  267. FIG 4-1 Communication with children is enhanced by direct eye contact and by body language that conveys attentiveness and openness.
  268. Physical Proximity and Environment
  269. FIG 4-2 For effective communication, the nurse needs to be at the child’s eye level.
  270. Listening
  271. Attentiveness
  272. Clarification through Reflection
  273. Empathy
  274. Impartiality
  275. Visual Communication
  276. NURSING QUALITY ALERT: Tips to Enhance Listening and Communication Skills
  277. Tone of Voice
  278. TABLE 4-1 OPEN AND CLOSED BODY POSTURES
  279. Body Language
  280. Timing
  281. Family-Centered Communication
  282. NURSING QUALITY ALERT: Communicating with Families
  283. Establishing Rapport
  284. Availability and Openness to Questions
  285. FIG 4-3 The child’s continuing health care, both preventive and during illness, is enhanced by participation of the family.
  286. Family Education and Empowerment
  287. Effective Management of Conflict
  288. BOX 4-1 STRATEGIES FOR MANAGING CONFLICT
  289. TABLE 4-2 CHOOSING WORDS CAREFULLY
  290. Feedback from Children and Families
  291. Spirituality
  292. Transcultural Communication: Bridging the Gap
  293. BOX 4-2 WARNING SIGNS OF OVERINVOLVEMENT
  294. BOX 4-3 WARNING SIGNS OF UNDERINVOLVEMENT
  295. Therapeutic Relationships: Developing and Maintaining Trust
  296. NURSING QUALITY ALERT: Maintaining a Therapeutic Relationship
  297. Nursing Care
  298. Communicating with Children and Families
  299. Assessment
  300. Nursing Diagnosis and Planning
  301. Expected Outcomes
  302. Expected Outcome
  303. Expected Outcomes
  304. Expected Outcomes
  305. Expected Outcomes
  306. CRITICAL THINKING EXERCISE 4-1
  307. Interventions
  308. TABLE 4-3 DEVELOPMENTAL MILESTONES AND THEIR RELATIONSHIP TO COMMUNICATION APPROACHES
  309. Play
  310. BOX 4-4 STORYTELLING STRATEGIES
  311. Storytelling
  312. Explaining Procedures and Treatments
  313. Strategies for Enhancing Self-Esteem
  314. TABLE 4-4 CONSIDERATIONS IN CHOOSING LANGUAGE
  315. TABLE 4-5 SELF-ESTEEM IN CHILDREN: COMMUNICATION PRACTICES
  316. Evaluation
  317. Communicating with Children with Special Needs
  318. The Child with a Visual Impairment
  319. NURSING QUALITY ALERT: Communicating with Children with Special Needs
  320. The Child with a Hearing Impairment
  321. The Child Who Speaks Another Language
  322. The Child with Other Communication Challenges
  323. The Child with a Profound Neurologic Impairment
  324. KEY CONCEPTS
  325. References and Readings
  326. Chapter 5 Health Promotion for the Developing Child
  327. Learning Objectives
  328. Overview of Growth and Development
  329. Definition of Terms
  330. TABLE 5-1 STAGES OF GROWTH AND DEVELOPMENT The Following Stages and Age-Groupings Refer to Stages of Childhood Growth and Development
  331. Stages of Growth and Development
  332. Parameters of Growth
  333. Principles of Growth and Development
  334. Patterns of Growth and Development
  335. FIG 5-1 Changes in body proportions with growth.
  336. BOX 5-1 PATTERNS OF GROWTH AND DEVELOPMENT
  337. BOX 5-2 DIRECTIONAL PATTERNS OF GROWTH AND DEVELOPMENT
  338. Cephalocaudal Pattern (Head to Toe)
  339. Examples
  340. Proximodistal Pattern (from the Center Outward)
  341. Examples
  342. Critical Periods
  343. Factors Influencing Growth and Development
  344. Genetics
  345. Environment
  346. Culture
  347. FIG 5-2 Pediatric environmental history (0 to 18 years of age).
  348. Nutrition
  349. Health Status
  350. Family
  351. Parental Attitudes
  352. Child-Rearing Philosophies
  353. Theories of Growth and Development
  354. Piaget’s Theory of Cognitive Development
  355. Nursing Implications of Piaget’s Theory
  356. Freud’s Theory of Psychosexual Development
  357. TABLE 5-2 THEORIES OF GROWTH AND DEVELOPMENT
  358. Nursing Implications of Freud’s Theory
  359. Erikson’s Psychosocial Theory
  360. Nursing Implications of Erikson’s Theory
  361. Kohlberg’s Theory of Moral Development
  362. Nursing Implications of Kohlberg’s Theory
  363. Theories of Language Development
  364. Assessment of Growth
  365. Assessment of Development
  366. Denver Developmental Screening Test II (DDST-II)
  367. Nurse’s Role in Promoting Optimal Growth and Development
  368. Developmental Assessment
  369. Interviewing ExemplarInterview
  370. Play
  371. Classifications of Play
  372. Social Aspects of Play
  373. Solitary Play
  374. Parallel Play
  375. Associative Play
  376. Cooperative Play
  377. Onlooker Play
  378. Types of Play
  379. Dramatic Play
  380. Familiarization Play
  381. FIG 5-3 Types of play.
  382. Functions of Play
  383. Physical Development and Play
  384. Cognitive Development
  385. Emotional Development
  386. Social Development
  387. Moral Development
  388. Health Promotion
  389. Vaccination ExemplarImmunizations
  390. Active and Passive Immunity
  391. SAFETY ALERT: Preventing Vaccine Reactions
  392. Obstacles to Immunizations
  393. Informed Consent
  394. BOX 5-3 BARRIERS TO IMMUNIZATION
  395. Immunization Schedule
  396. Children with an Uncertain History of Immunization
  397. Administration of Vaccines
  398. Precautions and Contraindications
  399. BOX 5-4 NURSING RESPONSIBILITY IN ADMINISTERING VACCINES
  400. SAFETY ALERT: Special Considerations Related to Immunizations
  401. BOX 5-5 COMMON MISCONCEPTIONS ABOUT ADMINISTRATION AND SAFETY OF VACCINES
  402. Immunocompromised Children
  403. Education
  404. Nutrition and Activity
  405. Carbohydrates
  406. Fats
  407. Proteins
  408. Water
  409. Vitamins and Minerals
  410. Dietary Guidelines
  411. BOX 5-6 KEY DIETARY RECOMMENDATIONS SPECIFIC TO CHILDREN AND ADOLESCENTS
  412. Energy, Calories, and Servings
  413. Physical Activity
  414. FIG 5-4 MyPlate.
  415. Cultural and Religious Influences on Diet
  416. Assessment of Nutritional Status
  417. Anthropometric Data
  418. Clinical Evaluation
  419. Dietary History
  420. Twenty-Four-Hour Recall
  421. Food Frequency Questionnaire
  422. Food Diary
  423. Safety
  424. Injury prevention ExemplarInjury Prevention
  425. Anticipatory Guidance
  426. BOX 5-7 WHAT NURSES CAN DO TO PREVENT CHILDHOOD INJURIES
  427. SAFETY ALERT: Relationship Between Safety and Childhood Development
  428. Teaching Strategies
  429. KEY CONCEPTS
  430. References and Readings
  431. Chapter 6 Health Promotion for the Infant
  432. Learning Objectives
  433. Growth and Development of the Infant
  434. TABLE 6-1 SUMMARY OF GROWTH AND DEVELOPMENT: THE INFANT
  435. HEALTH PROMOTION: Healthy People 2020 Objectives for Infants
  436. Physical Growth and Maturation of Body Systems
  437. Neurologic System
  438. Respiratory System
  439. Cardiovascular System
  440. Safety Alert: Risks Caused by the Infant’s Immature Body Systems
  441. Immune System
  442. Gastrointestinal System
  443. Renal System
  444. Motor Development
  445. PATIENT-CENTERED TEACHING: How to “Baby-Proof” the Home
  446. Cognitive Development
  447. NURSING QUALITY ALERT: Possible Signs of Developmental Delays
  448. Sensory Development
  449. Vision
  450. Hearing
  451. BOX 6-1 LANGUAGE DEVELOPMENT AND DEVELOPMENTAL MILESTONES IN INFANCY
  452. 1 to 3 Months
  453. 3 to 4 Months
  454. 4 to 6 Months
  455. 6 to 8 Months
  456. 8 to 9 Months
  457. 9 to 12 Months
  458. Language Development
  459. FIG 6-1 This 6-month-old infant responds delightedly to her mother with a true social smile. Such interactive responses between parent and child promote communication and emotional development.
  460. Psychosocial Development
  461. Parent-Infant Attachment
  462. Stranger Anxiety
  463. Health Promotion for the Infant and Family
  464. CRITICAL THINKING EXERCISE 6-1
  465. Immunization
  466. BOX 6-2 CONTINUING ASSESSMENT QUESTIONS
  467. Feeding and Nutrition
  468. NURSING QUALITY ALERT: Essential Information for Infant Nutrition
  469. Factors Influencing Choice of Feeding Method
  470. Breastfeeding
  471. Formula Feeding
  472. Types of Formula
  473. Cow’s Milk
  474. EVIDENCE-BASED PRACTICE
  475. Formula Feeding Techniques
  476. Weaning
  477. Juices
  478. Water
  479. Solid Foods
  480. BOX 6-3 READINESS FOR INTRODUCTION OF SOLIDS
  481. Finger Foods
  482. Health Promotion: 2-Week-Old to 1-Month-Old Infant
  483. Focused Assessment
  484. Developmental Milestones
  485. Health Maintenance
  486. Physical Measurements
  487. Immunizations
  488. Health Screening
  489. Anticipatory Guidance
  490. Nutrition
  491. Elimination
  492. Dental
  493. Sleep
  494. Hygiene
  495. Safety
  496. Snacks
  497. Food Allergies
  498. HEALTH PROMOTION: The 2-Month-Old Infant
  499. Focused Assessment
  500. Developmental Milestones
  501. Critical Milestones∗
  502. Health Maintenance
  503. Physical Measurements
  504. Immunizations
  505. Health Screening
  506. Anticipatory Guidance
  507. Nutrition
  508. Elimination
  509. Dental
  510. Sleep
  511. Hygiene
  512. Safety
  513. Play
  514. Dental Care
  515. Teething
  516. Assessment of Dental Risk
  517. Cleaning Teeth
  518. Fluoride Supplementation
  519. Bottle-Mouth Caries
  520. HEALTH PROMOTION: The 4-Month-Old Infant
  521. Focused Assessment
  522. Developmental Milestones
  523. Critical Milestones∗
  524. Health Maintenance
  525. Physical Measurements
  526. Immunizations
  527. Health Screening
  528. Anticipatory Guidance
  529. Nutrition
  530. Elimination
  531. Dental
  532. Sleep
  533. Hygiene
  534. Safety
  535. Play
  536. Sleep and Rest
  537. Safety
  538. Motor Vehicle Safety
  539. FIG 6-2 The infant rides facing the rear of the vehicle, ideally in the middle of the back seat. The infant seat is secured to the vehicle with the seatbelt, and straps on the car seat adjust to accommodate the growing baby.
  540. FIG 6-3 After the child reaches 2 years of age and has attained the manufacturer’s height and weight recommendations for a rear-facing car seat, the child uses a forward-facing upright car safety seat. The safety straps should be adjusted to provide a snug fit, and the seat should be placed in the back seat of the car, ideally in the middle.
  541. Providing a Safe Home Environment
  542. Burn Prevention
  543. Safe Baby Furnishings
  544. PATIENT-CENTERED TEACHING: Crib Safety
  545. Fall prevention ExemplarPreventing Falls
  546. FIG 6-4 Safety education for parents of infants should emphasize the need for constant supervision and the use of restraining devices to prevent falls.
  547. HEALTH PROMOTION: The 6-Month-Old Infant
  548. Focused Assessment
  549. Developmental Milestones
  550. Critical Milestones∗
  551. Health Maintenance
  552. Physical Measurements
  553. Immunizations
  554. Health Screening
  555. Anticipatory Guidance
  556. Nutrition
  557. Elimination
  558. Dental
  559. Sleep
  560. Hygiene
  561. Safety
  562. Play
  563. Preventing Asphyxiation
  564. BOX 6-4 LEAD EXPOSURE RISK ASSESSMENT
  565. Preventing Lead Exposure
  566. Concerns during Infancy
  567. Patterns of Crying
  568. HEALTH PROMOTION: The 9-Month-Old Infant
  569. Focused Assessment
  570. Developmental Milestones
  571. Critical Milestones∗
  572. Health Maintenance
  573. Physical Measurements
  574. Immunizations
  575. Health Screening
  576. Anticipatory Guidance
  577. Nutrition
  578. Elimination
  579. Dental
  580. Sleep
  581. Hygiene
  582. Safety
  583. Play
  584. The Infant with Colic
  585. Etiology
  586. Management
  587. Nursing Considerations
  588. HEALTH PROMOTION: The 12-Month-Old Infant
  589. Focused Assessment
  590. Developmental Milestones
  591. Critical Milestones∗
  592. Health Maintenance
  593. Physical Measurements
  594. Immunizations
  595. Health Screening
  596. Anticipatory Guidance
  597. Nutrition
  598. Elimination
  599. Dental
  600. Sleep
  601. Hygiene
  602. Safety
  603. Play
  604. KEY CONCEPTS
  605. References and Readings
  606. Chapter 7 Health Promotion During Early Childhood
  607. Learning Objectives
  608. Growth and Development During Early Childhood
  609. FIG 7-1 Growth and development of the toddler.
  610. Physical Growth and Development
  611. The Toddler
  612. The Preschooler
  613. FIG 7-2 Growth and development of the preschooler.
  614. HEALTH PROMOTION: Healthy People 2020 Objectives for Toddlers and Preschoolers
  615. Motor Development
  616. The Toddler
  617. The Preschooler
  618. Cognitive and Sensory Development
  619. The Toddler
  620. The Preschooler
  621. HEALTH PROMOTION: The 15- to 18-Month-Old Child
  622. Focused Assessment
  623. Developmental Milestones
  624. Critical Milestones∗
  625. Health Maintenance
  626. Physical Measurements
  627. Immunizations
  628. Health Screening
  629. Anticipatory Guidance
  630. Nutrition
  631. Elimination
  632. Dental
  633. Sleep
  634. Hygiene
  635. Safety
  636. Play
  637. TABLE 7-1 Characteristics of Preoperational Thinking
  638. HEALTH PROMOTION: The 2-Year-Old Child
  639. Focused Assessment
  640. Developmental Milestones
  641. Critical Milestones∗
  642. Health Maintenance
  643. Physical Measurements
  644. Immunizations
  645. Health Screening
  646. Anticipatory Guidance
  647. Nutrition
  648. Elimination
  649. Dental
  650. Sleep
  651. Hygiene
  652. Safety
  653. Self-Esteem and Competence
  654. Play
  655. Language Development
  656. The Toddler
  657. The Preschooler
  658. Psychosocial Development
  659. The Toddler
  660. Negativism
  661. Ritualism and the Importance of Routine
  662. Separation Anxiety
  663. Play
  664. Psychosexual Development
  665. FIG 7-3 Types of play.
  666. BOX 7-1 Age-Related Activities and Toys for Toddlers and Preschoolers
  667. General Activities
  668. Toddler
  669. Preschooler
  670. Toys and Specific Types of Play
  671. Toddler
  672. Preschooler
  673. NURSING QUALITY ALERT: Important Tasks of the Toddler Period
  674. The Preschooler
  675. Play
  676. Psychosexual Development
  677. Spiritual and Moral Development
  678. Health Promotion for the Toddler or Preschooler and Family
  679. Nutrition
  680. BOX 7-2 Nutritious Snacks
  681. Nutritional Requirements
  682. Solid Foods
  683. FIG 7-4 By age 1 year, most children are eating the same foods as the rest of the family. Toddlers should be offered three meals and two healthy snacks each day. Most 2-year-olds can drink from a cup and use a spoon well if given the opportunity to practice.
  684. Age-Related Nutritional Challenges
  685. Food Jags
  686. Physiologic Anorexia
  687. BOX 7-3 Increasing Nutritional Intake
  688. Obesity Risk
  689. Dental Care
  690. Sleep and Rest
  691. FIG 7-5 Care of the deciduous teeth promotes healthy development of the permanent teeth. Some toddlers and preschoolers enjoy brushing their own teeth, but because toddlers and preschoolers lack the manual dexterity to remove plaque adequately, parents must assume this responsibility.
  692. CRITICAL THINKING EXERCISE 7-1
  693. Discipline
  694. Toddler Safety
  695. Car Safety
  696. PARENTS WANT TO KNOW: Guidelines for Disciplining a Toddler
  697. PATIENT-CENTERED TEACHING: Childhood Poison Prevention
  698. SAFETY ALERT: Car Safety
  699. Airplane Safety
  700. Fire and Burn Safety
  701. Preventing Falls
  702. Water Safety
  703. Preventing Poisoning
  704. Preschooler Safety
  705. Car Safety
  706. FIG 7-6 A high-back booster seat designed to properly hold a car lap and shoulder belt is strongly recommended for children who have outgrown a child safety seat. Booster seats raise the young child high enough to allow the car seatbelts to be correctly positioned over the child’s chest and pelvis.
  707. Fire and Burn Safety
  708. Firearm Safety
  709. Personal Safety
  710. Sexual Abuse
  711. Selected Issues Related to the Toddler
  712. Toilet Training
  713. HEALTH PROMOTION: The 3-Year-Old Child
  714. Focused Assessment
  715. Developmental Milestones
  716. Critical Milestones∗
  717. Health Maintenance
  718. Physical Measurements
  719. Immunizations
  720. Health Screening
  721. Anticipatory Guidance
  722. Nutrition
  723. Elimination
  724. Dental
  725. Sleep
  726. Hygiene
  727. Safety
  728. Self-Esteem and Competence
  729. Play
  730. BOX 7-4 Signs of Readiness for Toilet Training
  731. Physical Readiness
  732. Psychological Readiness
  733. FIG 7-7 No set rules exist for toilet training. The nurse can help parents understand that both physical readiness and psychological readiness are necessary for success.
  734. Temper Tantrums
  735. Sibling Rivalry
  736. PARENTS WANT TO KNOW: Strategies to Decrease Sibling Rivalry
  737. Selected Issues Related to the Preschooler
  738. Stuttering
  739. PARENTS WANT TO KNOW: How to Help the Child Who Stutters
  740. Preschool and Daycare Programs
  741. HEALTH PROMOTION: The 4- and 5-Year-Old Child
  742. Focused Assessment
  743. Developmental Milestones
  744. Critical Milestones∗
  745. Health Maintenance
  746. Physical Measurements
  747. Immunizations
  748. Health Screening
  749. Anticipatory Guidance
  750. Nutrition
  751. Elimination
  752. Dental
  753. Sleep
  754. Safety
  755. Self-Esteem and Competence
  756. Play
  757. Preparing the Child for School
  758. BOX 7-5 Checklist for School Readiness
  759. KEY CONCEPTS
  760. References and Readings
  761. Chapter 8 Health Promotion for the School-Age Child
  762. Learning Objectives
  763. Growth and Development of the School-Age Child
  764. Physical Growth and Development
  765. HEALTH PROMOTION: Healthy People 2020 Objectives for School-Age Children
  766. Body Systems
  767. Dentition
  768. Sexual Development
  769. FIG 8-1 Growth and development of the school-age child.
  770. NURSING QUALITY ALERT: Components of Sex Education
  771. BOX 8-1 AGE-RELATED ACTIVITIES AND TOYS FOR THE SCHOOL-AGE CHILD
  772. General Activities
  773. Toys and Specific Types of Play
  774. Motor Development
  775. Development of Gross Motor Skills
  776. Importance of Active Play
  777. PATIENT-CENTERED TEACHING: Assessing an Organized Recreational Sports Program
  778. Preventing Fatigue and Dehydration
  779. Development of Fine Motor Skills
  780. Cognitive Development
  781. Intuitive Thought Stage
  782. Concrete Operations Stage
  783. Reversibility
  784. Conservation
  785. Classification and Logic
  786. Humor
  787. Sensory Development
  788. Vision
  789. Hearing
  790. Language Development
  791. Psychosocial Development
  792. Development of a Sense of Industry
  793. Fostering Self-Esteem
  794. PATIENT-CENTERED TEACHING: How to Promote Self-Esteem in School-Age Children
  795. Spiritual and Moral Development
  796. Piaget
  797. Kohlberg
  798. Family Influence
  799. Spirituality and Religion
  800. Health Promotion for the School-Age Child and Family
  801. Nutrition During Middle Childhood
  802. Nutritional Requirements
  803. Age-Related Nutritional Challenges
  804. Dental Care
  805. Malocclusion
  806. Preventing Dental Injuries
  807. Dental Health Education
  808. Sleep and Rest
  809. HEALTH PROMOTION: The 6- to 8-Year-Old Child
  810. Focused Assessment
  811. Developmental Milestones
  812. Health Maintenance
  813. Physical Measurements
  814. Immunizations
  815. Health Screening
  816. Anticipatory Guidance
  817. Nutrition
  818. Elimination
  819. Dental
  820. Sleep
  821. Safety
  822. Play
  823. Self-Esteem and Competence
  824. CRITICAL THINKING EXERCISE 8-1
  825. Discipline
  826. Safety
  827. Car Safety
  828. Fire and Burn Safety
  829. SAFETY ALERT: Fire Safety Rules
  830. Bicycle, In-line Skating, Scooter, and Skateboard Safety
  831. PATIENT-CENTERED TEACHING: Bicycle, In-line Skating, Scooter, and Skateboard Safety
  832. Rules of the Road
  833. Pedestrian Safety
  834. Water Safety
  835. HEALTH PROMOTION: The 9- to 11-Year-Old Child
  836. Focused Assessment
  837. Developmental Milestones
  838. Health Maintenance
  839. Physical Measurements
  840. Immunizations
  841. Health Screening
  842. Anticipatory Guidance
  843. Nutrition
  844. Elimination
  845. Dental
  846. Sleep
  847. Hygiene
  848. Safety
  849. Play
  850. Self-Esteem and Competence
  851. Selected Issues Related to the School-Age Child
  852. Adjustment to School
  853. Peer Influence
  854. Influence of Teachers
  855. Parents’ Role
  856. School Refusal
  857. Helping a Child Overcome School Refusal
  858. Self-Care Children
  859. Obesity ExemplarObesity
  860. Assessing the Scope of the Problem
  861. Prevention
  862. Diet ExemplarInterventions and Anticipatory Guidance
  863. PARENTS WANT TO KNOW: How to Prevent and Manage Obesity
  864. EVIDENCE-BASED PRACTICE
  865. Stress
  866. Sources of Stress in Children
  867. BOX 8-2 MANIFESTATIONS OF STRESS IN CHILDREN
  868. School Pressures
  869. Physical Threats
  870. Competitive Sports
  871. Tight Schedules and Adaptation Overload
  872. Family Pressures
  873. Media Influence
  874. Interventions and Anticipatory Guidance
  875. FIG 8-2 Health promotion for the school-age child and family.
  876. NURSING QUALITY ALERT: Sources of Stress for School-Age Children
  877. Bullying ExemplarPeer Victimization
  878. KEY CONCEPTS
  879. References and Readings
  880. Chapter 9 Health Promotion for the Adolescent
  881. Learning Objectives
  882. Adolescent Growth and Development
  883. HEALTH PROMOTION: Selected Healthy People 2020 Objectives for Adolescents
  884. Physical Growth and Development
  885. Psychosexual Development, Hormonal Changes, and Sexual Maturation
  886. NURSING QUALITY ALERT: Understanding Tanner Staging
  887. Female Sexual Maturation
  888. TABLE 9-1 SEXUAL MATURITY RATING (SMR): TANNER STAGES OF ADOLESCENT SEXUAL DEVELOPMENT
  889. Male Sexual Maturation
  890. Motor Development
  891. SAFETY ALERT: The Adolescent Who Is Involved in Athletics
  892. BOX 9-1 NURSING GOALS FOR PREPARTICIPATION SPORTS PHYSICAL EXAMINATION
  893. Cognitive Development
  894. Sensory Development
  895. Language Development
  896. PARENTS WANT TO KNOW: Communicating with Adolescents
  897. Psychosocial Development
  898. FIG 9-1 Adolescent growth and development.
  899. BOX 9-2 AGE-RELATED ACTIVITIES AND GAMES FOR ADOLESCENTS
  900. General Activities
  901. Games and Special Types of Play
  902. NURSING QUALITY ALERT: The Adolescent and Erikson
  903. Early Adolescence
  904. Middle Adolescence
  905. BOX 9-3 SIGNS OF GANG INVOLVEMENT
  906. NURSING QUALITY ALERT: Elements of Adolescent Care
  907. Vocational Exploration
  908. Late Adolescence (18 to 21 Years)
  909. Moral and Spiritual Development
  910. Health Promotion for the Adolescent and Family
  911. CRITICAL THINKING EXERCISE 9-1
  912. Nutrition during Adolescence
  913. BOX 9-4 FACTORS INFLUENCING THE ADOLESCENT’S DIET
  914. Age-Related Nutritional Challenges
  915. Nutritional Guidance for the Adolescent
  916. Hygiene
  917. Dental Care
  918. PATIENT-CENTERED TEACHING: Caring for a Child with an Avulsed Tooth
  919. Sleep and Rest
  920. HEALTH PROMOTION: The Adolescent
  921. Focused Assessment
  922. Developmental Milestones
  923. Health Maintenance
  924. Physical Measurements
  925. Immunizations
  926. Health Screening
  927. Anticipatory Guidance
  928. Nutrition
  929. Elimination
  930. Dental
  931. Sleep and Activity
  932. Safety
  933. Emotional Health
  934. Exercise and Activity
  935. Safety
  936. Car Safety
  937. Water Safety
  938. Suicide
  939. Violence Toward Others
  940. BOX 9-5 FACTORS CONTRIBUTING TO ADOLESCENT VIOLENCE
  941. Selected Issues Related to the Adolescent
  942. Body Piercing
  943. Tattoos
  944. ADOLESCENTS WANT TO KNOW: Tattooing
  945. Tanning
  946. Sexual Activity
  947. Adolescent Sexuality
  948. NURSING QUALITY ALERT: Factors to Consider in Selecting Adolescent Contraception
  949. Contraception
  950. KEY CONCEPTS
  951. References and Readings
  952. Chapter 10 Hereditary and Environmental Influences on Development
  953. Learning Objectives
  954. Hereditary Influences
  955. Structure of Genes and Chromosomes
  956. DNA
  957. FIG 10-1 Diagrammatic representation of the deoxyribonucleic acid (DNA) helix, which is the building block of genes and chromosomes.
  958. Genes
  959. Chromosomes
  960. FIG 10-2 When viewed before karyotyping, chromosomes appear jumbled. This photo is a spectral karyotype (SKY) from a normal female.
  961. Transmission of Traits by Single Genes
  962. Alleles
  963. Dominance
  964. FIG 10-3 Karyotypes of chromosomes that were stained, creating bands to distinguish each chromosome and identify missing or duplicated chromosome material. A, Normal male karyotype: 46,XY. B, Normal female karyotype 46,XX.
  965. Chromosome Location
  966. Patterns of Single-Gene Inheritance
  967. CRITICAL TO REMEMBER: Single-Gene Abnormalities
  968. Autosomal Dominant Traits
  969. BOX 10-1 SINGLE-GENE TRAITS
  970. Genogram (Pedigree) Symbols
  971. Autosomal Recessive
  972. Characteristics
  973. Transmission of Trait from Parent to Child
  974. Examples
  975. Genogram
  976. Autosomal Dominant
  977. Characteristics
  978. Transmission of Trait from Parent to Child
  979. Examples
  980. Genogram
  981. X-Linked Recessive
  982. Characteristics
  983. Transmission of Trait from Parent to Child
  984. Examples
  985. Genogram
  986. Autosomal Recessive Traits
  987. X-Linked Traits
  988. X-Linked Recessive Disorders
  989. Chromosome Abnormalities
  990. FIG 10-4 Karyotype of a male with trisomy 21 (Down syndrome: 47, XY, +21).
  991. CRITICAL TO REMEMBER: Chromosome Abnormalities
  992. Numerical
  993. Structural
  994. Numerical Abnormalities
  995. Trisomy
  996. FIG 10-5 Karyotype of a female with monosomy X (Turner syndrome 45,X).
  997. Monosomy
  998. Polyploidy
  999. Structural Abnormalities
  1000. FIG 10-6 Illustration of a translocation of chromosome material between chromosomes 4 and 20.
  1001. Multifactorial Disorders
  1002. CRITICAL TO REMEMBER: Multifactorial Birth Defects
  1003. Characteristics of Multifactorial Disorders
  1004. Risk for Occurrence
  1005. Environmental Influences
  1006. Teratogens
  1007. BOX 10-2 SELECTED ENVIRONMENTAL SUBSTANCES KNOWN OR THOUGHT TO HARM THE FETUS∗
  1008. Avoiding Fetal Exposure
  1009. Infections
  1010. Drugs and Other Substances
  1011. Ionizing Radiation
  1012. Maternal Hyperthermia
  1013. Manipulating the Fetal Environment
  1014. Mechanical Disruptions to Fetal Development
  1015. Genetic testing ExemplarGenetic Counseling
  1016. Availability
  1017. Focus on the Family
  1018. BOX 10-3 DIAGNOSTIC METHODS THAT MAY BE USED IN GENETIC COUNSELING
  1019. Preconception Screening
  1020. Prenatal Diagnosis for Fetal Abnormalities
  1021. Postnatal Diagnosis for an Infant with a Birth Defect
  1022. Process of Genetic Counseling
  1023. Supplemental Services
  1024. Nursing Care of Families Concerned About Birth Defects
  1025. Nurses as Part of a Genetic Counseling Team
  1026. PARENTS WANT TO KNOW: About Birth Defects
  1027. Nurses in General Practice
  1028. Women’s Health Nurses
  1029. Antepartum Nurses
  1030. Identifying Families for Referral
  1031. Helping the Woman Decide About Genetic Counseling
  1032. Teaching About Lifestyle
  1033. BOX 10-4 REASONS FOR REFERRAL TO A GENETIC COUNSELOR OR OTHER HEALTH CARE SPECIALIST
  1034. BOX 10-5 PROBLEMS ENCOUNTERED IN GENETIC COUNSELING AND PRENATAL DIAGNOSIS
  1035. Providing Emotional Support
  1036. Helping the Woman and Family Deal with Abnormal Results
  1037. Intrapartum and Neonatal Nurses
  1038. Pediatric Nurses
  1039. KEY CONCEPTS
  1040. References and Readings
  1041. Maternity Nursing Care
  1042. Interactive Review – Maternity Nursing Care
  1043. Chapter 11 Reproductive Anatomy and Physiology
  1044. Learning Objectives
  1045. Sexual Development
  1046. Prenatal Development
  1047. Childhood
  1048. Sexual Maturation
  1049. Initiation of Sexual Maturation
  1050. Female Puberty Changes
  1051. Breast Changes
  1052. Body Contours
  1053. Body Hair
  1054. Skeletal Growth
  1055. Reproductive Organs
  1056. Menarche
  1057. Male Puberty Changes
  1058. Growth of the Testes and Penis
  1059. TABLE 11-1 Major Hormones in Reproduction
  1060. TABLE 11-2 Comparison Of Secondary Sex Characteristics In Females And Males
  1061. Nocturnal Emissions
  1062. Body Hair
  1063. Body Composition
  1064. Skeletal Growth
  1065. Voice Changes
  1066. Decline in Fertility
  1067. FIG 11-1 External female reproductive structures.
  1068. Female Reproductive Anatomy
  1069. External Female Reproductive Organs
  1070. Mons Pubis
  1071. Labia Majora and Labia Minora
  1072. FIG 11-2 Internal female reproductive structures, anterior view.
  1073. Clitoris
  1074. Vestibule
  1075. Perineum
  1076. Internal Female Reproductive Organs
  1077. Vagina
  1078. Uterus
  1079. Divisions of the Uterus
  1080. Corpus
  1081. FIG 11-3 Internal female reproductive structures, midsagittal view.
  1082. Isthmus
  1083. Cervix
  1084. Layers of the Uterus
  1085. Perimetrium
  1086. Myometrium
  1087. FIG 11-4 Layers of the myometrium, showing the three types of smooth muscle fiber.
  1088. Endometrium
  1089. FIG 11-5 Structures of the bony pelvis, shown in lateral, A, and anterior, B, views.
  1090. Fallopian Tubes
  1091. Ovaries
  1092. Support Structures
  1093. Pelvis
  1094. Muscles
  1095. FIG 11-6 Muscles of the female pelvic floor.
  1096. Ligaments
  1097. Lateral Support
  1098. Anterior Support
  1099. Posterior Support
  1100. Blood Supply
  1101. Nerve Supply
  1102. Female Reproductive Cycle
  1103. FIG 11-7 The female reproductive cycle, showing the changes in hormone secretion from the anterior pituitary and interrelated changes in the ovary and uterine endometrium.
  1104. Ovarian Cycle
  1105. Follicular Phase
  1106. Ovulatory Phase
  1107. Luteal Phase
  1108. Endometrial Cycle
  1109. Proliferative Phase
  1110. Secretory Phase
  1111. Menstrual Phase
  1112. Changes in Cervical Mucus
  1113. The Female Breast
  1114. Structure
  1115. FIG 11-8 Structures of the female breast.
  1116. Function
  1117. Male Reproductive Anatomy and Physiology
  1118. External Male Reproductive Organs
  1119. Penis
  1120. Scrotum
  1121. FIG 11-9 Structures of the male reproductive system, midsagittal view.
  1122. Internal Male Reproductive Organs
  1123. Testes
  1124. FIG 11-10 Internal structures of the testis. Production of sperm begins within the tiny coiled seminiferous tubules. Immature sperm pass from the seminiferous tubules to the epididymis and then to the vas deferens. During their passage through these structures, the sperm mature and acquire the ability to propel themselves.
  1125. Accessory Ducts and Glands
  1126. KEY CONCEPTS
  1127. References and Readings
  1128. Pageburst Integrated Resource
  1129. Animation
  1130. Chapter 12 Conception and Prenatal Development
  1131. Learning Objectives
  1132. Gametogenesis
  1133. Oogenesis
  1134. FIG 12-1 Gametogenesis. A, Formation of the mature ovum. B, Formation of mature sperm.
  1135. TABLE 12-1 COMPARISON OF FEMALE AND MALE GAMETOGENESIS
  1136. Spermatogenesis
  1137. Conception
  1138. Preparation for Conception in the Female
  1139. Release of the Ovum
  1140. Ovum Transport
  1141. Preparation for Conception in the Male
  1142. FIG 12-2 Mature sperm.
  1143. Ejaculation
  1144. Transport of Sperm in the Female Reproductive Tract
  1145. Preparation of Sperm for Fertilization
  1146. Fertilization
  1147. Entry of One Spermatozoon into the Ovum
  1148. Fusion of the Nuclei of Sperm and Ovum
  1149. FIG 12-3 Process of fertilization. A, A sperm enters the ovum. B, The 23 chromosomes from the sperm mingle with the 23 chromosomes from the ovum, restoring the diploid number to 46. C, The fertilized ovum, now called a zygote, is ready for the first mitotic cell division.
  1150. Pre-Embryonic Period
  1151. Initiation of Cell Division
  1152. Entry of the Zygote into the Uterus
  1153. Implantation in the Decidua
  1154. Maintaining the Decidua
  1155. Location of Implantation
  1156. Mechanism of Implantation
  1157. FIG 12-4 Prenatal development from fertilization through implantation of the blastocyst. Implantation gradually occurs from the 6th through the 10th days. Implantation is complete by the 10th day.
  1158. Embryonic Period
  1159. Differentiation of Cells
  1160. Second Week
  1161. Third Week
  1162. Fourth Week
  1163. FIG 12-5 Embryonic development from the 3rd week through the 8th week after fertilization. CRL, Crown-rump length.
  1164. TABLE 12-2 TIMETABLE OF PRENATAL DEVELOPMENT BASED ON FERTILIZATION AGE∗
  1165. TABLE 12-3 DERIVATIVES OF THE THREE GERM LAYERS: DEVELOPING STRUCTURES
  1166. Fifth Week
  1167. Sixth Week
  1168. Seventh Week
  1169. Eighth Week
  1170. Fetal Period
  1171. Weeks 9 Through 12
  1172. Weeks 13 Through 16
  1173. Weeks 17 Through 20
  1174. Weeks 21 Through 24
  1175. Weeks 25 Through 28
  1176. Weeks 29 Through 32
  1177. FIG 12-6 Fetal development from 9 weeks of fertilization age through 38 weeks of fertilization age. Gestational age, measured from the first day of the last menstrual period, is about 2 weeks longer than the fertilization age.
  1178. Weeks 33 Through 38
  1179. Auxiliary Structures
  1180. Placenta
  1181. Maternal Component
  1182. Development
  1183. Circulation in the Maternal Side
  1184. Fetal Component
  1185. Development
  1186. Circulation in the Fetal Side
  1187. Metabolic Functions
  1188. Transfer Functions
  1189. Gas Exchange
  1190. FIG 12-7 A, Placental structure, showing relationship of placenta, fetal membranes, and uterus. Arrows indicate the direction of blood flow between the fetus and placenta through the umbilical arteries and vein. Blood from the woman bathes the fetal chorionic villi within the intervillous spaces to allow exchange of oxygen, nutrients, and waste products without gross mixing of maternal and fetal blood. B, Structure of a chorionic villus, showing its fetal capillary network.
  1191. FIG 12-8 Placental variations. Normal placenta, with insertion of umbilical cord near center and branching of fetal umbilical vessels over the surface Placenta with cord inserted near margin of placenta Placenta with a small accessory lobe Velamentous insertion of umbilical cord. Cord vessels branch far out on membranes. When membranes rupture, fetal umbilical vessels may be torn, and the fetus can hemorrhage.
  1192. TABLE 12-4 MECHANISMS OF PLACENTAL TRANSFER
  1193. Nutrient Transfer
  1194. Waste Removal
  1195. Antibody Transfer
  1196. Transfer of Maternal Hormones
  1197. Endocrine Functions
  1198. Fetal Membranes and Amniotic Fluid
  1199. Fetal Circulation
  1200. Umbilical Cord
  1201. Fetal Circulatory Circuit
  1202. FIG 12-9 A, Fetal circulation. Three shunts—the ductus venosus, the ductus arteriosus, and the foramen ovale—allow most blood from the placenta to bypass the fetal lungs and liver. B, Circulation after birth. Note that the fetal shunts have closed. The umbilical vessels, the ductus venosus, and the ductus arteriosus have been converted to ligaments.
  1203. Changes in Blood Circulation After Birth
  1204. FIG 12-10 A, Monozygotic twinning. The single inner cell mass divides into two inner cell masses during the blastocyst stage. These twins have a single placenta and chorion, but each twin develops in its own amnion. B, Dizygotic twinning. Two ova are released during ovulation, and each is fertilized by a separate spermatozoon. The ova may implant near each other in the uterus, or they may be far apart.
  1205. Multifetal Pregnancy
  1206. Monozygotic Twinning
  1207. Dizygotic Twinning
  1208. KEY CONCEPTS
  1209. References and Readings
  1210. Pageburst Integrated Resource
  1211. Animation
  1212. Chapter 13 Adaptations to Pregnancy
  1213. Learning Objectives
  1214. Physiologic Responses to Pregnancy
  1215. Changes in Body Systems
  1216. Reproductive System
  1217. Uterus
  1218. Growth
  1219. FIG 13-1 Uterine growth pattern during pregnancy.
  1220. Pattern of Uterine Growth
  1221. Contractility
  1222. Uterine Blood Flow
  1223. FIG 13-2 Cervical changes that occur during pregnancy. Note the thick mucous plug filling the cervical canal.
  1224. Cervix
  1225. Vagina and Vulva
  1226. FIG 13-3 Breast changes that occur during pregnancy. The breasts increase in size and become more vascular, the areolae become darker, and the nipples become more erect.
  1227. Ovaries
  1228. Breasts
  1229. Cardiovascular System
  1230. Heart
  1231. Heart Size and Position
  1232. Heart Sounds
  1233. Blood Volume
  1234. Total Volume
  1235. Plasma Volume
  1236. Red Blood Cell Mass
  1237. Cardiac Output
  1238. Systemic Vascular Resistance
  1239. Blood Pressure
  1240. Effect of Position on Blood Pressure
  1241. Supine Hypotension
  1242. FIG 13-4 Supine hypotensive syndrome. When the pregnant woman is supine, the weight of the uterus partially occludes the vena cava and the descending aorta. A side-lying position corrects supine hypotension.
  1243. Blood Flow
  1244. Blood Components
  1245. Respiratory System
  1246. Oxygen Consumption
  1247. Hormonal Factors
  1248. Progesterone
  1249. Estrogen
  1250. TABLE 13-1 LABORATORY VALUES IN NONPREGNANT AND PREGNANT WOMEN
  1251. Physical Changes
  1252. Gastrointestinal System
  1253. Mouth
  1254. Esophagus
  1255. Stomach
  1256. Large and Small Intestine
  1257. Liver and Gallbladder
  1258. Urinary System
  1259. Bladder
  1260. Kidneys and Ureters
  1261. Changes in Size and Shape
  1262. Functional Changes
  1263. Integumentary System
  1264. Skin
  1265. Hyperpigmentation
  1266. Cutaneous Vascular Changes
  1267. Connective Tissue
  1268. FIG 13-5 Linea nigra, a dark line of pigmentation from the fundus to the symphysis pubis, appears during pregnancy.
  1269. Hair
  1270. Musculoskeletal System
  1271. Calcium Storage
  1272. Postural Changes
  1273. Abdominal Wall
  1274. Endocrine System
  1275. Pituitary Gland
  1276. Thyroid Gland
  1277. Parathyroid Glands
  1278. Pancreas
  1279. Adrenal Glands
  1280. Changes Caused by Placental Hormones
  1281. Human Chorionic Gonadotropin
  1282. Estrogen
  1283. Progesterone
  1284. Human Chorionic Somatomammotropin (hCS)
  1285. Relaxin
  1286. Changes in Metabolism
  1287. Weight Gain
  1288. Water Metabolism
  1289. Dependent Edema
  1290. Carpal Tunnel Syndrome
  1291. Carbohydrate Metabolism
  1292. Sensory Organs
  1293. Eye
  1294. Ear
  1295. Immune System
  1296. Confirmation of Pregnancy
  1297. Presumptive Indications of Pregnancy
  1298. Amenorrhea
  1299. Nausea and Vomiting
  1300. Fatigue
  1301. Urinary Frequency
  1302. FIG 13-6 Maternal changes based on the date of the last menstrual period.
  1303. TABLE 13-2 INDICATIONS OF PREGNANCY AND OTHER POSSIBLE CAUSES
  1304. Breast and Skin Changes
  1305. Vaginal and Cervical Color Changes
  1306. FIG 13-7 Hegar’s sign—compressibility of the lower uterus—reflects softening of the isthmus of the cervix.
  1307. Fetal Movement
  1308. Probable Indications of Pregnancy
  1309. Abdominal Enlargement
  1310. Cervical Softening
  1311. Changes in the Uterus
  1312. Uterine Consistency
  1313. FIG 13-8 When the cervix is tapped, the fetus floats upward in the amniotic fluid. A rebound is felt by the examiner when the fetus falls back.
  1314. Ballottement
  1315. Braxton Hicks Contractions
  1316. Palpation of the Fetal Outline
  1317. Uterine Souffle
  1318. Pregnancy Tests
  1319. Agglutination Inhibition Test
  1320. Radioreceptor Assay
  1321. Radioimmunoassay
  1322. Inaccurate Pregnancy Test Results
  1323. Positive Indications of Pregnancy
  1324. Auscultation of Fetal Heart Sounds
  1325. Fetal Movements Felt by Examiner
  1326. Visualization of the Fetus
  1327. Antepartum Assessment and Care
  1328. Preconception and Interconception Care
  1329. Initial Visit
  1330. History
  1331. Obstetric History
  1332. BOX 13-1 CALCULATION OF GRAVIDA AND PARA
  1333. Menstrual History and Estimated Date of Delivery
  1334. CRITICAL THINKING EXERCISE 13-1
  1335. Gynecologic and Contraceptive History
  1336. Medical and Surgical History
  1337. Family Health History
  1338. Partner’s Health History
  1339. Psychosocial History
  1340. Physical Examination
  1341. Vital Signs
  1342. Blood Pressure
  1343. Pulse
  1344. Respiratory Effort
  1345. Temperature
  1346. Cardiovascular System
  1347. Venous Congestion
  1348. Edema
  1349. Musculoskeletal System
  1350. Posture and Gait
  1351. Height and Weight
  1352. Abdomen
  1353. Neurologic System
  1354. Integumentary System
  1355. Endocrine System
  1356. Gastrointestinal System
  1357. Mouth
  1358. Intestine
  1359. Urinary System
  1360. Protein
  1361. Glucose
  1362. Ketones
  1363. Bacteria
  1364. Reproductive System
  1365. Breasts
  1366. External Reproductive Organs
  1367. TABLE 13-3 COMMON LABORATORY TESTS
  1368. Internal Reproductive Organs
  1369. Pelvic Measurements
  1370. Laboratory Data
  1371. Risk Assessment
  1372. Subsequent Assessments
  1373. TABLE 13-4 SUMMARY OF HIGH-RISK FACTORS IN PREGNANCY
  1374. Vital Signs
  1375. Weight
  1376. Urinalysis
  1377. Fundal Height
  1378. FIG 13-9 Measuring the uterus involves measuring from the upper border of the symphysis pubis to the top of the fundus.
  1379. Leopold’s Maneuvers
  1380. Fetal Heart Rate
  1381. Fetal Activity
  1382. Signs of Labor
  1383. Ultrasound Screen
  1384. Glucose Screen
  1385. Isoimmunization
  1386. Pelvic Examinations
  1387. Multifetal Pregnancy
  1388. Diagnosis
  1389. Maternal Adaptation to Multifetal Pregnancy
  1390. Antepartum Care in Multifetal Pregnancy
  1391. Common Discomforts of Pregnancy
  1392. PATIENT-CENTERED TEACHING: How to Overcome the Common Discomforts of Pregnancy
  1393. Nausea and Vomiting
  1394. Heartburn
  1395. Backache
  1396. Round Ligament Pain
  1397. Urinary Frequency
  1398. Varicosities
  1399. Constipation
  1400. Hemorrhoids
  1401. Leg Cramps
  1402. Nausea and Vomiting
  1403. Heartburn
  1404. Backache
  1405. Round Ligament Pain
  1406. Urinary Frequency
  1407. FIG 13-10 Posture during pregnancy may cause or alleviate backache. A, Incorrect posture. The neck is jutting forward, the shoulders are slumping, and the back is sharply curved, creating back pain and discomfort. B, Correct posture. The neck and shoulders are straight, the back is flattened, and the pelvis is tucked under and slightly upward.
  1408. Varicosities
  1409. Constipation
  1410. Hemorrhoids
  1411. FIG 13-11 Techniques for lifting. Squatting places less strain on the back. A, Incorrect technique. Stooping or bending places a great deal of strain on muscles of the lower back. B, Correct technique. Squatting and moving the object close permits the stronger muscles of the legs to do the lifting.
  1412. Leg Cramps
  1413. Nursing Care
  1414. Family Responses to Physical Changes of Pregnancy
  1415. Assessment
  1416. Nursing Diagnosis and Planning
  1417. FIG 13-12 Exercises to prevent backache.
  1418. Expected Outcomes
  1419. Interventions
  1420. Teaching Health Behaviors
  1421. Bathing
  1422. NURSING CARE PLAN: Early Pregnancy Concerns
  1423. Focused Assessment
  1424. Nursing Diagnosis
  1425. Planning
  1426. Expected Outcomes
  1427. Interventions and Rationales
  1428. Evaluation
  1429. Additional Nursing Diagnosis to Consider
  1430. Hot Tubs and Saunas
  1431. Douching
  1432. Breast Care
  1433. Clothing
  1434. Exercise
  1435. FIG 13-13 During the third trimester, pillows supporting the abdomen and back provide a comfortable position for rest.
  1436. Sleep and Rest
  1437. Nutrition
  1438. Employment
  1439. Maternal Safety
  1440. Exposure to Teratogens
  1441. Travel
  1442. Immunizations
  1443. Teaching Necessary Lifestyle Changes
  1444. Prescription and Over-the-Counter Drugs
  1445. Complementary and Alternative Therapies
  1446. Tobacco
  1447. Alcohol
  1448. Illegal Drugs
  1449. Signs of Possible Complications
  1450. Evaluation
  1451. SAFETY ALERT: Signs of Possible Complications During Pregnancy
  1452. Psychological Responses to Pregnancy
  1453. Maternal Responses
  1454. First Trimester
  1455. Uncertainty
  1456. Ambivalence
  1457. The Self as Primary Focus
  1458. Second Trimester
  1459. Physical Evidence of Pregnancy
  1460. FIG 13-14 Fetal movement (quickening) confirms that a separate life is developing.
  1461. The Fetus as Primary Focus
  1462. Narcissism and Introversion
  1463. Body Image
  1464. NURSING CARE PLAN: Body Image During Pregnancy
  1465. Focused Assessment
  1466. Nursing Diagnosis
  1467. Planning
  1468. Expected Outcomes
  1469. Interventions and Rationales
  1470. Evaluation
  1471. Additional Nursing Diagnoses to Consider
  1472. Changes in Sexuality
  1473. Third Trimester
  1474. Vulnerability
  1475. Increasing Dependence
  1476. FIG 13-15 During the third trimester, the mother feels increasingly vulnerable. She cradles her fetus to signify her protectiveness.
  1477. Preparation for Birth
  1478. TABLE 13-5 PROGRESSIVE CHANGES IN MATERNAL RESPONSES TO PREGNANCY
  1479. Maternal Role Transition
  1480. Transitions Experienced throughout Pregnancy
  1481. Steps in Maternal Role Taking
  1482. Mimicry
  1483. Role Play
  1484. Fantasy
  1485. The Search for a Role Fit
  1486. Grief Work
  1487. Maternal Tasks of Pregnancy
  1488. Seeking Safe Passage
  1489. Securing Acceptance
  1490. Learning to Give of Herself
  1491. Committing Herself to the Unknown Child
  1492. Paternal Adaptation
  1493. Variations in Paternal Adaptation
  1494. Developmental Processes
  1495. Grappling with the Reality of Pregnancy and the Child
  1496. Struggling for Recognition as a Parent
  1497. FIG 13-16 Reality boosters such as hearing the sounds of the fetal heart make the fetus more real for the father.
  1498. Creating the Role of Involved Father
  1499. Parenting Information
  1500. Couvade
  1501. Adaptation of Grandparents
  1502. Age
  1503. Number and Spacing of Other Grandchildren
  1504. Perceptions of the Role of Grandparents
  1505. Adaptation of Siblings
  1506. Toddlers
  1507. Older Children
  1508. Adolescents
  1509. Factors that Influence Psychosocial Adaptations
  1510. Age
  1511. Multiparity
  1512. CRITICAL THINKING EXERCISE 13-2
  1513. FIG 13-17 A pregnant woman spends time with her child to provide affection and a sense of security.
  1514. Social Support
  1515. Absence of a Partner
  1516. TABLE 13-6 IMPACT OF SOCIOECONOMIC FACTORS ON FAMILY’S RESPONSE TO PREGNANCY
  1517. Socioeconomic Status
  1518. Abnormal Situations
  1519. Barriers to Prenatal Care
  1520. EVIDENCE-BASED PRACTICE
  1521. Cultural Influences on Childbearing
  1522. Differences within Cultures
  1523. Cultural Differences that May Cause Conflict
  1524. Health Care Practices Beliefs ExemplarHealth Beliefs
  1525. Health Maintenance During Pregnancy
  1526. Belief in Fate
  1527. Preventing Illness
  1528. Restoring Health
  1529. Modesty
  1530. Female Genital Cutting
  1531. Therapeutic communication ExemplarPatient Provider Communication ExemplarCommunication Techniques
  1532. Language
  1533. Communication Style
  1534. NURSING CARE PLAN: Language Barrier During Pregnancy
  1535. Focused Assessment
  1536. Nursing Diagnosis
  1537. Planning
  1538. Expected Outcomes
  1539. Interventions and Rationales
  1540. Evaluation
  1541. Additional Nursing Diagnoses to Consider
  1542. Developmental Family roles ExemplarDecision Making
  1543. Eye Contact
  1544. Touch
  1545. Time Orientation
  1546. Culturally Competent Nursing Care
  1547. Cultural Assessment
  1548. TABLE 13-7 PSYCHOSOCIAL ASSESSMENT
  1549. Cultural Negotiation
  1550. Nursing Care
  1551. Psychosocial Concerns
  1552. Assessment
  1553. Nursing Diagnosis and Planning
  1554. Expected Outcomes
  1555. Interventions
  1556. Providing Information
  1557. Adapting Nursing Care to Pregnancy Progress
  1558. Discussing Resources
  1559. Helping the Family Prepare for the Birth
  1560. Modeling Communication Techniques
  1561. Identifying Cultural Factors that Could Cause Conflict
  1562. Evaluation
  1563. Childbirth education ExemplarPerinatal Education
  1564. Providers of Education
  1565. Class Participants
  1566. Choices for Childbearing
  1567. Setting and Health Care Provider
  1568. FIG 13-18 An expectant mother may ask a sister or close female friend to be her labor partner and to attend classes with her.
  1569. BOX 13-2 BIRTH PLAN CONSIDERATIONS
  1570. Support Person
  1571. Education
  1572. Types of Classes Available
  1573. Preconception Classes
  1574. Early Pregnancy Classes
  1575. Exercise Classes
  1576. Childbirth Preparation Classes
  1577. FIG 13-19 The nurse teaches the support person how to check for relaxation.
  1578. Cesarean Birth Preparation Classes
  1579. Breastfeeding Classes
  1580. Parenting Classes
  1581. Classes For Fathers
  1582. Postpartum Classes
  1583. KEY CONCEPTS
  1584. References and Readings
  1585. Chapter 14 Nutrition for Childbearing
  1586. Learning Objectives
  1587. Weight Gain During Pregnancy
  1588. Recommendations for Total Weight Gain
  1589. TABLE 14-1 RECOMMENDED WEIGHT GAIN DURING PREGNANCY
  1590. Pattern of Weight Gain
  1591. FIG 14-1 Distribution of weight gain in pregnancy for women of normal prepregnancy weight. The numbers represent a general distribution because variation among women is great. Weight increases with the greatest fluctuation are those attributed to extravascular fluids (edema) and maternal reserves of fat.
  1592. Maternal and Fetal Distribution
  1593. Factors that Influence Weight Gain
  1594. Nutritional Requirements During Pregnancy
  1595. Dietary Reference Intakes
  1596. Energy
  1597. Carbohydrates
  1598. Fats
  1599. TABLE 14-2 DIETARY REFERENCE INTAKES: RECOMMENDED ENERGY AND PROTEIN INTAKES
  1600. Calories
  1601. Protein
  1602. Vitamins
  1603. Folic Acid
  1604. Minerals
  1605. Iron
  1606. TABLE 14-3 DIETARY REFERENCE INTAKES: RECOMMENDATIONS FOR VITAMINS AND MINERALS
  1607. TABLE 14-4 FOODS HIGH IN IRON
  1608. BOX 14-1 CALCIUM SOURCES APPROXIMATELY EQUIVALENT TO 1 CUP OF MILK
  1609. Calcium
  1610. BOX 14-2 FOODS HIGH IN SODIUM
  1611. Sodium
  1612. Nutritional Supplementation
  1613. Purpose
  1614. Disadvantages and Dangers of Nutritional Supplementation
  1615. PATIENT-CENTERED TEACHING: Vitamins and Minerals
  1616. Water
  1617. Food Plan
  1618. Whole Grains
  1619. Vegetables and Fruits
  1620. TABLE 14-5 FOOD PLAN FOR PREGNANCY AND LACTATION
  1621. Dairy Group
  1622. Protein Group
  1623. Other Elements
  1624. Food Precautions
  1625. SAFETY ALERT: Food Safety During Pregnancy and Lactation
  1626. Factors that Influence Nutrition
  1627. Age
  1628. Nutritional Knowledge
  1629. Exercise
  1630. Diet Nutrition ExemplarCulture
  1631. Southeast Asian Dietary Practices
  1632. Effect of Culture on Diet During Childbearing
  1633. Increasing Nutrients with Traditional Foods
  1634. Hispanic Dietary Practices
  1635. Nutritional Risk Factors
  1636. Socioeconomic Status
  1637. Poverty
  1638. Food Supplement Programs
  1639. Adolescence
  1640. Nutrient Needs
  1641. Common Problems
  1642. NURSING CARE PLAN: Nutrition for the Pregnant Adolescent
  1643. Focused Assessment
  1644. Nursing Diagnosis
  1645. Planning
  1646. Expected Outcomes
  1647. Interventions and Rationales
  1648. Evaluation
  1649. Additional Nursing Diagnoses to Consider
  1650. Teaching the Adolescent
  1651. Vegetarianism
  1652. Meeting the Nutritional Requirements of the Pregnant Vegetarian
  1653. Energy
  1654. Protein
  1655. Calcium
  1656. Iron
  1657. Zinc
  1658. Vitamin B12
  1659. Vitamin A
  1660. Lactose Intolerance
  1661. Nausea and Vomiting of Pregnancy
  1662. Anemia
  1663. Abnormal Prepregnancy Weight
  1664. Eating Disorders
  1665. Food Cravings and Aversions
  1666. Pica
  1667. CRITICAL THINKING EXERCISE 14-1
  1668. Multiparity and Multifetal Pregnancy
  1669. Substance Use and Abuse
  1670. Smoking
  1671. Caffeine
  1672. Alcohol
  1673. Drugs
  1674. Other Risk Factors
  1675. Nutrition After Birth
  1676. Nutrition for the Lactating Mother
  1677. Energy
  1678. Protein
  1679. Fats
  1680. Vitamins and Minerals
  1681. Specific Nutritional Concerns
  1682. Dieting
  1683. Adolescence
  1684. Vegan Diet
  1685. Avoidance of Dairy Products
  1686. Inadequate Diet
  1687. Alcohol
  1688. Caffeine
  1689. Fluids
  1690. Foods to Avoid
  1691. Nutrition for the Nonlactating Mother
  1692. Weight Loss
  1693. Nursing Care
  1694. Nutrition for Childbearing
  1695. Assessment
  1696. Interview
  1697. Appetite
  1698. Eating Habits
  1699. Food Preferences
  1700. Identify Potential Problems
  1701. Diet History
  1702. Twenty-Four-Hour Diet History
  1703. Food Intake Records
  1704. Food-Frequency Questionnaires
  1705. Physical Assessment
  1706. FIG 14-2 Weight gain for pregnancy. The range for weight gain in women of normal prepregnancy weight is 11.5 to 16 kg (25 to 35 lb).
  1707. Weight at Initial Visit
  1708. CRITICAL THINKING EXERCISE 14-2
  1709. Weight at Subsequent Visits
  1710. Signs of Nutrient Deficiency
  1711. Laboratory Tests
  1712. Reassessing Nutritional Status at Each Visit
  1713. Nursing Diagnosis and Planning
  1714. Expected Outcomes
  1715. Interventions
  1716. Explaining Nutrient Needs
  1717. Providing Reinforcement
  1718. FIG 14-3 Women often make changes in their diets for the good of their unborn children that they would not consider for themselves alone.
  1719. Evaluating Weight Gain
  1720. Encouraging Supplement Intake
  1721. Making Referrals
  1722. Evaluation
  1723. KEY CONCEPTS
  1724. References And Readings
  1725. Chapter 15 Prenatal Diagnostic Tests
  1726. Learning Objectives
  1727. Indications for Prenatal Diagnostic Tests
  1728. Ultrasound
  1729. Emotional Responses
  1730. FIG 15-1 Two-dimensional sonogram showing the fetal body profile and details of the fetal arm, hand, and fingers.
  1731. BOX 15-1 INDICATIONS FOR FETAL DIAGNOSTIC PROCEDURES
  1732. Medical Conditions
  1733. Demographic Factors
  1734. Obstetric Factors
  1735. Concurrent Maternal Factors
  1736. FIG 15-2 Three-dimensional ultrasound image of a fetus in the third trimester, showing the detail of facial features.
  1737. First Trimester
  1738. Procedure
  1739. Purposes
  1740. Second and Third Trimesters
  1741. Procedure
  1742. Purposes
  1743. FIG 15-3 The sonographer provides information as she moves the transducer over the mother’s abdomen to obtain an image.
  1744. Advantages
  1745. Disadvantages
  1746. Doppler Ultrasound Blood Flow Assessment
  1747. Purpose
  1748. Color Doppler
  1749. FIG 15-4 Color Doppler imaging of the umbilical vein and two arteries. Blood flow toward the transducer is typically shown as red whereas the flow away from the transducer is shown as blue.
  1750. Alpha-Fetoprotein Screening
  1751. Purpose
  1752. BOX 15-2 CONDITIONS ASSOCIATED WITH ABNORMAL MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS
  1753. Elevated Levels of Alpha-Fetoprotein (AFP)
  1754. Low Levels of AFP
  1755. Procedure
  1756. Advantages
  1757. Limitations
  1758. Multiple-Marker Screening
  1759. Chorionic Villus Sampling
  1760. Purpose
  1761. Indications
  1762. Procedure
  1763. FIG 15-5 Transcervical chorionic villus sampling. Tissue is aspirated to identify some genetic defects in the fetus. Transabdominal aspiration is an alternative method.
  1764. Advantages
  1765. Limitations
  1766. Amniocentesis
  1767. FIG 15-6 In amniocentesis, a needle is inserted through the mother’s abdomen to aspirate fluid from the amniotic sac. The fluid can then be tested to detect chromosomal abnormalities in fetal cells or other problems and to determine fetal lung maturity.
  1768. Purposes
  1769. Second-Trimester Amniocentesis
  1770. Third-Trimester Amniocentesis
  1771. BOX 15-3 COMMON INDICATIONS FOR SECOND-TRIMESTER AMNIOCENTESIS
  1772. Tests to Determine Fetal Lung Maturity
  1773. Test for Fetal Hemolytic Disease
  1774. Procedure
  1775. Advantages
  1776. Disadvantages
  1777. Risks
  1778. FIG 15-7 In percutaneous umbilical blood sampling, a needle is inserted through the mother’s abdomen and into an umbilical vessel (vein or artery) to withdraw a sample of fetal blood.
  1779. Percutaneous Umbilical Blood Sampling
  1780. Procedure
  1781. Risks
  1782. Antepartum Fetal Surveillance
  1783. Nonstress Test
  1784. Purpose
  1785. Procedure
  1786. Interpretation
  1787. FIG 15-8 A nonstress test is a noninvasive test that measures the ability of the fetal heart to accelerate, often in response to fetal movements. Here the nurse reassures the parents by pointing to fetal heart rate accelerations detected by the external fetal monitor.
  1788. Advantages
  1789. Disadvantages
  1790. FIG 15-9 A, Several accelerations have a duration of at least 15 seconds, reaching a peak of 25 to 30 beats per minute in this example of a reactive nonstress test. Comparable accelerations without fetal movement are also reassuring. B, In this recording of a nonreactive nonstress test, accelerations are absent after fetal movement.
  1791. Vibroacoustic (Acoustic) Stimulation
  1792. Purpose and Procedure
  1793. Fetal Responses
  1794. Risks
  1795. Contraction Stress Test
  1796. Purpose
  1797. Procedure
  1798. Interpretation
  1799. Advantages
  1800. Disadvantages
  1801. Biophysical Profile
  1802. Purpose
  1803. FIG 15-10 Interpretation of contraction stress test (CST). UPI, Uteroplacental insufficiency.
  1804. FIG 15-11 Effects of gradual hypoxemia and worsening fetal acidosis.
  1805. Procedure and Interpretation
  1806. TABLE 15-1 SCORING THE BIOPHYSICAL PROFILE FOR A TERM FETUS
  1807. Modified Biophysical Profile
  1808. Advantages
  1809. Disadvantages
  1810. Maternal Assessment of Fetal Movement
  1811. Advantages
  1812. Disadvantages
  1813. Nursing Care
  1814. The Patient Who Has Diagnostic Testing
  1815. Assessment
  1816. Nursing Diagnosis and Planning
  1817. Expected Outcomes
  1818. Interventions
  1819. Providing Information
  1820. Providing Support
  1821. Helping Patients Set Realistic Goals
  1822. Supporting the Woman’s Decision
  1823. Evaluation
  1824. KEY CONCEPTS
  1825. References and Readings
  1826. Chapter 16 Giving Birth
  1827. Learning Objectives
  1828. Issues for New Nurses
  1829. Pain Associated with Birth
  1830. Inexperience or Negative Experiences
  1831. Unpredictability
  1832. Intimacy
  1833. Physiologic Effects of the Birth Process
  1834. Maternal Response
  1835. Reproductive System
  1836. Characteristics of Contractions
  1837. Coordinated Contractions
  1838. Involuntary Contractions
  1839. Intermittent Contractions
  1840. Contraction Cycle
  1841. Uterine Body
  1842. FIG 16-1 Contraction cycle.
  1843. Cervical Changes
  1844. FIG 16-2 Opposing characteristics of uterine contraction in the upper and lower segments of the uterus.
  1845. Effacement
  1846. Dilation
  1847. Cardiovascular System
  1848. Respiratory System
  1849. Gastrointestinal System
  1850. FIG 16-3 Cervical dilation and effacement. During labor, the multigravida’s cervix remains thicker than that of the primigravida.
  1851. Urinary System
  1852. Hematopoietic System
  1853. Fetal Response
  1854. Placental Circulation
  1855. Cardiovascular System
  1856. Pulmonary System
  1857. Components of the Birth Process
  1858. Powers
  1859. Uterine Contractions
  1860. Maternal Pushing Efforts
  1861. Passage
  1862. Passenger
  1863. Fetal Head
  1864. Bones, Sutures, and Fontanels
  1865. Fetal Head Diameters
  1866. Variations in the Passenger
  1867. Fetal Lie
  1868. Attitude
  1869. Presentation
  1870. FIG 16-4 Pelvic divisions and measurements. INLET The boundaries of the inlet are the symphysis pubis anteriorly, the sacral promontory posteriorly, and the linea terminalis on the sides. The inlet is slightly wider in its transverse diameter (13.5 cm) than in its anteroposterior (diagonal conjugate) diameter (11.5 cm or greater). The diagonal conjugate is slightly larger than both the obstetric and true conjugates. The obstetric conjugate is the narrowest of the three conjugate diameters but cannot be measured directly. The obstetric conjugate is estimated by first measuring the diagonal conjugate and then subtracting 1.5 to 2 cm. If the inlet is small, the fetal head may not be able to enter it. Because it is almost entirely surrounded by bone, except for cartilage at the sacroiliac joint and symphysis pubis, the inlet cannot enlarge much to accommodate the fetus. The bony measurements are essentially fixed.
  1871. MIDPELVIS The midpelvis, or pelvic cavity, is the narrowest part of the pelvis through which the fetus must pass during birth. Midpelvic diameters are measured at the level of the ischial spines. The anteroposterior diameter averages 12 cm. The transverse diameter (bispinous or interspinous) averages 10.5 cm. Prominent ischial spines that project into the midpelvis can reduce the bispinous diameter.
  1872. OUTLET Three important diameters of the pelvic outlet are (1) the anteroposterior, (2) the transverse (bi-ischial or intertuberous), and (3) the posterior sagittal. The angle of the pubic arch also is an important pelvic outlet measure. The anteroposterior diameter ranges from 9.5 to 11.5 cm, varying with the curve between the sacrococcygeal joint and the tip of the coccyx. The anteroposterior diameter can increase if the coccyx is easily movable. The transverse diameter is the bi-ischial, or intertuberous, diameter. This is the distance between the ischial tuberosities (“sit bones”). It averages 11 cm. The posterior sagittal diameter is normally at least 7.5 cm. It is a measure of the posterior pelvis. The posterior sagittal diameter measures the distance from the sacrococcygeal joint to the middle of the transverse (bi-ischial) diameter.
  1873. The angle of the pubic arch is important because it must be wide enough for the fetus to pass under it. The angle of the pubic arch should be at least 90 degrees. A narrow pubic arch displaces the fetus posteriorly toward the coccyx as it tries to pass under the arch.
  1874. FIG 16-5 A, Bones, sutures, fontanels of the fetal head. Note that the anterior fontanel has a diamond shape, whereas the posterior fontanel is triangular. B, Lateral view of the fetal head. Anteroposterior diameters vary with the amount of flexion or extension.
  1875. FIG 16-6 Lie. A, In a longitudinal lie, the long axis of the fetus is parallel to the long axis of the woman. B, In a transverse lie, the long axis of the fetus is at right angles to the long axis of the mother. The woman’s abdomen has a wide, short appearance.
  1876. Cephalic Presentation
  1877. FIG 16-7 Attitude. A, The fetus is in the normal attitude of flexion, with the head, arms, and legs flexed tightly against the trunk. B, The fetus is in an abnormal attitude of extension. The head is extended, and the right arm is extended. A face presentation is illustrated.
  1878. Vertex
  1879. FIG 16-8 Four types of cephalic presentation. The vertex presentation is normal. Note positional changes of the anterior and posterior fontanels in relation to the maternal pelvis.
  1880. Military
  1881. Brow
  1882. Face
  1883. Breech Presentation
  1884. Frank breech
  1885. Full (or complete) breech
  1886. Footling breech
  1887. Shoulder
  1888. Position
  1889. Right (R) or Left (L)
  1890. Occiput (O), Mentum (M), or Sacrum (S)
  1891. Anterior (A), Posterior (P), or Transverse (T)
  1892. FIG 16-9 Three variations of a breech presentation. Frank breech is the most common variation. Footling breeches may be single or double.
  1893. FIG 16-10 Four quadrants of the maternal pelvis, used to describe fetal position.
  1894. Psyche
  1895. Interrelationships of the Components of Birth
  1896. Individual and Cultural Values
  1897. FIG 16-11 Fetal presentations and positions.
  1898. Birth as an Experience
  1899. Normal Labor
  1900. Theories of Onset
  1901. Premonitory Signs
  1902. True Labor and False Labor
  1903. Mechanisms of Labor
  1904. PATIENT-CENTERED TEACHING: How to Know Whether Labor Is “Real”
  1905. Stages and Phases of Labor
  1906. First Stage of Labor
  1907. Latent Phase
  1908. Active Phase
  1909. FIG 16-12 Mechanisms (cardinal movements) of labor.
  1910. TABLE 16-1 CHARACTERISTICS OF NORMAL LABOR
  1911. FIG 16-13 A labor curve, often called a Friedman curve, may be used to identify whether a woman’s cervical dilation is progressing at the expected rate. Typical labor curves for a multiparous and a nulliparous woman are illustrated for comparison of patterns.
  1912. Second Stage of Labor
  1913. Third Stage of Labor
  1914. Fourth Stage of Labor
  1915. EVIDENCE-BASED PRACTICE
  1916. FIG 16-14 A, Fetal side of the placenta. B, Maternal side of the placenta. C, Separating membranes. D, Umbilical cord vessels—two arteries and one vein.
  1917. Duration of Labor
  1918. Nursing Care During Labor and Birth
  1919. Admission to the Birth Center
  1920. Nursing Responsibilities during Admission
  1921. Establishing a Therapeutic Relationship
  1922. Making the Family Feel Welcome
  1923. PATIENT-CENTERED TEACHING: When to Go to the Hospital or Birth Center
  1924. Contractions
  1925. Ruptured Membranes
  1926. Bleeding
  1927. Decreased Fetal Movement
  1928. Other Concerns
  1929. CRITICAL THINKING EXERCISE 16-1
  1930. Determining Family Expectations about Birth
  1931. Conveying Confidence
  1932. Assigning a Primary Nurse
  1933. Using Touch for Comfort
  1934. Respecting Cultural Values
  1935. Assessments at the Time of Admission
  1936. Focused Assessment
  1937. Fetal Assessment
  1938. Maternal Vital Signs
  1939. Impending Birth
  1940. Database Assessment
  1941. Basic Information
  1942. TABLE 16-2 INTRAPARTUM ASSESSMENT GUIDE Women who have had prenatal care have much of this information available on their prenatal record. The nurse need only verify it or update it as needed.
  1943. PROCEDURE: Leopold’s Maneuvers
  1944. Purposes
  1945. First Maneuver
  1946. Second Maneuver
  1947. Third Maneuver
  1948. Fourth Maneuver
  1949. Fetal Assessments
  1950. Labor Status
  1951. Physical Examination
  1952. Admission Procedures
  1953. Notifying the Physician or Midwife
  1954. Consent Forms
  1955. CRITICAL THINKING EXERCISE 16-2
  1956. Laboratory Tests
  1957. Intravenous Access
  1958. Assessments After Admission
  1959. Fetal Assessments
  1960. FHR
  1961. Amniotic Fluid
  1962. Maternal Assessments
  1963. Vital Signs
  1964. Contractions
  1965. Progress of Labor
  1966. Intake and Output
  1967. Response to Labor
  1968. PROCEDURE: Palpating Contractions
  1969. Purpose
  1970. The Support Person’s Response
  1971. Nursing Care
  1972. The Woman with False or Early Labor
  1973. Assessment
  1974. Nursing Diagnosis and Planning
  1975. Expected Outcomes
  1976. Interventions
  1977. Providing Reassurance
  1978. Teaching
  1979. Evaluation
  1980. Nursing Care
  1981. The Woman in True Labor
  1982. SAFETY ALERT: Conditions Associated with Fetal Compromise
  1983. Fetal Oxygenation
  1984. Assessment
  1985. Nursing Diagnosis and Planning
  1986. Expected Outcome
  1987. Interventions
  1988. Promoting Placental Function
  1989. Observing for Conditions Associated with Fetal Compromise
  1990. Evaluation
  1991. Discomfort
  1992. Assessment
  1993. Nursing Diagnosis and Planning
  1994. Expected Outcomes
  1995. Interventions
  1996. Providing Comfort Measures
  1997. Lighting
  1998. Temperature
  1999. Cleanliness
  2000. Mouth Care
  2001. Bladder
  2002. Positioning
  2003. Water
  2004. Teaching
  2005. First Stage of Labor
  2006. Second Stage of Labor
  2007. Laboring Down
  2008. Positions
  2009. Method and Breathing Pattern
  2010. Labor Support
  2011. Providing Encouragement
  2012. FIG 16-15 Maternal positions for labor.
  2013. Giving of Self
  2014. Offering Pharmacologic Measures
  2015. Caring for the Birth Partner
  2016. Evaluation
  2017. Preventing Injury
  2018. Assessment
  2019. Nursing Diagnosis and Planning
  2020. Expected Outcome
  2021. Interventions
  2022. Transfer to a Delivery Room
  2023. Positioning for Birth
  2024. Observing the Perineum
  2025. BOX 16-1 ASSISTING WITH AN EMERGENCY BIRTH
  2026. Nursing Priorities for an Emergency Birth in Any Setting
  2027. Preparing for an Emergency Birth in the Birth Facility
  2028. During the Birth
  2029. After the Birth
  2030. Evaluation
  2031. Nursing Care During the Late Intrapartum Period
  2032. Responsibilities During Birth
  2033. Responsibilities After Birth
  2034. Care of the Infant
  2035. Maintaining Cardiopulmonary Function
  2036. Supporting Thermoregulation
  2037. FIG 16-16 Sequence of delivery.
  2038. Identifying the Infant
  2039. FIG 16-17 Vaginal birth.
  2040. Care of the Mother
  2041. Observing for Hemorrhage
  2042. Vital Signs
  2043. Fundus
  2044. NURSING CARE PLAN: Normal Labor and Birth
  2045. Focused Assessment
  2046. Nursing Diagnosis
  2047. Planning
  2048. Expected Outcomes
  2049. Interventions and Rationales
  2050. Evaluation
  2051. Focused Assessment
  2052. Nursing Diagnosis
  2053. Planning
  2054. Expected Outcome
  2055. Interventions and Rationales
  2056. Evaluation
  2057. Focused Assessment
  2058. Nursing Diagnosis
  2059. Planning
  2060. Expected Outcome
  2061. Interventions and Rationales
  2062. Evaluation
  2063. Focused Assessment
  2064. Nursing Diagnosis
  2065. Planning
  2066. Expected Outcome
  2067. Interventions and Rationales
  2068. Evaluation
  2069. TABLE 16-3 APGAR SCORE∗
  2070. FIG 16-18 When the birthing room nurse turns over care of the newborn to the nursery nurse, both check the identification bands and record for the same information.
  2071. Bladder
  2072. Lochia
  2073. Relieving Discomfort
  2074. Ice Packs
  2075. Analgesics
  2076. TABLE 16-4 MATERNAL PROBLEMS DURING THE FOURTH STAGE OF LABOR
  2077. Warmth
  2078. Promoting Early Family Attachment
  2079. KEY CONCEPTS
  2080. References and Readings
  2081. Pageburst Integrated Resource
  2082. Animation
  2083. Chapter 17 Intrapartum Fetal Surveillance
  2084. Learning Objectives
  2085. Fetal Oxygenation
  2086. Uteroplacental Exchange
  2087. Fetal Circulation
  2088. Fetal Heart Rate Regulation
  2089. Autonomic Nervous System
  2090. Baroreceptors
  2091. Chemoreceptors
  2092. Adrenal Glands
  2093. Central Nervous System
  2094. Pathologic Influences on Fetal Oxygenation
  2095. Maternal Cardiopulmonary Alterations
  2096. BOX 17-1 POTENTIAL MATERNAL, FETAL, OR NEONATAL RISK FACTORS
  2097. Antepartum Period
  2098. Maternal History
  2099. Problems Identified during Pregnancy
  2100. Intrapartum Period
  2101. Maternal Problems
  2102. Fetal or Placental Problems
  2103. Uterine Activity
  2104. Placental Disruptions
  2105. Interruptions in Umbilical Flow
  2106. Fetal Alterations
  2107. Risk Factors for Fetal Compromise
  2108. Auscultation and Palpation
  2109. Advantages
  2110. Limitations
  2111. Evaluating Auscultated Fetal Heart Rate Data
  2112. FIG 17-1 Low intervention methods for evaluating fetal heart rate during labor. A, Fetoscope with head attachment to enhance conduction of faint fetal heart sounds. B, Doppler ultrasound transducer to sense the fetal heart rate electronically.
  2113. Electronic Fetal Monitoring
  2114. PROCEDURE: Auscultating the Fetal Heart Rate
  2115. Purpose
  2116. Advantages
  2117. Limitations
  2118. Electronic Fetal Monitoring Equipment
  2119. Bedside Monitor Unit
  2120. FIG 17-2 Paper strip for recording electronic fetal monitoring data. Each dark vertical line represents 1 minute, and each lighter vertical line represents 10 seconds. Computerized displays that depict the fetal heart rate and uterine activity patterns have a similar appearance.
  2121. Paper Strip
  2122. Remote Surveillance
  2123. Devices for External Fetal Monitoring
  2124. FIG 17-3 The nurse applies the uterine activity transducer to the woman’s upper abdomen, in the fundal area. The Doppler transducer for sensing the fetal heart rate is usually placed on her lower abdomen when the fetus is in the cephalic presentation.
  2125. PROCEDURE: External Fetal Monitor
  2126. Purposes
  2127. FIG 17-4 Fetal scalp electrode and intrauterine pressure catheter (IUPC). A, Parts of the fetal scalp electrode before it is applied. B, Fetal scalp electrode and IUPC in place and connected to the bedside monitor unit.
  2128. Fetal Heart Rate Monitoring with an Ultrasound Transducer
  2129. Uterine Activity Monitoring with a Tocotransducer
  2130. Devices for Internal Fetal Monitoring
  2131. Fetal Heart Rate Monitoring with a Scalp Electrode
  2132. FIG 17-5 Intrauterine pressure catheter (IUPC) with transducer in its tip. This model has a lumen for amnioinfusion and is shown with its introducer over the catheter. The amnioinfusion port is on the side of the catheter connection and has a blue cap covering it when not in use.
  2133. Uterine Activity Monitoring with an Intrauterine Pressure Catheter
  2134. Evaluating Electronic Fetal Monitoring Strips
  2135. Baseline Fetal Heart Rate
  2136. Baseline FHR Variability
  2137. FIG 17-6 Electronic fetal monitor strip showing a reassuring pattern of fetal heart rate and uterine activity. The baseline fetal heart rate averages 135 beats per minute (bpm), with a moderate variability of 10 bpm. An acceleration to 150 bpm is present. The contraction frequency is approximately every 2 to 3 minutes, duration is about 50 to 60 seconds, intensity is 75 to 90 mm Hg, and uterine resting tone is approximately 10 mm Hg. Fetal scalp electrode and intrauterine pressure catheter (IUPC) are being used.
  2138. Periodic Patterns in FHR
  2139. Accelerations
  2140. Decelerations
  2141. Early Decelerations
  2142. FIG 17-7 Contrasts in fetal heart rate variability. A fetal scalp electrode is being used. A, Minimal variability (less than 5 beats per minute [bpm]). Note the smooth, flat line in the upper graph for the fetal heart rate. B, Moderate variability (average 20 bpm variability). Note the zigzag appearance of the fetal heart rate line compared with the flat appearance in A.
  2143. FIG 17-8 Accelerations in the fetal heart rate.
  2144. FIG 17-9 Early decelerations. The slowing of the fetal heart rate is gradual, and the nadir of the deceleration occurs at the peak of the contraction. It returns to the baseline by the end of the contraction. Cause: fetal head compression.
  2145. FIG 17-10 Late decelerations. Note that the decelerations look similar to early decelerations but are offset to the right. They begin at about the peak of the contraction, and the nadir occurs well after the peak of the contraction, often during the interval. Cause: uteroplacental insufficiency.
  2146. Late Decelerations
  2147. FIG 17-11 Variable decelerations. The decelerations are sharp in onset and offset. Note slight rate accelerations (shoulders) after each variable deceleration. These variable decelerations are periodic in that they occur during contractions. Cause: umbilical cord compression.
  2148. SAFETY ALERT: Differences Between Early and Late Decelerations
  2149. Both Early and Late Decelerations
  2150. Early Decelerations
  2151. Late Decelerations
  2152. Variable Decelerations
  2153. Uterine Activity
  2154. Significance of FHR Patterns
  2155. Reassuring Patterns
  2156. Indeterminate Patterns
  2157. Nonreassuring Patterns
  2158. SAFETY ALERT: Nursing Responses to Nonreassuring Fetal Heart Rate Patterns
  2159. FIG 17-12 Fetal scalp stimulation identifies fetal response to gentle massage. An acceleration in the fetal heart rate of 15 beats per minute for 15 seconds suggests that the fetus is in normal oxygen and acid-base balance. Accelerations often occur with vaginal examination unrelated to nonreassuring fetal heart rate patterns.
  2160. TABLE 17-1 REASSURING (NORMAL) AND NONREASSURING (ABNORMAL) FETAL SURVEILLANCE ASSESSMENTS
  2161. Clarification of Data
  2162. Fetal Scalp Stimulation
  2163. VAS
  2164. Fetal Scalp Blood Sampling
  2165. Fetal Oxygen Saturation Monitor
  2166. Cord Blood Gases and pH
  2167. Interventions for Nonreassuring Patterns
  2168. FIG 17-13 Obtaining a blood sample to determine umbilical cord blood gas values and pH. Samples are drawn from the umbilical artery and vein. Arterial samples most closely reflect fetal oxygen and acid-base status. The samples in capped syringes may be kept for up to 60 minutes at room temperature.
  2169. Identifying the Cause of a Nonreassuring Pattern
  2170. Increasing Placental Perfusion
  2171. Increasing Maternal Blood Oxygen Saturation
  2172. Reducing Cord Compression
  2173. FIG 17-14 The nurse teaches the woman and her partner about electronic fetal monitoring to reduce anxiety and promote the woman’s comfort during labor. Electronic fetal monitoring is only one method used to evaluate fetal well-being during labor.
  2174. Nursing Care
  2175. The Woman Having Intrapartum Fetal Monitoring
  2176. Learning Needs
  2177. Assessment
  2178. NURSING CARE PLAN: Intrapartum Fetal Compromise
  2179. Focused Assessment
  2180. Nursing Diagnosis
  2181. Planning
  2182. Expected Outcome
  2183. Interventions and Rationales
  2184. Evaluation
  2185. Focused Assessment
  2186. Potential Complication
  2187. Planning
  2188. Expected Outcomes
  2189. Interventions and Rationales
  2190. Evaluation
  2191. Focused Assessment
  2192. Nursing Diagnosis
  2193. Planning
  2194. Expected Outcomes
  2195. Interventions and Rationales
  2196. Evaluation
  2197. Nursing Diagnosis and Planning
  2198. Expected Outcome
  2199. Interventions
  2200. Explaining FHR Auscultation with Uterine Palpation
  2201. Explaining the Electronic Fetal Monitor
  2202. Addressing Parents’ Safety Concerns
  2203. Coping with Misleading Data
  2204. PARENTS WANT TO KNOW: About Electronic Fetal Monitoring
  2205. Can I move around with the monitor?
  2206. What if I need to go to the bathroom?
  2207. Will the monitor shock me? I don’t know if I want to be hooked to an electrical outlet, especially since my water has broken
  2208. Why is the baby’s heart beating so fast?
  2209. Why do those numbers for the baby’s heart rate change all the time?
  2210. What do those numbers for contractions on the machine (external monitor) mean? They change all the time
  2211. My contractions don’t look very strong, but they sure seem strong to me! (External uterine activity monitor is being used.)
  2212. Will the internal monitor hurt my baby?
  2213. Including the Labor Partner
  2214. CRITICAL THINKING EXERCISE 17-1
  2215. CRITICAL THINKING EXERCISE 17-2
  2216. Enhancing Comfort
  2217. Evaluation
  2218. Fetal Oxygenation
  2219. Assessment
  2220. BOX 17-2 GUIDELINES FOR ASSESSMENT AND DOCUMENTATION OF FETAL HEART RATE AUSCULTATION FOR WOMEN AT LOW RISK
  2221. Active First-Stage Labor
  2222. Second-Stage Labor
  2223. Other Times to Document Fetal Heart Rate
  2224. Nursing Diagnosis and Planning
  2225. Interventions
  2226. Taking Corrective Actions
  2227. Reassuring Parents
  2228. Reporting Nonreassuring Patterns
  2229. Documentation ExemplarDocumenting Assessments and Care
  2230. Evaluation
  2231. BOX 17-3 DOCUMENTING ELECTRONIC FETAL MONITORING
  2232. Documentation When Monitoring Is Initiated
  2233. Monitor Strip
  2234. Labor Record (If Paper-Only Documentation)
  2235. Continuing Documentation
  2236. Monitor Strip
  2237. Labor Record
  2238. KEY CONCEPTS
  2239. References and Readings
  2240. Chapter 18 Pain Management for Childbirth
  2241. Learning Objectives
  2242. Unique Nature of Pain During Birth
  2243. Adverse Effects of Excessive Pain
  2244. Physiologic Effects
  2245. Psychological Effects
  2246. Variables in Childbirth Pain
  2247. Physical Factors
  2248. Sources of Pain
  2249. Tissue Ischemia
  2250. Cervical Dilation
  2251. Pressure and Pulling on Pelvic Structures
  2252. Distention of the Vagina and Perineum
  2253. Factors Influencing the Perception or Tolerance of Pain
  2254. FIG 18-1 Pathways of pain transmission during labor. Pain stimuli from cervical dilation enter the spinal cord at these segments. Pain stimuli from vaginal and perineal distention travel through the pudendal nerve and enter the spinal cord at these segments
  2255. Intensity of Labor
  2256. Cervical Readiness
  2257. Fetal Position
  2258. Characteristics of the Pelvis
  2259. Fatigue
  2260. Intervention of Caregivers
  2261. Psychosocial Factors
  2262. Culture
  2263. Anxiety and Fear
  2264. Previous Experiences with Pain
  2265. Preparation for Childbirth
  2266. Support System
  2267. Standards for Pain Management
  2268. Nonpharmacologic Pain Management
  2269. Advantages
  2270. Limitations
  2271. Preparation for Pain Management
  2272. FIG 18-2 General comfort measures such as the nurse’s reassuring presence or a cool, damp cloth applied to the face supplement other methods of nonpharmacologic and pharmacologic pain control.
  2273. Application of Nonpharmacologic Techniques
  2274. Relaxation techniques ExemplarRelaxation
  2275. Environmental Comfort
  2276. General Comfort
  2277. Reducing Anxiety and Fear
  2278. Implementing Specific Relaxation Techniques
  2279. Cutaneous Stimulation
  2280. Self-Massage
  2281. Massage by Others
  2282. FIG 18-3 The coach applies sacral pressure to counter the back pain that is common during labor.
  2283. Thermal Stimulation
  2284. Acupressure
  2285. Hydrotherapy
  2286. BOX 18-1 USE OF WATER THERAPY DURING LABOR
  2287. Benefits
  2288. Disadvantages
  2289. Contraindications and Precautions
  2290. Mental Stimulation
  2291. Imagery ExemplarImagery
  2292. FIG 18-4 A woman and her partner who are prepared for labor have learned a variety of skills to master pain as labor progresses. The coach uses hand signals to tell the woman how to change her pattern of paced breathing.
  2293. Focal Point
  2294. Breathing Techniques
  2295. First-Stage Breathing
  2296. Cleansing Breath
  2297. FIG 18-5 Slow-paced breathing. Although a specific rate may or may not be taught, slow-paced breathing should be no slower than half the woman’s usual respiratory rate to ensure adequate oxygenation. This pace is generally about six to nine breaths per minute.
  2298. FIG 18-6 Modified-paced breathing. The pattern for modified-paced breathing should be comfortable to the woman and no faster than twice her normal respiratory rate to prevent hyperventilation or interference with relaxation.
  2299. Slow-Paced Breathing
  2300. Modified-Paced Breathing
  2301. Pattern-Paced Breathing
  2302. FIG 18-7 Combining breathing techniques during a contraction. Slow- and modified-paced breathing can be combined by using the slower breathing at the beginning and end of the contraction and the more rapid breathing over the peak of the contraction.
  2303. FIG 18-8 Pattern-paced breathing. Pattern-paced breathing adds a slight emphasis or “blow” on the exhalation in a pattern. The diagram shows the emphasis after every third inhalation.
  2304. Controlling the Urge to Push
  2305. Common Problems
  2306. Second-Stage Breathing
  2307. Pharmacologic Pain Management
  2308. Special Considerations When Medicating a Pregnant Woman
  2309. Effects on the Fetus
  2310. Maternal Physiologic Alterations
  2311. Cardiovascular Changes
  2312. Respiratory Changes
  2313. Gastrointestinal Changes
  2314. Nervous System Changes
  2315. Effects on the Course of Labor
  2316. Effects of Complications
  2317. Interactions with Other Substances
  2318. Regional Pain Management Techniques
  2319. Epidural Block
  2320. FIG 18-9 A, Cross section of spinal cord, meninges, and protective vertebra. The dura and arachnoid lie close together. The pia mater is the innermost of the meninges and covers the brain and spinal cord. The subarachnoid space is between the arachnoid and pia mater. B, Sagittal section of spinal cord, meninges, and vertebrae. The epidural and subarachnoid spaces are illustrated. Note that the spinal cord ends at the L2 vertebra.
  2321. Technique
  2322. Dural Puncture
  2323. Contraindications and Precautions
  2324. FIG 18-10 Technique for epidural block.
  2325. Adverse Effects of Epidural Block
  2326. Maternal Hypotension
  2327. Bladder Distention
  2328. Prolonged Second Stage
  2329. Migration of the Epidural Catheter
  2330. Fever
  2331. TABLE 18-1 DRUGS COMMONLY USED FOR INTRAPARTUM PAIN MANAGEMENT
  2332. Adverse Effects of Epidural Opioids
  2333. Nausea and Vomiting
  2334. Pruritus
  2335. Delayed Respiratory Depression
  2336. Nursing Care
  2337. Intrathecal (Subarachnoid) Opioid Analgesics
  2338. Technique
  2339. Adverse Effects of Intrathecal Opioids
  2340. Nursing Care
  2341. Subarachnoid (Spinal) Block
  2342. Technique
  2343. Contraindications and Precautions
  2344. Adverse Effects of an SAB
  2345. Systemic Drugs for Labor
  2346. Opioid Analgesics
  2347. FIG 18-11 Technique for subarachnoid block.
  2348. FIG 18-12 Levels of anesthesia for epidural and subarachnoid blocks. A level of T10 through S5 is adequate for vaginal birth. A higher level, to T4-T6, is needed for cesarean birth.
  2349. Opioid Antagonists
  2350. Adjunctive Drugs
  2351. FIG 18-13 Blood patch for relief of spinal headache. Ten to 15 mL of the woman’s blood is injected into the epidural space to seal a dural puncture.
  2352. Sedatives
  2353. Vaginal Birth Anesthesia
  2354. Local Infiltration Anesthesia
  2355. Pudendal Block
  2356. FIG 18-14 Local infiltration anesthesia numbs the perineum just before birth for an episiotomy or after birth for suturing of a laceration. The birth attendant protects the fetal head by placing a finger inside the vagina while injecting the perineum in a fanlike pattern or as needed.
  2357. General Anesthesia
  2358. Technique
  2359. FIG 18-15 Pudendal block provides anesthesia for an episiotomy and the use of low forceps. A needle guide (“trumpet”) protects the maternal and fetal tissues from the long needle needed to reach the pudendal nerve. Only about 1.25 cm (½ in) of the long needle protrudes from the guide.
  2360. Adverse Effects of General Anesthesia
  2361. Maternal Aspiration of Gastric Contents
  2362. Respiratory Depression
  2363. Uterine Relaxation
  2364. Methods to Minimize Adverse Effects
  2365. FIG 18-16 Sellick maneuver to prevent vomitus from entering the woman’s trachea while she is being intubated for general anesthesia. An assistant applies pressure to the cricoid cartilage to obstruct the esophagus. Once the woman is successfully intubated with a cuffed endotracheal tube, gastric secretions cannot enter the trachea.
  2366. Nursing Care
  2367. Pain Management
  2368. Pain
  2369. Assessment
  2370. NURSING CARE PLAN: Intrapartum Pain Management
  2371. Focused Assessment
  2372. Nursing Diagnosis
  2373. Planning
  2374. Expected Outcomes
  2375. Interventions and Rationales
  2376. Evaluation
  2377. Focused Assessment
  2378. Nursing Diagnosis
  2379. Planning
  2380. Expected Outcomes
  2381. Interventions and Rationales
  2382. Evaluation
  2383. Additional Nursing Diagnoses and Collaborative Problems to Consider:
  2384. Labor Status
  2385. CRITICAL THINKING EXERCISE 18-1
  2386. Nursing Diagnosis and Planning
  2387. Expected Outcomes
  2388. Interventions
  2389. Promoting Relaxation
  2390. Reducing Outside Sources of Discomfort
  2391. Reducing Anxiety and Fear
  2392. Helping the Woman Use Nonpharmacologic Techniques
  2393. Massage
  2394. Mental Stimulation
  2395. Breathing
  2396. Incorporating Pharmacologic Methods
  2397. PARENTS WANT TO KNOW: How Will This Medicine Affect Our Baby?
  2398. Evaluation
  2399. Respiratory Compromise
  2400. Assessment
  2401. Nursing Diagnosis and Planning
  2402. Expected Outcome
  2403. Interventions
  2404. Identifying Risk Factors
  2405. Reducing Risk for Aspiration or Lung Injury
  2406. Perioperative Care
  2407. TABLE 18-2 PHARMACOLOGIC METHODS OF INTRAPARTUM PAIN MANAGEMENT
  2408. Postoperative Care
  2409. Evaluation
  2410. KEY CONCEPTS
  2411. References and Readings
  2412. Chapter 19 Nursing Care During Obstetric Procedures
  2413. Learning Objectives
  2414. Amniotomy
  2415. Indications
  2416. Risks
  2417. Prolapse of the Umbilical Cord
  2418. Infection
  2419. Abruptio Placentae
  2420. Technique
  2421. FIG 19-1 A, Disposable plastic membrane perforator (Amnihook). B, Hook end of plastic membrane perforator. C, Correct method of opening the package. D, Technique for artificial rupture of membranes.
  2422. Nursing Considerations
  2423. Obtaining Baseline Information
  2424. Assisting with Amniotomy
  2425. Providing Care after Amniotomy
  2426. Identifying Complications
  2427. CRITICAL THINKING EXERCISE 19-1
  2428. Promoting Comfort
  2429. Induction and Augmentation of Labor
  2430. Indications
  2431. Determining Whether Induction Is Indicated
  2432. Contraindications
  2433. TABLE 19-1 BISHOP SCORING SYSTEM TO EVALUATE THE CERVIX
  2434. Risks
  2435. Technique
  2436. Cervical Ripening
  2437. Medical Methods
  2438. TABLE 19-2 PROSTAGLANDIN PREPARATIONS FOR CERVICAL RIPENING AT TERM
  2439. Mechanical Methods
  2440. Oxytocin Administration
  2441. FIG 19-2 Intravenous (IV) pump setup for infusion from two IV lines. Fluid in the primary line (nonadditive, or maintenance line) contains no medication but is regulated by the infusion pump to maintain the correct rate. Oxytocin solution is regulated in the secondary line in the same pump, giving the nurse options to change or discontinue the oxytocin infusion rate while maintaining the primary line infusion at the same rate. A single IV line at the lower part of the pump connects to the woman’s infusion site.
  2442. Nursing Considerations
  2443. DRUG GUIDE: Oxytocin (Pitocin)
  2444. CRITICAL THINKING EXERCISE 19-2
  2445. Observing the Fetal Response
  2446. Observing the Mother’s Response
  2447. SAFETY ALERT: Signs of Tachysystole
  2448. Nursing Actions for Tachysystole
  2449. Version
  2450. Indications
  2451. External Cephalic Version
  2452. Internal Version
  2453. Contraindications
  2454. Risks
  2455. Technique
  2456. External Version
  2457. FIG 19-3 External version. Intravenous (IV) access is established in case of emergency or for some tocolytic drugs. If terbutaline is the tocolytic drug, it is given by subcutaneous injection.
  2458. Internal Version
  2459. Nursing Considerations
  2460. Providing Information
  2461. Promoting Maternal and Fetal Health
  2462. Reducing Anxiety
  2463. Operative Vaginal Birth
  2464. Indications
  2465. Contraindications
  2466. FIG 19-4 Obstetric forceps and their application.
  2467. Risks
  2468. Technique
  2469. FIG 19-5 Birth assisted with a vacuum extractor. The chignon is scalp edema that often forms under the suction cup when the vacuum extractor is used.
  2470. Nursing Considerations
  2471. FIG 19-6 A, Vacuum extractor with a low-profile cup that can be used for occiput posterior fetal positions. Note the green band that denotes adequate suction and the red band that warns of excess suction. B, Application of the low-profile cup to the fetal head in an occiput posterior position.
  2472. Episiotomy
  2473. Technique
  2474. Nursing Considerations
  2475. FIG 19-7 Types of episiotomies.
  2476. Cesarean Birth
  2477. VBAC
  2478. BOX 19-1 VAGINAL BIRTH AFTER CESAREAN BIRTH
  2479. Indications
  2480. Contraindications
  2481. Risks
  2482. Technique
  2483. Preparation
  2484. FIG 19-8 Skin (abdominal wall) incisions for cesarean birth.
  2485. Surgical incision ExemplarIncisions
  2486. FIG 19-9 Uterine incisions for cesarean birth. The abdominal and uterine incisions do not always match. VBAC, Vaginal birth after cesarean.
  2487. Nursing Considerations
  2488. Providing Emotional Support
  2489. BOX 19-2 NURSING CARE FOR A WOMAN HAVING A CESAREAN BIRTH
  2490. Before the Cesarean Birth
  2491. During the Recovery Period
  2492. NURSING CARE PLAN: Cesarean Birth
  2493. Focused Assessment
  2494. Nursing Diagnosis
  2495. Planning
  2496. Expected Outcomes
  2497. Interventions and Rationales
  2498. Evaluation
  2499. Focused Assessment
  2500. Nursing Diagnosis
  2501. Planning
  2502. Expected Outcomes
  2503. Interventions and Rationales
  2504. Evaluation
  2505. Additional Nursing Diagnoses to Consider
  2506. Teaching
  2507. Promoting Safety
  2508. Providing Postoperative Care
  2509. KEY CONCEPTS
  2510. References and Readings
  2511. Chapter 20 Postpartum Adaptations
  2512. Learning Objectives
  2513. Reproductive System
  2514. Involution of the Uterus
  2515. Descent of the Uterine Fundus
  2516. Afterpains
  2517. Etiology
  2518. Nursing Considerations
  2519. FIG 20-1 Involution of the uterus. Height of the uterine fundus decreases by approximately 1 cm/day. The fundus is no longer palpable by 14 days.
  2520. Lochia
  2521. Changes in Color
  2522. Amount
  2523. FIG 20-2 Guidelines for assessing the volume of lochia based on the amount of stain on a perineal pad in 1 hour.
  2524. TABLE 20-1 CHARACTERISTICS OF LOCHIA
  2525. Cervix
  2526. Vagina
  2527. BOX 20-1 LACERATIONS OF THE BIRTH CANAL
  2528. Perineum
  2529. Periurethral Area
  2530. Vaginal Wall
  2531. Cervix
  2532. Perineum
  2533. Discomfort
  2534. Nursing Considerations
  2535. Cardiovascular System
  2536. Cardiac Output
  2537. Plasma Volume
  2538. Blood Values
  2539. Coagulation
  2540. Gastrointestinal System
  2541. Urinary System
  2542. FIG 20-3 A full bladder displaces and prevents contraction of the uterus.
  2543. Musculoskeletal System
  2544. Muscles and Joints
  2545. Abdominal Wall
  2546. Integumentary System
  2547. FIG 20-4 Diastasis recti occurs when the longitudinal muscles of the abdomen separate during pregnancy.
  2548. FIG 20-5 Abdominal exercises for diastasis recti. A, The woman inhales and supports the abdominal wall firmly with her hands. B, Exhaling, the woman raises her head as she pulls the abdominal muscles together.
  2549. Neurologic System
  2550. Endocrine System
  2551. Resumption of Ovulation and Menstruation
  2552. Lactation
  2553. Weight Loss
  2554. Postpartum Assessments
  2555. Clinical Pathways
  2556. Initial Assessments
  2557. Chart Review
  2558. Need for Rho(D) Immune Globulin
  2559. Need for Vaccines
  2560. Rubella Vaccine
  2561. Pertussis Vaccine
  2562. DRUG GUIDE: Rubella Vaccine
  2563. Risk Factors for Hemorrhage and Infection
  2564. SAFETY ALERT: Postpartum Risk Factors
  2565. Hemorrhage
  2566. Infection
  2567. Focused Assessments after Vaginal Birth
  2568. Vital Signs
  2569. Blood Pressure
  2570. Orthostatic Hypotension
  2571. TABLE 20-2 OBSERVATIONS OF THE UTERINE FUNDUS AND NURSING ACTIONS
  2572. Pulse
  2573. Respirations
  2574. Temperature
  2575. Pain
  2576. Fundus
  2577. Lochia
  2578. PROCEDURE: Assessing the Uterine Fundus
  2579. Purpose
  2580. Perineum
  2581. Bladder Elimination
  2582. SAFETY ALERT: Signs of a Distended Bladder
  2583. PROCEDURE: Assessing the Perineum
  2584. Purpose
  2585. Breasts
  2586. Lower Extremities
  2587. Homans Sign
  2588. Edema and Deep Tendon Reflexes
  2589. Care in the Immediate Postpartum Period
  2590. Providing Comfort Measures
  2591. Ice Packs
  2592. Sitz Baths
  2593. Perineal Care
  2594. Topical Medications
  2595. Sitting Measures
  2596. Analgesics
  2597. Promoting Bladder Elimination
  2598. CRITICAL THINKING EXERCISE 20-1
  2599. Providing Fluids and Food
  2600. Preventing Thrombophlebitis
  2601. Nursing Care After Cesarean Birth
  2602. Assessment
  2603. Pain Relief
  2604. Respirations
  2605. Abdomen
  2606. Intake and Output
  2607. Interventions
  2608. The First 24 Hours
  2609. Providing Pain Relief
  2610. Overcoming the Effects of Immobility
  2611. Providing Comfort
  2612. After 24 Hours
  2613. Resuming Normal Activities
  2614. Assisting the Mother with Infant Care
  2615. Preventing Abdominal Distention
  2616. Nursing Care
  2617. Teaching After Birth
  2618. Assessment
  2619. Nursing Diagnosis and Planning
  2620. Expected Outcomes
  2621. Interventions
  2622. Preparing for Teaching
  2623. Determining Teaching Topics
  2624. NURSING CARE PLAN: Postpartum Hypotension, Fatigue, and Pain
  2625. Focused Assessment
  2626. Nursing Diagnosis
  2627. Planning
  2628. Expected Outcome
  2629. Interventions and Rationales
  2630. Evaluation
  2631. Focused Assessment
  2632. Nursing Diagnosis
  2633. Planning
  2634. Expected Outcomes
  2635. Interventions and Rationales
  2636. Evaluation
  2637. Additional Nursing Diagnoses to Consider
  2638. Teaching the Process of Involution
  2639. Teaching Self-Care
  2640. Handwashing
  2641. Breast Care for Lactating Mothers
  2642. Measures to Suppress Lactation
  2643. Care of the Cesarean Incision
  2644. Perineal Care
  2645. Kegel Exercises
  2646. Promoting Rest and Sleep
  2647. Rest at the Birth Facility
  2648. Rest at Home
  2649. Providing Nutrition Counseling
  2650. Food Supply
  2651. Diet
  2652. Promoting Regular Bowel Elimination
  2653. Promoting Good Body Mechanics
  2654. Exercise
  2655. Preventing Back Strain
  2656. Counseling about Sexual Activity
  2657. FIG 20-6 Postpartum exercises.
  2658. Instructing About Follow-up Appointments
  2659. Teaching about Signs and Symptoms that Should Be Reported
  2660. Ensuring that All Elements Have Been Taught
  2661. Documenting Teaching
  2662. Evaluation
  2663. The Process of Becoming Acquainted
  2664. FIG 20-7 The infant is quiet and alert during the initial sensitive period. The newborn gazes at the mother and responds to her voice and touch. The mother touches only with her fingertips at first.
  2665. Bonding
  2666. Attachment
  2667. FIG 20-8 The mother begins to stroke her infant as she progresses in becoming acquainted.
  2668. NURSING QUALITY ALERT: Reciprocal Attachment Behaviors
  2669. Maternal Touch
  2670. FIG 20-9 Mothers progress from exploratory touching to enfolding the infant. Their pleasure is enhanced by skin-to-skin contact.
  2671. FIG 20-10 The binding-in, or claiming, process includes the mother’s identification of her baby’s specific features, relating them to other family members. This mother states, “His long toes are exactly like mine.”
  2672. Verbal Behaviors
  2673. The Process of Maternal Role Adaptation
  2674. Puerperal Phases
  2675. Taking-In Phase
  2676. Taking-Hold Phase
  2677. Letting-Go Phase
  2678. CRITICAL THINKING EXERCISE 20-2
  2679. Maternal Role Attainment
  2680. Heading Toward a New Normal
  2681. Appreciating the Body
  2682. Settling In
  2683. Becoming a New Family
  2684. Redefining Roles
  2685. Role Conflict
  2686. NURSING CARE PLAN: Adaptation of the Working Mother
  2687. Focused Assessment
  2688. Nursing Diagnosis
  2689. Planning
  2690. Expected Outcomes
  2691. Interventions and Rationales
  2692. Evaluation
  2693. Additional Nursing Diagnoses to Consider
  2694. Major Maternal Concerns
  2695. Body Image
  2696. Smoking
  2697. Postpartum Blues
  2698. FIG 20-11 Fathers’ behaviors at initial contact with their infants often correspond to maternal behaviors. The intense fascination that fathers exhibit is called engrossment. Note the eye-to-eye contact between father and infant.
  2699. Expanding family ExemplarThe Process of Family Adaptation
  2700. Fathers
  2701. FIG 20-12 A, Although they may hesitate to touch the infant, children often want to be close. B, This boy’s relief and joy are obvious as he reclaims a favorite spot.
  2702. Siblings
  2703. Grandparents
  2704. FIG 20-13 Grandparents may develop strong bonds with grandchildren.
  2705. Factors Affecting Family Adaptation
  2706. Discomfort and Fatigue
  2707. Knowledge of Infant Needs
  2708. Previous Experience
  2709. Expectations about the Newborn
  2710. Maternal Age
  2711. Maternal Temperament
  2712. Temperament of the Infant
  2713. Availability of a Strong Support System
  2714. Other Factors
  2715. Cesarean Birth
  2716. Preterm or Ill Infant
  2717. Birth of Multiple Infants
  2718. NURSING QUALITY ALERT: Factors That Affect Adaptation
  2719. Cultural Influences on Adaptation
  2720. Communication
  2721. Dietary Practices
  2722. Health Beliefs
  2723. Nursing Care
  2724. Maternal Adaptation
  2725. Assessment
  2726. TABLE 20-3 ASSESSING MATERNAL ADAPTATION
  2727. Nursing Diagnosis and Planning
  2728. Expected Outcomes
  2729. Interventions
  2730. Assisting the Mother through Recovery Phases
  2731. “Mother” the Mother
  2732. Monitor and Protect
  2733. Listen to the Birth Experience
  2734. Foster Independence
  2735. Promote Bonding and Attachment
  2736. FIG 20-14 By teaching about the newborn and family, the nurse helps parents develop confidence in their ability to provide care for the infant.
  2737. Involve Parents in Infant Care
  2738. Evaluation
  2739. Nursing Care
  2740. Family Adaptation
  2741. Assessment
  2742. Fathers
  2743. Siblings
  2744. Support System
  2745. Nonverbal Behavior
  2746. Nursing Diagnosis and Planning
  2747. Expected Outcomes
  2748. TABLE 20-4 ASSESSING FAMILY ADAPTATION
  2749. Interventions
  2750. Teaching the Family about the Newborn
  2751. Infant Needs
  2752. Infant Signals
  2753. Helping the Family Adapt
  2754. Providing Anticipatory Guidance about Stress Reduction
  2755. Helping the Father Co-parent
  2756. Providing Ways to Reduce Sibling Rivalry
  2757. Identifying Resources
  2758. Evaluation
  2759. Postpartum Home and Community Care
  2760. Criteria for Discharge
  2761. EVIDENCE-BASED PRACTICE
  2762. Community-Based Care
  2763. KEY CONCEPTS
  2764. References and Readings
  2765. Chapter 21 The Normal Newborn: Adaptation and Assessment
  2766. Learning Objectives
  2767. Initiation of Respirations
  2768. Development of the Lungs
  2769. FIG 21-1 Internal causes of the initiation of respirations are the chemical changes that take place at birth. External causes of respirations include thermal, sensory, and mechanical factors.
  2770. Causes of Respirations
  2771. Chemical Factors
  2772. Mechanical Factors
  2773. Thermal Factors
  2774. Sensory Factors
  2775. Continuation of Respirations
  2776. Cardiovascular Adaptation: Transition from Fetal to Neonatal Circulation
  2777. Ductus Venosus
  2778. Foramen Ovale
  2779. Pulmonary Blood Vessels
  2780. Ductus Arteriosus
  2781. Changes at Birth
  2782. CRITICAL THINKING EXERCISE 21-1
  2783. Neurologic Adaptation: Thermoregulation
  2784. Newborn Characteristics Leading to Heat Loss
  2785. Methods of Heat Loss
  2786. FIG 21-2 Methods of heat loss.
  2787. Nonshivering Thermogenesis
  2788. FIG 21-3 Sites of brown fat in the neonate.
  2789. Effects of Cold Stress
  2790. Neutral Thermal Environment
  2791. FIG 21-4 Effects of cold stress.
  2792. BOX 21-1 HAZARDS OF COLD STRESS
  2793. Hyperthermia
  2794. Hematologic Adaptation
  2795. Factors Affecting the Blood
  2796. Blood Values
  2797. Erythrocytes and Hemoglobin
  2798. TABLE 21-1 LABORATORY VALUES IN THE NEWBORN
  2799. Hematocrit
  2800. Leukocytes
  2801. Risk of Clotting Deficiency
  2802. Gastrointestinal System
  2803. Stomach
  2804. Intestines
  2805. Digestive Enzymes
  2806. Stools
  2807. Hepatic System
  2808. Blood Glucose Maintenance
  2809. Conjugation of Bilirubin
  2810. Source and Effect of Bilirubin
  2811. Normal Conjugation
  2812. FIG 21-5 Sources of bilirubin and how it is removed from the body.
  2813. Risk Factors for Elevated Bilirubin
  2814. Hyperbilirubinemia
  2815. Physiologic Jaundice
  2816. Nonphysiologic (Pathologic) Jaundice
  2817. Jaundice Associated with Breastfeeding
  2818. Breastfeeding or Early Onset Jaundice
  2819. True Breast Milk Jaundice
  2820. Blood Coagulation
  2821. Iron Storage
  2822. Drug Metabolism
  2823. Urinary System
  2824. Kidney Development
  2825. Kidney Function
  2826. Fluid Balance
  2827. Water Distribution
  2828. BOX 21-2 INTAKE AND OUTPUT IN THE NEWBORN
  2829. First 3 to 5 Days of Life
  2830. After the First 3 to 5 Days
  2831. Insensible Water Loss
  2832. Urine Dilution and Concentration
  2833. Acid-Base and Electrolyte Balance
  2834. Immune System
  2835. IgG
  2836. IgM
  2837. IgA
  2838. Psychosocial Adaptation
  2839. Periods of Reactivity
  2840. First Period of Reactivity
  2841. Period of Sleep or Decreased Activity
  2842. Second Period of Reactivity
  2843. Behavioral States
  2844. Deep or Quiet Sleep State
  2845. Light or Active Sleep State
  2846. Drowsy State
  2847. Quiet Alert State
  2848. Active Alert State
  2849. Crying State
  2850. Early Assessments
  2851. SAFETY ALERT: Protection from Bloodborne Infections
  2852. TABLE 21-2 SUMMARY OF NEWBORN ASSESSMENT
  2853. History
  2854. Assessment of Cardiorespiratory Status
  2855. Airway
  2856. Respiratory Rate
  2857. Breath Sounds
  2858. Infant respiratory distress syndrome ExemplarSigns of Respiratory Distress
  2859. Tachypnea
  2860. PROCEDURE: Assessing Vital Signs in the Newborn
  2861. Purpose
  2862. Temperature
  2863. Respirations
  2864. Apical Pulse
  2865. Retractions
  2866. Flaring of the Nares
  2867. Cyanosis
  2868. FIG 21-6 Acrocyanosis.
  2869. Grunting
  2870. Seesaw or Paradoxical Respirations
  2871. Asymmetry
  2872. Choanal Atresia
  2873. Color
  2874. Pallor
  2875. Ruddy Color
  2876. Heart Sounds
  2877. Position
  2878. Rhythm and Murmurs
  2879. Brachial and Femoral Pulses
  2880. Blood Pressure
  2881. Capillary Refill
  2882. Assessment of Thermoregulation
  2883. FIG 21-7 The infant is held securely to prevent injury and obtain an accurate reading when taking the temperature.
  2884. BOX 21-3 NORMAL VITAL SIGNS IN THE NEWBORN
  2885. Assessing for Anomalies
  2886. Head
  2887. Molding
  2888. Fontanels
  2889. FIG 21-8 Palpation of the anterior fontanel. Note elevation of the head.
  2890. Caput Succedaneum
  2891. FIG 21-9 Caput succedaneum is an edematous area on the head from pressure against the cervix. It may cross suture lines.
  2892. Cephalhematoma
  2893. Face
  2894. Neck and Clavicles
  2895. FIG 21-10 A cephalhematoma is characterized by bleeding between the bone and its covering, the periosteum. It may occur on one or both sides and does not cross suture lines.
  2896. Cord
  2897. Extremities
  2898. Hands and Feet
  2899. Hips
  2900. Vertebral Column
  2901. Measurements
  2902. Weight
  2903. FIG 21-11 Assessment of the hips. Place the fingers over the infant’s greater trochanter and thumbs over the femur. Flex the knees and hips. A, Barlow test: adduct the hips, and apply gentle pressure down and back with the thumbs. In hip dysplasia, the examiner can feel the femoral head move out of the acetabulum. B, Ortolani test: abduct the thighs, and apply gentle pressure forward over the greater trochanter. A “clunking” sensation indicates a dislocated femoral head moving into the acetabulum. A hip click is normal from ligament movement.
  2904. FIG 21-12 Note the symmetry of gluteal and thigh creases.
  2905. FIG 21-13 A tape is placed alongside the infant to measure the length. A mark can be made on the bed at the head and foot and the distance between the marks measured.
  2906. Length
  2907. Head and Chest Circumference
  2908. CRITICAL THINKING EXERCISE 21-2
  2909. Assessment of Body Systems
  2910. Neurologic System
  2911. Reflexes
  2912. Sensory Assessment
  2913. Ears
  2914. Eyes
  2915. Sense of Smell and Taste
  2916. Other Neurologic Signs
  2917. FIG 21-14 Reflexes.
  2918. FIG 21-15 An imaginary line is drawn from the outer canthus of the eye to the ear. The line should intersect with the area where the upper ear joins the head.
  2919. TABLE 21-3 SUMMARY OF NEONATAL REFLEXES
  2920. BOX 21-4 RISK FACTORS FOR HYPOGLYCEMIA
  2921. Assessment of Hepatic Function
  2922. Blood Glucose
  2923. SAFETY ALERT: Signs of Hypoglycemia
  2924. PROCEDURE: Obtaining Blood Samples from the Newborn by Heel Puncture
  2925. Purpose
  2926. EVIDENCE-BASED PRACTICE
  2927. Bilirubin
  2928. BOX 21-5 RISK FACTORS FOR HYPERBILIRUBINEMIA
  2929. Gastrointestinal System
  2930. Mouth
  2931. Suck
  2932. Initial Feeding
  2933. Abdomen
  2934. Stools
  2935. Genitourinary System
  2936. Kidney Palpation
  2937. Urine
  2938. Genitalia
  2939. Female
  2940. Male
  2941. Integumentary System
  2942. Skin
  2943. FIG 21-16 The testes are palpated from front to back with the thumb and forefinger. Placing a finger over the inguinal canal holds the testes in place for palpation.
  2944. Color
  2945. Harlequin Color Change
  2946. Mottling
  2947. Vernix Caseosa
  2948. Lanugo
  2949. Milia
  2950. FIG 21-17 Lanugo is abundant on this slightly preterm infant.
  2951. FIG 21-18 Milia.
  2952. FIG 21-19 Erythema toxicum.
  2953. Erythema Toxicum
  2954. Birthmarks
  2955. FIG 21-20 Mongolian spots.
  2956. FIG 21-21 Nevus simplex (stork bite, salmon patch).
  2957. FIG 21-22 Nevus flammeus (port-wine stain).
  2958. Marks from Delivery
  2959. Other Skin Assessments
  2960. Documentation
  2961. Breasts
  2962. Hair and Nails
  2963. Assessment of Gestational Age
  2964. Assessment Tools
  2965. Neuromuscular Characteristics
  2966. Posture
  2967. Square Window
  2968. Arm Recoil
  2969. Popliteal Angle
  2970. FIG 21-23 New Ballard Score.
  2971. Scarf Sign
  2972. FIG 21-24 Posture in newborns. A, The healthy, full-term infant remains in a strongly flexed position. B, The preterm infant’s extremities are extended.
  2973. FIG 21-25 The square window sign is performed on an arm without an identification bracelet. The nurse flexes the wrist and measures the angle. A, Infant near full term. B, Preterm infant.
  2974. Heel to Ear
  2975. Physical Characteristics
  2976. Skin
  2977. Lanugo
  2978. FIG 21-26 Arm recoil. A, Arms flexed. B, Arms extended. C, Recoil for the full-term infant.
  2979. FIG 21-27 The popliteal angle is measured by flexing the thigh against the abdomen and extending the lower leg to the point of resistance. A, Full-term infant. B, Preterm infant.
  2980. FIG 21-28 Scarf sign. The nurse determines how far the arm will move across the chest and observes the position of the elbow when resistance is felt. A, Full-term infant. B, Preterm infant. (Note the many visible veins in the preterm infant and the absence of visible veins in the full-term infant.)
  2981. FIG 21-29 Heel to ear. The nurse grasps the foot and brings it up toward the ear. The score is recorded when resistance is felt. A, Full-term infant. B, Preterm infant.
  2982. FIG 21-30 Plantar creases begin to develop at the base of the toes and extend to the heel. A, The postterm infant has deep creases. B, The preterm infant has few creases on the entire foot.
  2983. Plantar Surface
  2984. Breasts
  2985. Eyes and Ears
  2986. FIG 21-31 The nurse places a finger on either side of the breast bud and measures the size. In the full-term infant, the areola is raised and the nipple is easily distinguished from surrounding skin. (Note the peeling skin.)
  2987. Genitals
  2988. FIG 21-32 Ear maturation. A, The nurse folds the ears and notes how quickly they return to position. B, Ears in the full-term infant are well formed and have instant recoil. C, In the preterm infant, ears show less incurving of the pinna and recoil slowly or not at all.
  2989. FIG 21-33 Female genitals. As the female fetus matures, the labia majora cover the labia minora and clitoris completely; in the preterm infant, these structures are not covered. A, Near-term infant. B, Preterm infant.
  2990. Scoring
  2991. Gestational Age and Infant Size
  2992. FIG 21-34 Male genitals. A, The full-term infant has a pendulous scrotum with deep rugae. B, In the preterm infant, the testes may not be descended and rugae are few.
  2993. Assessment of Behavior
  2994. Periods of Reactivity
  2995. Behavioral Changes
  2996. Orientation
  2997. Habituation
  2998. Self-Consoling Activities
  2999. Parents’ Response
  3000. KEY CONCEPTS
  3001. References and Readings
  3002. Chapter 22 The Normal Newborn: Nursing Care
  3003. Learning Objectives
  3004. Early Care
  3005. Administering Vitamin K
  3006. Providing Eye Treatment
  3007. DRUG GUIDE: Vitamin K1 (phytonadione)
  3008. FIG 22-1 Administration of ophthalmic ointment. The nurse gently cleans the eyes of blood or vernix wiping from inner to outer canthus. Then, placing a finger and thumb near the edge of each lid, the nurse gently presses against the periorbital ridges to open the eyes, avoiding pressure on the eye itself. A ribbon of ointment is squeezed into each conjunctival sac.
  3009. DRUG GUIDE: Erythromycin Ophthalmic Ointment
  3010. Nursing Care
  3011. Cardiorespiratory Status
  3012. Assessment
  3013. Nursing Diagnosis and Planning
  3014. Expected Outcome
  3015. Interventions
  3016. Positioning and Suctioning
  3017. PROCEDURE: Using a Bulb Syringe
  3018. Purpose
  3019. Providing Continuing Care
  3020. Evaluation
  3021. Nursing Care
  3022. Thermoregulation
  3023. Assessment
  3024. Nursing Diagnosis and Planning
  3025. Expected Outcome
  3026. Interventions
  3027. Preventing Heat Loss
  3028. Preparing the Environment Before Birth
  3029. Providing Immediate Care
  3030. FIG 22-2 Radiant warmers allow easy access to the infant without increasing heat loss caused by exposure. The nurse should be careful not to come between the infant and the overhead source of heat when giving care.
  3031. Providing Ongoing Prevention
  3032. Restoring Thermoregulation
  3033. Performing Expanded Assessments
  3034. Evaluation
  3035. Nursing Care
  3036. Hepatic Function
  3037. NURSING CARE PLAN: The Normal Newborn
  3038. Focused Assessment
  3039. Nursing Diagnosis
  3040. Planning
  3041. Expected Outcomes
  3042. Interventions and Rationales
  3043. Evaluation
  3044. Focused Assessment
  3045. Nursing Diagnosis
  3046. Planning
  3047. Expected Outcomes
  3048. Interventions and Rationales
  3049. Evaluation
  3050. Additional Nursing Diagnoses to Consider
  3051. Blood Glucose
  3052. Assessment
  3053. Nursing Diagnosis and Planning
  3054. Interventions
  3055. Maintaining Safe Glucose Levels
  3056. Repeating Glucose Tests
  3057. Providing Other Care
  3058. Evaluation
  3059. CRITICAL THINKING EXERCISE 22-1
  3060. Bilirubin
  3061. Assessment
  3062. Nursing Diagnosis and Planning
  3063. Expected Outcomes
  3064. Interventions
  3065. Evaluation
  3066. Ongoing Assessments and Care
  3067. Providing Skin Care
  3068. Bathing
  3069. Cleansing the Diaper Area
  3070. Providing Cord Care
  3071. Assisting with Feedings
  3072. FIG 22-3 The cord clamp is removed when the end of the cord is dry and crisp. The clamp is cut (A) and separated (B).
  3073. Positioning the Infant
  3074. Protecting the Infant
  3075. Identifying the Infant
  3076. Preventing Infant Abduction
  3077. FIG 22-4 The nurse unwraps the infant to compare the infant’s identification band with the mother’s band. The mother may be asked to read the identification number on her band as the nurse checks the infant’s band or the nurse may look at both bands together.
  3078. BOX 22-1 PRECAUTIONS TO PREVENT INFANT ABDUCTIONS
  3079. FIG 22-5 The nurse uses a code to open the door to maternity units.
  3080. Preventing Infection
  3081. Circumcision
  3082. Reasons for Choosing Circumcision
  3083. Reasons for Rejecting Circumcision
  3084. Pain Relief
  3085. Methods
  3086. Nursing Considerations
  3087. Assisting in Decision Making
  3088. FIG 22-6 Circumcision using the Gomco (Yellen) clamp. The physician pulls the prepuce over a cone-shaped device that rests against the glans. A clamp is placed around the cone and prepuce and is tightened to provide enough pressure to crush the blood vessels. This procedure prevents bleeding when the prepuce is removed after 3 to 5 minutes.
  3089. FIG 22-7 Circumcision using the PlastiBell. The physician places the PlastiBell, a plastic ring, over the glans, draws the prepuce over it, and ties a suture around the prepuce and PlastiBell. This procedure prevents bleeding when the excess prepuce is removed. The handle is removed, leaving only the ring in place over the glans. The PlastiBell usually falls off in 7 to 14 days.
  3090. PATIENT-CENTERED TEACHING: How to Care for an Uncircumcised Penis
  3091. Providing Care during Circumcision
  3092. Evaluating Pain
  3093. Providing Postprocedure Care
  3094. FIG 22-8 The infant is placed on the circumcision board just before the procedure is begun.
  3095. FIG 22-9 An infant with a newly circumcised penis.
  3096. PATIENT-CENTERED TEACHING: How to Care for a Circumcision Site
  3097. PATIENT-CENTERED TEACHING: Techniques for Infant Care
  3098. Handling the Infant
  3099. Head Support
  3100. Positioning
  3101. Wrapping
  3102. Normal Body Processes
  3103. Breathing
  3104. Using a Bulb Syringe
  3105. Temperature
  3106. Using a Thermometer
  3107. Urine Output
  3108. Stool Output
  3109. Diarrhea
  3110. Skin Care
  3111. Cord
  3112. Diaper Area
  3113. Bathing
  3114. Sponge Baths
  3115. Tub Bath
  3116. Behavior
  3117. Sleep Phases
  3118. Awake Phases
  3119. Socialization
  3120. Teaching Parents
  3121. SAFETY ALERT: Signs of Complications after Circumcision
  3122. Nursing Care
  3123. Parents’ Knowledge of Newborn Care
  3124. Assessment
  3125. Nursing Diagnosis and Planning
  3126. Expected Outcomes
  3127. Interventions
  3128. Determining Who Teaches
  3129. Setting Priorities
  3130. Using Various Teaching Methods
  3131. Modeling Behavior
  3132. Teaching Intermittently
  3133. Including the Father
  3134. Documenting Teaching
  3135. Incorporating Cultural Considerations
  3136. Providing for Follow-up Care
  3137. Evaluation
  3138. Immunization
  3139. Newborn Screening
  3140. Hearing Screening
  3141. Other Screening Tests
  3142. Discharge and Newborn Follow-Up Care
  3143. Discharge
  3144. Follow-up Care
  3145. Home Visits
  3146. Content of the Home Visit
  3147. Identification of Jaundice
  3148. Feeding Concerns
  3149. General Considerations in Home Visits
  3150. Outpatient Visits
  3151. Telephone Counseling
  3152. Follow-up Calls
  3153. Warm Lines
  3154. Telephone Techniques
  3155. Guidelines and Documentation
  3156. KEY CONCEPTS
  3157. References and Readings
  3158. Chapter 23 Newborn Feeding
  3159. Learning Objectives
  3160. Nutritional Needs of the Newborn
  3161. Calories
  3162. Nutrients
  3163. Water
  3164. BOX 23-1 DAILY CALORIE AND FLUID NEEDS OF THE NEWBORN
  3165. Breast Milk and Formula Composition
  3166. Breast Milk
  3167. Changes in Composition
  3168. Lactogenesis I
  3169. Lactogenesis II
  3170. Lactogenesis III
  3171. Nutrients
  3172. Protein
  3173. Carbohydrate
  3174. Fat
  3175. Vitamins
  3176. Minerals
  3177. Enzymes
  3178. Infection-Preventing Components
  3179. Effect of Maternal Diet
  3180. Formulas
  3181. Cow’s Milk
  3182. Formulas for Infants with Special Needs
  3183. Considerations in Choosing a Feeding Method
  3184. Breastfeeding
  3185. BOX 23-2 BENEFITS OF BREASTFEEDING
  3186. For the Infant
  3187. For the Mother
  3188. Formula Feeding
  3189. Combination Feeding
  3190. Factors Influencing Choice
  3191. Support from Others
  3192. Culture
  3193. Employment
  3194. Staff Knowledge
  3195. Other Factors
  3196. Normal Breastfeeding
  3197. Breast Changes during Pregnancy
  3198. Milk Production
  3199. Hormonal Changes at Birth
  3200. Prolactin
  3201. Oxytocin
  3202. Continued Milk Production
  3203. Preparation of Breasts for Breastfeeding
  3204. FIG 23-1 Effect of prolactin and oxytocin on milk production. When the infant begins to suckle at the breast, nerve impulses travel to the hypothalamus and cause the anterior pituitary to secrete prolactin to increase milk production. Suckling causes the posterior pituitary to secrete oxytocin, producing the let-down reflex, which releases milk from the breast. Oxytocin also causes the uterus to contract, which aids in involution.
  3205. FIG 23-2 Normal everted nipple and other types of nipples that may cause the infant difficulty in latching on. Nipples shown after stimulation.
  3206. Nursing Care
  3207. Breastfeeding
  3208. Assessment
  3209. Maternal Assessment
  3210. Breasts and Nipples
  3211. BOX 23-3 HUNGER CUES IN INFANTS
  3212. Knowledge
  3213. Assessment of Infant Feeding Behaviors
  3214. LATCH Scoring Tool
  3215. Nursing Diagnosis and Planning
  3216. Expected Outcomes
  3217. FIG 23-3 For the cradle hold, the mother positions the infant’s head at or near the antecubital space and level with her nipple, with her arm supporting the infant’s body. Her other hand is free to hold the breast. Once the infant is positioned, pillows or blankets can be used to support the mother’s arm, which may tire from holding the baby.
  3218. Interventions
  3219. Assisting with the First Feeding
  3220. Teaching Feeding Techniques
  3221. Position of the Mother and Infant
  3222. FIG 23-4 For the football or clutch hold, the mother supports the infant’s head in her hand, with the infant’s body resting on pillows alongside her hip. This method allows the mother to see the position of the infant’s mouth on the breast, helps her control the infant’s head, and is especially helpful for mothers with heavy breasts. This hold also avoids pressure against an abdominal incision.
  3223. FIG 23-5 The cross-cradle or modified cradle hold is helpful for infants who are preterm or have a fractured clavicle. The mother holds the infant’s head in the hand opposite the side on which the infant will feed and supports the infant’s body across her lap with her arm. The other hand holds the breast. The mother can guide the infant’s head to the breast and see the mouth on the breast during the feeding.
  3224. FIG 23-6 The side-lying position avoids pressure on episiotomy or abdominal incisions and allows the mother to rest while feeding. She lies on her side, with her lower arm supporting her head or placed around the infant. Pillows behind her back and between her legs provide comfort. Her upper hand and arm are used to position the infant on the side at nipple level and hold the breast. When the infant’s mouth opens to nurse, the mother draws the infant to her to insert the nipple into the mouth.
  3225. Position of the Mother’s Hands
  3226. Latch-On Techniques
  3227. Eliciting Latch-On
  3228. FIG 23-7 C position of hand on breast. The hand is positioned so the thumb is on top of the breast while the fingers support the breast from below. Note the flaring of the infant’s lips.
  3229. FIG 23-8 Position of infant’s mouth while suckling. When the nipple and areola are properly positioned in the infant’s mouth, the gums compress the areola instead of the nipple. The tongue is between the lower gum and the breast. The infant’s lips are flared outward.
  3230. Position of the Mouth
  3231. Suckling Pattern
  3232. Removal from the Breast
  3233. Frequency of Feedings
  3234. Length of Feedings
  3235. Preventing Problems
  3236. Teaching
  3237. Minimizing Interruptions
  3238. EVIDENCE-BASED PRACTICE
  3239. Formula Gift Packs
  3240. Formula Supplements
  3241. Insufficient Milk Supply
  3242. Increasing Confidence
  3243. Providing Resources
  3244. Evaluation
  3245. MOTHERS WANT TO KNOW: Is My Baby Getting Enough Milk?
  3246. Common Breastfeeding Concerns
  3247. Infant Problems
  3248. SAFETY ALERT: Infant Signs of Breastfeeding Problems
  3249. Sleepy Infant
  3250. Nipple Confusion
  3251. Latch-on Problems
  3252. Infant Complications
  3253. Jaundice
  3254. Prematurity
  3255. NURSING CARE PLAN: Breastfeeding an Infant with a Complication
  3256. Focused Assessment
  3257. Nursing Diagnosis
  3258. Planning
  3259. Expected Outcomes
  3260. Interventions and Rationales
  3261. Evaluation
  3262. Late Preterm Infants
  3263. Illness and Congenital Defects
  3264. Maternal Concerns
  3265. SAFETY ALERT: Maternal Signs of Breastfeeding Problems
  3266. Common Breast Problems
  3267. Engorgement
  3268. Nipple Pain
  3269. Flat and Inverted Nipples
  3270. Plugged Ducts
  3271. Illness in the Mother
  3272. FIG 23-9 Note the cracked area on this nipple.
  3273. FIG 23-10 Rolling helps flat nipples become erect in preparation for latch-on.
  3274. PATIENT-CENTERED TEACHING: Solutions to Common Breastfeeding Problems
  3275. Problem: Sleepy Infant
  3276. Prevention
  3277. Solutions
  3278. Problem: Nipple Confusion
  3279. Prevention
  3280. Solution
  3281. Problem: Latch-on Difficulty
  3282. Prevention
  3283. Solution
  3284. Problem: Engorgement
  3285. Prevention
  3286. Solutions
  3287. Problem: Nipple Pain
  3288. Prevention
  3289. Solutions
  3290. Problem: Flat or Inverted Nipples
  3291. Prevention
  3292. Solutions
  3293. Drug Transfer to Breast Milk
  3294. FIG 23-11 To massage the breasts the mother places her hands against the chest wall with her fingers encircling the breasts. She gently slides her hands forward until the fingers overlap. The position of the hands is rotated to cover all breast tissue. Massaging with the fingertips in a circular motion over all areas of the breast also is helpful.
  3295. Conditions in which Breastfeeding Should Be Avoided
  3296. Previous Breast Surgery
  3297. Employment
  3298. Milk Expression and Storage
  3299. FIG 23-12 To express milk from the breast, the mother places her hand just behind the areola, with the thumb on top and the fingers supporting the breast. The tissue is pressed back against the chest wall; then the fingers and thumb are brought together and toward the nipple to cause the milk to flow. The action is repeated to simulate the infant’s suckling. Moving the hands around the areola allows compression of all areas and complete removal of milk from the breast. Compression should be gentle to avoid trauma.
  3300. FIG 23-13 The nurse helps the mother use an electric breast pump.
  3301. Hand Expression
  3302. Use of a Breast Pump
  3303. Milk Storage
  3304. Breastfeeding after Multiple Births
  3305. Weaning
  3306. Home Care
  3307. Other Concerns
  3308. Formula Feeding
  3309. Nursing Care
  3310. Formula Feeding
  3311. Assessment
  3312. Nursing Diagnosis and Planning
  3313. Expected Outcomes
  3314. Interventions
  3315. Teaching about Formula
  3316. Types of Formula
  3317. Ready-to-Use
  3318. Concentrated Liquid
  3319. Powdered Formula
  3320. Equipment
  3321. Preparation
  3322. SAFETY ALERT: Formula Dilution
  3323. Explaining Feeding Techniques
  3324. Positioning
  3325. Burping
  3326. FIG 23-14 This mother holds her infant close during bottle feeding. The bottle is positioned so the nipple is filled with milk at all times. The father offers encouragement.
  3327. Frequency and Amount
  3328. Cautions
  3329. Infant Variations
  3330. Evaluation
  3331. Key Concepts
  3332. References and Readings
  3333. Chapter 24 The Childbearing Family with Special Needs
  3334. Learning Objectives
  3335. Adolescent Pregnancy
  3336. Incidence of Teenage Pregnancy
  3337. Factors Associated with Teenage Pregnancy
  3338. BOX 24-1 FACTORS THAT CONTRIBUTE TO TEENAGE PREGNANCY
  3339. Sex Education
  3340. FIG 24-1 Pregnant adolescent. Of teenage girls who become pregnant, approximately 1 in 5 have had a previous birth.
  3341. Preconception Counseling
  3342. Options When Pregnancy Occurs
  3343. Socioeconomic Implications of Teenage Pregnancy
  3344. Implications for Maternal Health
  3345. Implications for Fetal-Neonatal Health
  3346. The Teenage Expectant Father
  3347. Impact of Teenage Pregnancy on Parenting
  3348. Nursing Care
  3349. The Pregnant Teenager
  3350. Assessment
  3351. Physical Assessment
  3352. Cognitive Development
  3353. Knowledge of Infant Needs
  3354. Family Assessment
  3355. Nursing Diagnosis and Planning
  3356. Expected Outcomes
  3357. Interventions
  3358. Eliminating Barriers to Health Care
  3359. NURSING CARE PLAN: An Adolescent’s Responses to Pregnancy and Birth
  3360. Focused Assessment
  3361. Nursing Diagnosis
  3362. Planning
  3363. Expected Outcomes
  3364. Interventions and Rationales
  3365. Evaluation
  3366. Focused Assessment
  3367. Nursing Diagnosis
  3368. Planning
  3369. Expected Outcomes
  3370. Interventions and Rationales
  3371. Evaluation
  3372. Focused Assessment
  3373. Nursing Diagnosis
  3374. Planning
  3375. Expected Outcomes
  3376. Interventions and Rationales
  3377. Evaluation
  3378. Additional Nursing Diagnoses to Consider
  3379. Applying Teaching or Learning Principles
  3380. Nutrition counseling ExemplarCounseling
  3381. Nutrition
  3382. Self-Care
  3383. Stress Reduction
  3384. Attachment to the Fetus
  3385. Breastfeeding
  3386. Promoting Family Support
  3387. Providing Support during Labor
  3388. Providing Referrals
  3389. Evaluation
  3390. Delayed Pregnancy
  3391. Maternal and Fetal Implications of Delayed Pregnancy
  3392. Advantages of Delayed Childbirth
  3393. Disadvantages of Delayed Childbirth
  3394. FIG 24-2 Older primigravidas bring maturity and problem-solving skills to the maternal role, but they are at somewhat increased risk for physiologic problems related to pregnancy and birth.
  3395. Nursing Considerations
  3396. Preconception Care
  3397. Reinforcing and Clarifying Information
  3398. Facilitating Expression of Emotions
  3399. Providing Parenting Information
  3400. Substance Abuse
  3401. Incidence
  3402. Maternal and Fetal Effects
  3403. Tobacco
  3404. TABLE 24-1 MATERNAL AND FETAL OR NEONATAL EFFECTS OF COMMONLY ABUSED SUBSTANCES
  3405. Alcohol
  3406. Marijuana
  3407. Cocaine
  3408. Actions
  3409. Maternal and Fetal Effects
  3410. Neonatal Effects
  3411. Amphetamines and Methamphetamines
  3412. Maternal and Fetal Effects
  3413. Neonatal Effects
  3414. Antidepressants
  3415. Maternal and Fetal Effects
  3416. Neonatal Effects
  3417. Opioids
  3418. Fetal Effects
  3419. Neonatal Effects
  3420. Diagnosis and Management of Substance Abuse
  3421. Nursing Care
  3422. Maternal Substance Abuse
  3423. Antepartum Period
  3424. Assessment
  3425. CRITICAL TO REMEMBER: Behaviors Associated with Substance Abuse
  3426. Medical and Obstetric History
  3427. History of Substance Abuse
  3428. Nursing Diagnosis and Planning
  3429. Expected Outcomes
  3430. Interventions
  3431. Examining Attitudes
  3432. Preventing Substance Abuse
  3433. Communicating with the Woman
  3434. Helping the Woman Identify Strengths
  3435. Providing Ongoing Care
  3436. Evaluation
  3437. Intrapartum Period
  3438. Assessment
  3439. Cocaine
  3440. CRITICAL TO REMEMBER: Signs and Symptoms of Recent Cocaine Use
  3441. Heroin
  3442. Nursing Diagnosis and Planning
  3443. Expected Outcome
  3444. Interventions
  3445. Preventing Injury
  3446. Admitting Procedure
  3447. Setting Limits
  3448. Initiating Seizure Precautions
  3449. Maintaining Effective Communication
  3450. Providing Pain Control
  3451. Preventing Heroin Withdrawal
  3452. Evaluation
  3453. Postpartum Period
  3454. Birth of an Infant with Congenital Anomalies
  3455. Factors Influencing Emotional Responses of Parents
  3456. Timing and Manner of Being Told
  3457. Prior Knowledge of the Defect
  3458. FIG 24-3 Touching and cuddling between parents and the infant with a congenital anomaly foster attachment and help resolve the grieving process. This infant has anomalies of the hand and arm.
  3459. Type of Defect
  3460. Irreparable Defect
  3461. Grief and Mourning
  3462. Nursing Considerations
  3463. Assisting with the Grieving Process
  3464. Promoting Bonding and Attachment
  3465. Providing Accurate Information
  3466. Facilitating Communication
  3467. Participating in Infant Care
  3468. Planning for Discharge
  3469. Providing Referrals
  3470. Perinatal Loss
  3471. Early Pregnancy Loss
  3472. Concurrent Death and Survival in Multifetal Pregnancy
  3473. Previous Pregnancy Loss
  3474. Nursing Care
  3475. Pregnancy Loss
  3476. Assessment
  3477. Nursing Diagnosis and Planning
  3478. Expected Outcome
  3479. Interventions
  3480. Allowing Expression of Feelings
  3481. Acknowledging the Infant
  3482. Presenting the Infant to the Parents
  3483. Preparing a Memory Box or Packet
  3484. Respecting Cultural Practices
  3485. Assisting with Other Needs
  3486. Providing Referrals
  3487. Evaluation
  3488. Adoption
  3489. Intimate Partner Violence
  3490. FIG 24-4 The woman who is abused by her partner lives with an ever-present risk of violence. Because they may not seek help, all women should be asked about abuse whenever they receive health care.
  3491. EVIDENCE-BASED PRACTICE
  3492. Effects of Intimate Partner Violence during Pregnancy
  3493. Factors that Promote Violence
  3494. Characteristics of the Abuser
  3495. TABLE 24-2 MYTHS AND REALITIES OF VIOLENCE AGAINST WOMEN
  3496. Cycle of Violence
  3497. Nurses’ Role in Prevention of Abuse
  3498. Nursing Care
  3499. The Battered Woman
  3500. Assessment
  3501. FIG 24-5 Types of behaviors evident in each step of the cycle of violence.
  3502. CRITICAL THINKING EXERCISE 24-1
  3503. CRITICAL TO REMEMBER: Cues Indicating Violence Against Women
  3504. Nursing Diagnosis and Planning
  3505. Expected Outcomes
  3506. Interventions
  3507. Listening
  3508. Developing a Personal Safety Plan
  3509. Affirming She Is Not to Blame
  3510. Providing Education
  3511. Providing Referrals
  3512. Evaluation
  3513. Key Concepts
  3514. References and Readings
  3515. Chapter 25 Pregnancy-Related Complications
  3516. Learning Objectives
  3517. Hemorrhagic Conditions of Early Pregnancy
  3518. Abortion
  3519. Spontaneous Abortion
  3520. FIG 25-1 Three types of spontaneous abortion.
  3521. Threatened Abortion
  3522. Manifestations
  3523. Therapeutic Management
  3524. Inevitable Abortion
  3525. Manifestations
  3526. Therapeutic Management
  3527. Incomplete Abortion
  3528. Manifestations
  3529. Therapeutic Management
  3530. Complete Abortion
  3531. Manifestations
  3532. Therapeutic Management
  3533. Missed Abortion
  3534. Manifestations
  3535. Therapeutic Management
  3536. Disseminated Intravascular Coagulation (Consumptive Coagulopathy)
  3537. Recurrent Spontaneous Abortion
  3538. Manifestations
  3539. Therapeutic Management
  3540. Nursing Considerations
  3541. CRITICAL THINKING EXERCISE 25-1
  3542. Ectopic Pregnancy
  3543. Incidence and Etiology
  3544. FIG 25-2 Sites of tubal ectopic pregnancy. Numbers indicate the order of prevalence. (1) Ampular, (2) Fimbrial, (3) Isthmic, (4) Interstitial.
  3545. BOX 25-1 RISK FACTORS FOR ECTOPIC PREGNANCY
  3546. Manifestations
  3547. Diagnostic Evaluation
  3548. Therapeutic Management
  3549. Nursing Considerations
  3550. Gestational Trophoblastic Disease (Hydatidiform Mole)
  3551. FIG 25-3 Hydatidiform mole.
  3552. Incidence and Etiology
  3553. Manifestations
  3554. Diagnostic Evaluation
  3555. Therapeutic Management
  3556. Nursing Considerations
  3557. Nursing Care
  3558. The Woman with a Hemorrhagic Condition of Early Pregnancy
  3559. Assessment
  3560. Nursing Diagnosis and Planning
  3561. Expected Outcomes
  3562. Interventions
  3563. Providing Information about Tests and Procedures
  3564. Teaching Measures to Prevent Infection
  3565. Providing Dietary Information
  3566. Teaching Signs of Infection to Report
  3567. Emphasizing the Importance of Follow-up Care
  3568. Evaluation
  3569. Hemorrhagic Conditions of Late Pregnancy
  3570. Placenta Previa
  3571. Incidence and Etiology
  3572. FIG 25-4 The three classifications of placenta previa.
  3573. Manifestations
  3574. Therapeutic Management
  3575. Nursing Considerations
  3576. Home Care
  3577. Inpatient Care
  3578. Abruptio Placentae
  3579. Incidence and Etiology
  3580. Manifestations
  3581. Therapeutic Management
  3582. FIG 25-5 Types of abruptio placentae.
  3583. SAFETY ALERT: Signs and Symptoms Suggesting Concealed Hemorrhage in Abruptio Placentae
  3584. CRITICAL THINKING EXERCISE 25-2
  3585. Nursing Considerations
  3586. Nursing Care
  3587. The Woman with a Hemorrhagic Condition of Late Pregnancy
  3588. Assessment
  3589. NURSING CARE PLAN: Antepartum Bleeding
  3590. Focused Assessment
  3591. Nursing Diagnosis
  3592. Planning
  3593. Expected Outcomes
  3594. Interventions and Rationales
  3595. Evaluation
  3596. Focused Assessment
  3597. Nursing Diagnosis
  3598. Planning
  3599. Expected Outcomes
  3600. Interventions and Rationales
  3601. Evaluation
  3602. Additional Nursing Diagnoses to Consider
  3603. Nursing Diagnosis and Planning
  3604. Interventions
  3605. Monitoring for Signs of Hypovolemic Shock
  3606. SAFETY ALERT: Signs and Symptoms of Impending Hypovolemic Shock Caused by Blood Loss
  3607. Monitoring the Fetus
  3608. Promoting Tissue Oxygenation
  3609. Collaborating with the Physician for Fluid Replacement
  3610. Providing Emotional Support
  3611. Care Related to Surgery
  3612. Evaluation
  3613. Hyperemesis Gravidarum
  3614. Etiology
  3615. Therapeutic Management
  3616. Nursing Considerations
  3617. Reducing Nausea and Vomiting
  3618. Maintaining Nutrition and Fluid Balance
  3619. Providing Emotional Support
  3620. Preeclampsia ExemplarHypertension During Pregnancy
  3621. TABLE 25-1 CLASSIFICATIONS OF HYPERTENSION IN PREGNANCY
  3622. Preeclampsia
  3623. Risk Factors
  3624. BOX 25-2 RISK FACTORS FOR PREGNANCY-RELATED HYPERTENSION
  3625. Pathophysiology
  3626. Preventive Measures
  3627. Manifestations
  3628. Classic Signs
  3629. Additional Signs
  3630. FIG 25-6 Generalized edema is a possible sign identified with preeclampsia, although it may occur in both normal pregnancy or in a pregnancy complicated by another disorder. A, Facial edema may be subtle. B, Pitting edema of the lower leg.
  3631. TABLE 25-2 ASSESSMENT OF EDEMA
  3632. Symptoms
  3633. Therapeutic Management
  3634. Home Care for Mild Preeclampsia
  3635. Activity Restrictions
  3636. Fetal Activity
  3637. Blood Pressure
  3638. TABLE 25-3 MILD VS SEVERE PREECLAMPSIA
  3639. Weight
  3640. Urinalysis
  3641. Diet
  3642. Fetal Assessment
  3643. Inpatient Management for Severe Preeclampsia
  3644. Antepartum Management
  3645. Bed rest
  3646. Anticonvulsant Medications
  3647. DRUG GUIDE: Magnesium Sulfate
  3648. Antihypertensive Medications
  3649. Intrapartum Management
  3650. Postpartum Management
  3651. PROCEDURE: Assessing Deep Tendon Reflexes
  3652. Purpose
  3653. Deep Tendon Reflex Rating Scale
  3654. TABLE 25-4 NURSING ASSESSMENTS FOR PREECLAMPSIA AND MAGNESIUM TOXICITY
  3655. Therapeutic Management of Eclampsia
  3656. Nursing Care
  3657. The Woman with Preeclampsia
  3658. Assessment
  3659. Assessments for Magnesium Toxicity
  3660. Psychosocial Assessment
  3661. NURSING CARE PLAN: Preeclampsia
  3662. Focused Assessment
  3663. Nursing Diagnosis
  3664. Planning
  3665. Expected Outcomes
  3666. Interventions and Rationales
  3667. Evaluation
  3668. Focused Assessment
  3669. Nursing Diagnosis
  3670. Planning
  3671. Expected Outcomes
  3672. Interventions and Rationales
  3673. Evaluation
  3674. Potential Complications to Consider
  3675. Nursing Diagnosis and Planning
  3676. Interventions
  3677. Interventions for Seizures
  3678. Initiating Preventive Measures
  3679. Monitoring for Signs of Impending Seizures
  3680. Preventing Seizure-Related Injury
  3681. Protecting the Woman and Fetus during a Seizure
  3682. Providing Information and Support for the Family
  3683. Interventions for Magnesium Toxicity
  3684. Monitoring for Signs of Magnesium Toxicity
  3685. Responding to Signs of Magnesium Toxicity
  3686. Evaluation
  3687. HELLP Syndrome
  3688. Chronic Hypertension
  3689. Incompatibility Between Maternal and Fetal Blood
  3690. Rh Incompatibility
  3691. Pathophysiology
  3692. Fetal and Neonatal Implications
  3693. FIG 25-7 The process of maternal sensitization to the Rh factor.
  3694. PARENTS WANT TO KNOW: About Rh Incompatibility
  3695. Prenatal Assessment and Management
  3696. DRUG GUIDE: Rho(D) Immune Globulin (RhoGAM, HypRho-D, Gamulin Rh)
  3697. Postpartum Management
  3698. ABO Incompatibility
  3699. Key Concepts
  3700. References and Readings
  3701. Chapter 26 Concurrent Disorders During Pregnancy
  3702. Learning Objectives
  3703. Diabetes Mellitus
  3704. Pathophysiology
  3705. Etiology
  3706. Effect of Pregnancy on Fuel Metabolism
  3707. Early Pregnancy
  3708. Late Pregnancy
  3709. Classification
  3710. BOX 26-1 CLASSIFICATION OF DIABETES MELLITUS
  3711. Incidence
  3712. Pathology
  3713. Preexisting Diabetes Mellitus
  3714. Maternal Effects
  3715. Fetal Effects
  3716. Congenital Malformation
  3717. Variations in Fetal Size
  3718. NURSING CARE PLAN: Pregnancy and Diabetes Mellitus
  3719. Focused Nursing Assessment
  3720. Nursing Diagnosis
  3721. Planning
  3722. Expected Outcomes
  3723. Interventions and Rationales
  3724. Evaluation
  3725. Focused Assessment
  3726. Nursing Diagnosis
  3727. Planning
  3728. Expected Outcomes
  3729. Interventions and Rationales
  3730. Evaluation
  3731. Additional Nursing Diagnoses to Consider
  3732. Neonatal Effects
  3733. Hypoglycemia
  3734. Hypocalcemia
  3735. Hyperbilirubinemia
  3736. Respiratory Distress Syndrome
  3737. Maternal Assessment
  3738. History
  3739. Physical Examination
  3740. Laboratory Tests
  3741. Fetal Surveillance
  3742. Therapeutic Management
  3743. Preconception Care
  3744. Diet
  3745. Self-Monitoring of Blood Glucose (SMBG)
  3746. Insulin Therapy
  3747. First Trimester
  3748. Second and Third Trimesters
  3749. During Labor
  3750. Postpartum
  3751. Timing of Delivery
  3752. Diabetes, gestational ExemplarGestational Diabetes Mellitus
  3753. Risk Factors
  3754. Identifying Gestational Diabetes Mellitus
  3755. Glucose Challenge Test
  3756. Oral Glucose Tolerance Test
  3757. Maternal, Fetal, and Neonatal Effects
  3758. TABLE 26-1 MAJOR EFFECTS OF DIABETES MELLITUS ON PREGNANCY
  3759. Therapeutic Management
  3760. Diet
  3761. Exercise
  3762. Glucose Level Monitoring
  3763. Fetal Surveillance
  3764. Nursing Considerations
  3765. Increasing Effective Communication
  3766. Providing Opportunities for Control
  3767. Providing Normal Pregnancy Care
  3768. Nursing Care
  3769. The Pregnant Woman with Diabetes Mellitus
  3770. Assessment
  3771. Nursing Diagnosis and Planning
  3772. Expected Outcomes
  3773. Interventions
  3774. Teaching Self-Care Skills
  3775. Self-Monitoring of Blood Glucose
  3776. Insulin Administration
  3777. Continuous Subcutaneous Insulin Infusion
  3778. Teaching Dietary Management
  3779. Recognizing and Correcting Hypoglycemia and Hyperglycemia
  3780. Hypoglycemia ExemplarHypoglycemia
  3781. SAFETY ALERT: Signs and Symptoms of Maternal Hypoglycemia
  3782. Hyperglycemia
  3783. SAFETY ALERT: Signs and Symptoms of Maternal Hyperglycemia
  3784. Explaining Procedures, Tests, and Plan of Care
  3785. Evaluation
  3786. Heart failure ExemplarCardiac Disease
  3787. SAFETY ALERT: Signs and Symptoms of Congestive Heart Failure
  3788. Incidence and Classification
  3789. EVIDENCE-BASED PRACTICE
  3790. U.S. Preventive Services Task Force (USPSTF) CHD Screening Recommendations
  3791. Implications for Nursing Practice
  3792. Rheumatic Heart Disease
  3793. Congenital Heart Disease
  3794. Left-to-Right Shunt
  3795. Atrial Septal Defect
  3796. Ventricular septal defect ExemplarVentricular Septal Defect
  3797. Patent Ductus Arteriosus
  3798. Right-to-Left Shunt
  3799. Tetralogy of Fallot
  3800. Eisenmenger Syndrome
  3801. Mitral Valve Prolapse
  3802. Peripartum and Postpartum Cardiomyopathy
  3803. Diagnostic Evaluation of Cardiac Disease
  3804. Therapeutic Management
  3805. Class I and Class II Heart Disease
  3806. BOX 26-2 NEW YORK HEART ASSOCIATION FUNCTIONAL CLASSIFICATION OF HEART DISEASE
  3807. Class III and Class IV Heart Disease
  3808. Drug Therapy
  3809. Anticoagulants
  3810. Antidysrhythmics
  3811. Antiinfectives
  3812. Drugs for Heart Failure
  3813. Intrapartum Management
  3814. Postpartum Management
  3815. Nursing Considerations
  3816. Anemias
  3817. Iron deficiency (anemia) ExemplarIron Deficiency Anemia
  3818. Maternal Effects
  3819. Fetal and Neonatal Effects
  3820. Therapeutic Management
  3821. Folic Acid Deficiency (Megaloblastic) Anemia
  3822. Maternal Effects
  3823. Fetal and Neonatal Effects
  3824. Therapeutic Management
  3825. Sickle Cell Disease
  3826. Maternal Effects
  3827. Fetal and Neonatal Effects
  3828. Therapeutic Management
  3829. Thalassemias
  3830. Maternal Effects
  3831. Fetal and Neonatal Effects
  3832. Therapeutic Management
  3833. Immune Complex Diseases
  3834. Systemic Lupus Erythematosus
  3835. Antiphospholipid Syndrome
  3836. Hashimoto’s Thyroiditis
  3837. Seizure Disorders: Epilepsy
  3838. Infections During Pregnancy
  3839. TABLE 26-2 INFECTIONS THAT IMPACT PREGNANCY: SEXUALLY TRANSMITTED DISEASES, VAGINAL AND URINARY TRACT INFECTIONS
  3840. Viral Infections
  3841. Cytomegalovirus
  3842. Fetal and Neonatal Effects
  3843. Therapeutic Management
  3844. Rubella
  3845. Fetal and Neonatal Effects
  3846. Therapeutic Management
  3847. Varicella-Zoster Virus
  3848. Fetal and Neonatal Effects
  3849. Therapeutic Management
  3850. Herpesvirus Serotypes 1 and 2
  3851. Fetal and Neonatal Effects
  3852. Therapeutic Management
  3853. Parvovirus B19
  3854. Fetal and Neonatal Effects
  3855. Therapeutic Management
  3856. Hepatitis B
  3857. Fetal and Neonatal Effects
  3858. Therapeutic Management
  3859. Human Immunodeficiency Virus (HIV)
  3860. Pathophysiology
  3861. Fetal and Neonatal Effects
  3862. Prevention
  3863. Therapeutic Management
  3864. Nursing Considerations
  3865. BOX 26-3 RECOMMENDATIONS FOR PREVENTION OF PERINATAL HUMAN IMMUNODEFICIENCY VIRUS INFECTION OF THE INFANT
  3866. Nonviral Infections
  3867. Toxoplasmosis
  3868. Fetal and Neonatal Effects
  3869. Therapeutic Management
  3870. Group B Streptococcus Infection
  3871. Fetal and Neonatal Effects
  3872. Therapeutic Management
  3873. Tuberculosis
  3874. Fetal and Neonatal Effects
  3875. Therapeutic Management
  3876. TABLE 26-3 MEDICAL CONDITIONS AND THEIR EFFECT ON PREGNANCY
  3877. KEY CONCEPTS
  3878. References and Readings
  3879. Chapter 27 The Woman with an Intrapartum Complication
  3880. Learning Objectives
  3881. Dysfunctional Labor
  3882. Problems of the Powers
  3883. Ineffective Contractions
  3884. TABLE 27-1 PATTERNS OF LABOR DYSFUNCTION
  3885. Hypotonic Labor Dysfunction
  3886. Hypertonic Labor Dysfunction
  3887. Ineffective Maternal Pushing
  3888. Problems with the Passenger
  3889. Fetal Size
  3890. Macrosomia
  3891. Shoulder Dystocia
  3892. FIG 27-1 Methods used to relieve shoulder dystocia. A, McRoberts maneuver. The woman flexes her thighs sharply against her abdomen, which straightens the pelvic curve. A supported squat has a similar effect and adds gravity to her pushing efforts. B, Suprapubic pressure by an assistant pushes the fetal anterior shoulder downward to displace it from above the mother’s symphysis pubis. Fundal pressure should not be used because it will push the anterior shoulder more firmly against the mother’s symphysis.
  3893. Abnormal Fetal Presentation or Position
  3894. Rotation Abnormalities
  3895. CRITICAL THINKING EXERCISE 27-1
  3896. FIG 27-2 A hands-and-knees position helps the fetus rotate from a left occiput posterior (LOP) position to an occiput anterior position.
  3897. FIG 27-3 The “lunge” to one side promotes rotation of the fetal occiput from a posterior position to an anterior one.
  3898. Deflexion Abnormalities
  3899. Breech Presentation
  3900. Multifetal Pregnancy
  3901. FIG 27-4 Twins can present in any combination of presentations and positions.
  3902. Fetal Anomalies
  3903. Problems of the Passage
  3904. Pelvis
  3905. Maternal Soft Tissue Obstructions
  3906. Problems of the Psyche
  3907. Abnormal Labor Duration
  3908. Prolonged Labor
  3909. FIG 27-5 Pelvic shapes.
  3910. Precipitate Labor
  3911. Nursing Care
  3912. The Woman in Dysfunctional Labor
  3913. Intrauterine Infection
  3914. Assessment
  3915. Nursing Diagnosis and Planning
  3916. Expected Outcomes
  3917. Interventions
  3918. Reducing the Risk for Infection
  3919. Identifying Infection
  3920. Evaluation
  3921. SAFETY ALERT: Signs Associated with Intrapartum Infection
  3922. Maternal Exhaustion
  3923. Assessment
  3924. Nursing Diagnosis and Planning
  3925. Expected Outcomes
  3926. Interventions
  3927. Conserving Maternal Energy
  3928. Promoting Coping Skills
  3929. Evaluation
  3930. Premature Rupture of the Membranes
  3931. Etiology
  3932. Complications
  3933. Therapeutic Management
  3934. Determining True Membrane Rupture
  3935. Gestation Near Term
  3936. Preterm Gestation
  3937. Maternal Antibiotics
  3938. Nursing Considerations
  3939. Preterm Labor
  3940. SAFETY ALERT: Late Preterm is Not Term
  3941. EVIDENCE-BASED PRACTICE
  3942. Associated Factors
  3943. Manifestations
  3944. Preventing Preterm Birth
  3945. Community Education
  3946. TABLE 27-2 MATERNAL RISK FACTORS FOR PRETERM LABOR
  3947. During Pregnancy
  3948. Improving Access to Care
  3949. Identifying Risk Factors
  3950. Progesterone Supplementation
  3951. Promoting Adequate Nutrition
  3952. Educating Women and Their Partners about Preterm Labor
  3953. Empowering Women and Their Partners
  3954. Therapeutic Management
  3955. Predicting Preterm Birth
  3956. Cervical Length
  3957. Fetal Fibronectin
  3958. Infections
  3959. Identifying Preterm Labor
  3960. Stopping Preterm Labor
  3961. Initial Measures
  3962. Identifying and Treating Infections
  3963. Identifying Other Causes for Preterm Contractions
  3964. Limiting Activity
  3965. Hydrating the Woman
  3966. Tocolytics
  3967. Magnesium Sulfate
  3968. Calcium Antagonists
  3969. Prostaglandin Synthesis Inhibitors
  3970. TABLE 27-3 DRUGS USED IN PRETERM LABOR
  3971. Beta-Adrenergic Drugs
  3972. Accelerating Fetal Lung Maturity
  3973. DRUG GUIDE: Betamethasone, Dexamethasone
  3974. Nursing Care
  3975. The Woman in Preterm Labor
  3976. Psychosocial Concerns
  3977. Assessment
  3978. Nursing Diagnosis and Planning
  3979. Expected Outcome
  3980. Interventions
  3981. Providing Information
  3982. Promoting Expression of Concerns
  3983. Teaching What May Occur during a Preterm Birth
  3984. Evaluation
  3985. Management of Home Care
  3986. Assessment
  3987. Nursing Diagnosis and Planning
  3988. Expected Outcomes
  3989. Interventions
  3990. Caring for Children
  3991. NURSING CARE PLAN: Preterm Labor
  3992. Focused Assessment
  3993. Nursing Diagnosis
  3994. Planning
  3995. Expected Outcome
  3996. Interventions and Rationales
  3997. Evaluation
  3998. Focused Assessment
  3999. Nursing Diagnosis
  4000. Planning
  4001. Expected Outcome
  4002. Interventions and Rationales
  4003. Evaluation
  4004. Additional Nursing Diagnoses to Consider
  4005. Maintaining the Household
  4006. Evaluation
  4007. Boredom
  4008. Assessment
  4009. Nursing Diagnosis and Planning
  4010. Expected Outcome
  4011. Interventions
  4012. Identifying Appropriate Activities
  4013. Changing the Physical Surroundings
  4014. Evaluation
  4015. Prolonged Pregnancy
  4016. Complications
  4017. Therapeutic Management
  4018. Nursing Considerations
  4019. Intrapartum Emergencies
  4020. Placental Abnormalities
  4021. Prolapsed Umbilical Cord
  4022. Etiology
  4023. FIG 27-6 Variations of prolapsed umbilical cord.
  4024. Manifestations
  4025. Therapeutic Management
  4026. SAFETY ALERT: Factors that Increase a Woman’s Risk for a Prolapsed Umbilical Cord
  4027. FIG 27-7 Measures to relieve pressure on a prolapsed umbilical cord until delivery can take place.
  4028. Nursing Considerations
  4029. Uterine Rupture
  4030. FIG 27-8 Uterine rupture in the lower uterine segment.
  4031. Etiology
  4032. Manifestations
  4033. Therapeutic Management
  4034. Nursing Considerations
  4035. Uterine Inversion
  4036. Etiology
  4037. Manifestations
  4038. Therapeutic Management
  4039. Nursing Considerations
  4040. Anaphylactoid Syndrome
  4041. Trauma
  4042. Therapeutic Management
  4043. Nursing Considerations
  4044. KEY CONCEPTS
  4045. References and Readings
  4046. Pageburst Integrated Resource
  4047. Animation
  4048. Chapter 28 The Woman with a Postpartum Complication
  4049. Learning Objectives
  4050. Postpartum Hemorrhage
  4051. Early Postpartum Hemorrhage
  4052. FIG 28-1 A, When the uterus remains contracted, the placental site is smaller, so bleeding is minimal. B, If uterine muscles fail to contract around the endometrial arteries at the placental site, hemorrhage occurs.
  4053. Uterine Atony
  4054. Predisposing Factors
  4055. Manifestations
  4056. BOX 28-1 COMMON PREDISPOSING FACTORS FOR POSTPARTUM HEMORRHAGE
  4057. FIG 28-2 Technique for fundal massage.
  4058. Therapeutic Management
  4059. DRUG GUIDE: Methylergonovine (Methergine)
  4060. DRUG GUIDE: Carboprost Tromethamine (Hemabate, Prostin/15M)
  4061. Trauma
  4062. FIG 28-3 Bimanual compression. One hand is inserted in the vagina, and the other compresses the uterus through the abdominal wall.
  4063. Predisposing Factors
  4064. Lacerations
  4065. Hematomas
  4066. Therapeutic Management
  4067. Late Postpartum Hemorrhage
  4068. Predisposing Factors
  4069. Therapeutic Management
  4070. Hypovolemic Shock
  4071. Pathophysiology
  4072. Manifestations
  4073. Therapeutic Management
  4074. Nursing Considerations
  4075. Immediate Care
  4076. SAFETY ALERT: Signs of Postpartum Hemorrhage
  4077. Nursing Care
  4078. The Woman with Excessive Bleeding
  4079. Assessment
  4080. Uterine Atony
  4081. Trauma
  4082. TABLE 28-1 NURSING ASSESSMENTS FOR POSTPARTUM HEMORRHAGE
  4083. Nursing Diagnosis and Planning
  4084. Interventions
  4085. Preventing Hemorrhage
  4086. Collaborating with the Health Care Provider
  4087. Providing Support for the Family
  4088. Posthemorrhage Care
  4089. Home Care
  4090. CRITICAL THINKING EXERCISE 28-1
  4091. Evaluation
  4092. Subinvolution of the Uterus
  4093. Therapeutic Management
  4094. Nursing Considerations
  4095. Venous thrombosis ExemplarThromboembolic Disorders
  4096. Incidence and Etiology
  4097. Venous Stasis
  4098. BOX 28-2 FACTORS THAT INCREASE THE RISK OF THROMBOSIS
  4099. Hypercoagulation
  4100. Blood Vessel Injury
  4101. Additional Predisposing Factors
  4102. Superficial Venous Thrombosis
  4103. Manifestations
  4104. Therapeutic Management
  4105. Deep Venous Thrombosis
  4106. Diagnostic Evaluation
  4107. Therapeutic Management
  4108. Preventing Thrombus Formation
  4109. Initial Treatment
  4110. Subsequent Treatment
  4111. Nursing Care
  4112. The Mother with Deep Venous Thrombosis
  4113. Assessment
  4114. WOMEN WANT TO KNOW: How Do I Prevent Thrombosis (Blood Clots)?
  4115. Nursing Diagnosis and Planning
  4116. Expected Outcomes
  4117. Interventions
  4118. Monitoring for Signs of Bleeding
  4119. Explaining Continued Therapy
  4120. Helping the Family Adapt to Home Care
  4121. Evaluation
  4122. Pulmonary embolism ExemplarPulmonary Embolism
  4123. Pathophysiology
  4124. Manifestations
  4125. Therapeutic Management
  4126. Nursing Considerations
  4127. Monitoring for Signs
  4128. Facilitating Oxygenation
  4129. Seeking Assistance
  4130. Puerperal Infection
  4131. Definition
  4132. Pathophysiology
  4133. Etiology
  4134. TABLE 28-2 RISK FACTORS FOR PUERPERAL INFECTION
  4135. Specific Infections
  4136. Endometritis
  4137. Etiology
  4138. Manifestations
  4139. Therapeutic Management
  4140. Complications
  4141. Nursing Considerations
  4142. Wound Infection
  4143. Manifestations
  4144. Therapeutic Management
  4145. Nursing Considerations
  4146. Urinary Tract Infections
  4147. Etiology
  4148. Manifestations
  4149. Therapeutic Management
  4150. Nursing Considerations
  4151. Mastitis
  4152. Etiology
  4153. Manifestations
  4154. FIG 28-4 Mastitis typically occurs in the breast of a woman who breastfeeds after 2 to 3 weeks following birth.
  4155. Therapeutic Management
  4156. Nursing Considerations
  4157. Septic Pelvic Thrombophlebitis
  4158. Manifestations
  4159. Therapeutic Management
  4160. Nursing Care
  4161. The Woman with an Infection
  4162. Assessment
  4163. SAFETY ALERT: Signs and Symptoms of Postpartum Infection
  4164. Nursing Diagnosis and Planning
  4165. Expected Outcome
  4166. NURSING CARE PLAN: Risk for Postpartum Infection
  4167. Assessment
  4168. Nursing Diagnosis
  4169. Planning
  4170. Expected Outcomes
  4171. Interventions and Rationales
  4172. Evaluation
  4173. Additional Nursing Diagnoses to Consider
  4174. Postpartum psychosis ExemplarAffective Disorders
  4175. Postpartum Mood Disorders
  4176. Postpartum Depression
  4177. Incidence
  4178. Etiology
  4179. Manifestations
  4180. Impact on the Family
  4181. Therapeutic Management
  4182. Postpartum Psychosis
  4183. Bipolar II Disorder
  4184. Postpartum Anxiety Disorders
  4185. Nursing Care
  4186. Postpartum Affective Disorders
  4187. Assessment
  4188. SAFETY ALERT: Signs and Symptoms of Postpartum Depression
  4189. Nursing Diagnosis and Planning
  4190. Expected Outcomes
  4191. Interventions
  4192. Providing Anticipatory Guidance
  4193. EVIDENCE-BASED PRACTICE
  4194. Demonstrating Caring
  4195. Helping the Mother Verbalize Feelings
  4196. Enhancing Sensitivity to Infant Cues
  4197. Helping Family Members
  4198. Discussing Options and Resources
  4199. Evaluation
  4200. CRITICAL THINKING EXERCISE 28-2
  4201. KEY CONCEPTS
  4202. References And Readings
  4203. Chapter 29 The High-Risk Newborn: Problems Related to Gestational Age and Development
  4204. Learning Objectives
  4205. Care of High-Risk Newborns
  4206. Late Preterm Infants
  4207. Incidence and Etiology
  4208. Characteristics of Late Preterm Infants
  4209. FIG 29-1 The infant in a neonatal intensive care unit (NICU) is cared for by nurses with highly specialized skills.
  4210. Therapeutic Management
  4211. Nursing Considerations
  4212. Assessment and Care of Common Problems
  4213. Thermoregulation
  4214. Feedings
  4215. Discharge
  4216. Preterm Infants
  4217. Incidence and Etiology
  4218. Scope of the Problem
  4219. Causes
  4220. Prevention
  4221. Characteristics of Preterm Infants
  4222. Appearance
  4223. Behavior
  4224. Assessment and Care of Common Problems
  4225. Problems with Respiration
  4226. Assessment
  4227. Nursing Interventions
  4228. Working with Respiratory Equipment
  4229. FIG 29-2 The oxygen hood is one way of delivering oxygen to an infant who can breathe unassisted.
  4230. Positioning the Infant
  4231. Suctioning Secretions
  4232. Maintaining Hydration
  4233. Problems with Thermoregulation
  4234. Assessment
  4235. FIG 29-3 This preterm infant has mildly mottled skin and slight abdominal distention and retractions.
  4236. SAFETY ALERT: Signs of Inadequate Thermoregulation
  4237. Nursing Interventions
  4238. Maintaining a Neutral Thermal Environment
  4239. Weaning to an Open Crib
  4240. Problems with Fluid and Electrolyte Balance
  4241. Assessment
  4242. Urinary Output
  4243. Weight
  4244. Signs of Dehydration or Overhydration
  4245. SAFETY ALERT: Signs of Fluid Imbalance in the Newborn
  4246. Dehydration
  4247. Overhydration
  4248. Nursing Interventions
  4249. Problems with the Skin
  4250. Assessment
  4251. Nursing Interventions
  4252. Problems with Infection
  4253. Assessment
  4254. Nursing Interventions
  4255. Problems with Pain
  4256. Assessment
  4257. NURSING QUALITY ALERT: Common Signs of Pain in Infants
  4258. Nursing Interventions
  4259. EVIDENCE-BASED PRACTICE
  4260. Nursing Care
  4261. The Preterm Infant
  4262. Environmentally Caused Stress
  4263. Assessment
  4264. Nursing Diagnosis and Planning
  4265. Expected Outcomes
  4266. SAFETY ALERT: Signs of Overstimulation in Preterm Infants
  4267. Oxygenation Changes
  4268. Behavior Changes
  4269. Interventions
  4270. Scheduling Care
  4271. Reducing Stimuli
  4272. Promoting Rest
  4273. Promoting Motor Development
  4274. Individualizing Care
  4275. Communicating Infants’ Needs
  4276. Evaluation
  4277. Nutrition
  4278. Assessment
  4279. Feeding Tolerance
  4280. Readiness for Nipple Feeding
  4281. NURSING QUALITY ALERT: Advancing to Nipple Feeding
  4282. Signs of Readiness for Nipple Feedings
  4283. Signs of Nonreadiness for Nipple Feedings
  4284. Adverse Signs during Nipple Feedings
  4285. Nursing Diagnosis and Planning
  4286. Expected Outcomes
  4287. Interventions
  4288. Administering Parenteral Nutrition
  4289. Administering Enteral Feedings
  4290. Administering Gavage Feedings
  4291. Administering Oral Feedings
  4292. Preparing for Feedings
  4293. FIG 29-4 The nurse feeds a preterm infant.
  4294. Giving Bottle Feedings
  4295. CRITICAL THINKING EXERCISE 29-1
  4296. Facilitating Breastfeeding
  4297. NURSING CARE PLAN: The Preterm Infant
  4298. Focused Assessment
  4299. Nursing Diagnosis
  4300. Planning
  4301. Expected Outcomes
  4302. Interventions and Rationales
  4303. Evaluation
  4304. Focused Assessment
  4305. Nursing Diagnosis
  4306. Planning
  4307. Expected Outcomes
  4308. Interventions and Rationales
  4309. Evaluation
  4310. Nursing Diagnoses to Consider
  4311. Making Ongoing Assessments
  4312. Evaluation
  4313. Parenting
  4314. Assessment
  4315. NURSING QUALITY ALERT: Signs that Bonding May Be Delayed
  4316. Nursing Diagnosis and Planning
  4317. Expected Outcomes
  4318. FIG 29-5 An infant in the NICU is surrounded by highly technologic equipment. This can be very frightening to parents at first. Preparing parents before they visit is an important nursing responsibility.
  4319. Interventions
  4320. Making Advance Preparations
  4321. Assisting Parents at Birth
  4322. Supporting Parents during Early Visits
  4323. BOX 29-1 INTRODUCING PARENTS TO THE NEONATAL INTENSIVE CARE UNIT SETTING
  4324. Before Parents Visit the Neonatal Intensive Care Unit (NICU)
  4325. When Parents Visit the NICU
  4326. Providing Information
  4327. Instituting Kangaroo Care (KC)
  4328. FIG 29-6 This mother holds her 27-week-gestation infant under her clothes against her skin as she gives kangaroo care.
  4329. Facilitating Interaction
  4330. FIG 29-7 To promote family bonding with the infant, parents are involved as much as possible in the care of their infant. This father bottle feeds his infant in a radiant warmer.
  4331. Increasing Parental Decision Making
  4332. FIG 29-8 The parents look on while the grandmother holds the infant in the NICU.
  4333. Alleviating Concerns
  4334. Helping with Ongoing Problems
  4335. Preparing for Discharge
  4336. Evaluation
  4337. Common Complications of Preterm Infants
  4338. Respiratory Distress Syndrome (RDS)
  4339. Pathophysiology
  4340. Manifestations
  4341. Therapeutic Management
  4342. Nursing Considerations
  4343. Bronchopulmonary Dysplasia (Chronic Lung Disease)
  4344. Intraventricular Hemorrhage
  4345. Pathophysiology
  4346. Manifestations
  4347. Therapeutic Management
  4348. Nursing Considerations
  4349. Retinopathy of Prematurity
  4350. Pathophysiology
  4351. Therapeutic Management
  4352. Nursing Considerations
  4353. Necrotizing Enterocolitis (NEC)
  4354. Pathophysiology
  4355. Manifestations
  4356. Therapeutic Management
  4357. Nursing Considerations
  4358. Postterm Infants
  4359. Scope of the Problem
  4360. FIG 29-9 The postmature infant has dry, cracked, peeling skin and no vernix.
  4361. Assessment
  4362. Therapeutic Management
  4363. Nursing Considerations
  4364. Small-for-Gestational-Age Infants
  4365. Etiology
  4366. Scope of the Problem
  4367. Characteristics of Small-for-Gestational-Age (SGA) Infants
  4368. Therapeutic Management
  4369. Nursing Considerations
  4370. Large-for-Gestational-Age Infants
  4371. Etiology
  4372. Scope of the Problem
  4373. Therapeutic Management
  4374. Nursing Considerations
  4375. KEY CONCEPTS
  4376. References and Readings
  4377. Chapter 30 The High-Risk Newborn: Acquired and Congenital Conditions
  4378. Learning Objectives
  4379. Respiratory Complications
  4380. Asphyxia
  4381. Manifestations
  4382. Infants at Risk
  4383. DRUG GUIDE: Naloxone Hydrochloride (Narcan)
  4384. Neonatal Resuscitation
  4385. Transient Tachypnea of the Newborn
  4386. Etiology
  4387. Manifestations
  4388. Therapeutic Management
  4389. PROCEDURE: Performing Resuscitation in Newborns
  4390. Purpose
  4391. Nursing Considerations
  4392. Meconium Aspiration Syndrome
  4393. Etiology
  4394. Manifestations
  4395. Therapeutic Management
  4396. Nursing Considerations
  4397. Persistent Pulmonary Hypertension of the Newborn
  4398. Etiology
  4399. Manifestations
  4400. Therapeutic Management
  4401. Nursing Considerations
  4402. Hyperbilirubinemia
  4403. Etiology
  4404. Therapeutic Management
  4405. Phototherapy
  4406. Exchange Transfusions
  4407. Procedure
  4408. Complications
  4409. Role of the Nurse
  4410. Nursing Care
  4411. The Infant with Hyperbilirubinemia
  4412. Assessment
  4413. Nursing Diagnosis and Planning
  4414. Expected Outcomes
  4415. Interventions
  4416. Maintaining a Neutral Thermal Environment
  4417. NURSING CARE PLAN: The Infant with Jaundice
  4418. Focused Assessment
  4419. Nursing Diagnosis
  4420. Planning
  4421. Expected Outcomes
  4422. Interventions and Rationales
  4423. Evaluation
  4424. Additional Nursing Diagnoses to Consider
  4425. Providing Optimal Nutrition
  4426. Protecting the Eyes
  4427. Enhancing Response to Therapy
  4428. FIG 30-1 The infant receiving phototherapy is wearing eye patches to protect the eyes.
  4429. Detecting Complications
  4430. Teaching Parents
  4431. Evaluation
  4432. CRITICAL THINKING EXERCISE 30-1
  4433. Infection
  4434. Transmission of Infection
  4435. Sepsis ExemplarSepsis Neonatorum
  4436. Etiology
  4437. TABLE 30-1 COMMON INFECTIONS IN THE NEWBORN
  4438. Therapeutic Management
  4439. Diagnostic Testing
  4440. Treatment
  4441. Nursing Considerations
  4442. Assessment
  4443. Risk Factors
  4444. Signs of Infection
  4445. Nursing Interventions
  4446. Preventing Infection
  4447. SAFETY ALERT: Signs of Sepsis in the Newborn
  4448. General Signs
  4449. Respiratory Signs
  4450. Cardiovascular Signs
  4451. Gastrointestinal Signs
  4452. Central Nervous System Signs
  4453. Signs that May Indicate Advanced Infection
  4454. Providing Antibiotics
  4455. Providing Other Supportive Care
  4456. Supporting Parents
  4457. Infant of a Diabetic Mother
  4458. Scope of the Problem
  4459. FIG 30-2 Macrosomia is common in infants of diabetic mothers.
  4460. Characteristics of Infants of Diabetic Mothers (IDMs)
  4461. Therapeutic Management
  4462. Nursing Considerations
  4463. Assessment
  4464. Nursing Interventions
  4465. Polycythemia
  4466. Causes
  4467. Manifestations
  4468. Therapeutic Management
  4469. Nursing Considerations
  4470. Hypocalcemia
  4471. Etiology
  4472. Manifestations
  4473. Therapeutic Management
  4474. Nursing Considerations
  4475. Prenatal Drug Exposure
  4476. EVIDENCE-BASED PRACTICE
  4477. Identification of Drug-Exposed Infants
  4478. SAFETY ALERT: Signs of Intrauterine Drug Exposure
  4479. Behavioral Signs
  4480. Signs Relating to Feeding
  4481. Respiratory Signs
  4482. Other Signs
  4483. Therapeutic Management
  4484. Nursing Considerations
  4485. Feeding
  4486. Assessment
  4487. Nursing Interventions
  4488. Rest
  4489. Assessment
  4490. Nursing Interventions
  4491. Bonding
  4492. Assessment
  4493. NURSING CARE PLAN: The Drug-Exposed Infant
  4494. Focused Assessment
  4495. Nursing Diagnosis
  4496. Planning
  4497. Expected Outcomes
  4498. Interventions and Rationales
  4499. Evaluation
  4500. Focused Assessment
  4501. Nursing Diagnosis
  4502. Planning
  4503. Expected Outcomes
  4504. Interventions and Rationales
  4505. Evaluation
  4506. Additional Nursing Diagnoses to Consider
  4507. Nursing Interventions
  4508. Phenylketonuria
  4509. Etiology
  4510. Manifestations
  4511. Therapeutic Management
  4512. Nursing Considerations
  4513. KEY CONCEPTS
  4514. References and Readings
  4515. Chapter 31 Management of Fertility and Infertility
  4516. Learning Objectives
  4517. Contraception
  4518. Role of the Nurse
  4519. Considerations when Choosing a Contraceptive Method
  4520. FIG 31-1 Success of contraception is more likely when both the woman and her partner are involved in discussions. The nurse demonstrates filling a foam applicator.
  4521. TABLE 31-1 ADVANTAGES AND DISADVANTAGES OF MOST COMMON CONTRACEPTIVE METHODS
  4522. Safety
  4523. Protection from Sexually Transmitted Diseases
  4524. Effectiveness
  4525. Acceptability
  4526. TABLE 31-2 PREGNANCY RATES OF COMMON TYPES OF CONTRACEPTION: UNITED STATES
  4527. Convenience
  4528. Education Needed
  4529. Benefits
  4530. Side Effects
  4531. Effect on Spontaneity
  4532. Availability
  4533. Expense
  4534. Preference
  4535. Religious and Personal Beliefs
  4536. Culture
  4537. Other Considerations
  4538. Informed Consent
  4539. Adolescents
  4540. Adolescent Knowledge
  4541. Misinformation
  4542. Risk-Taking Behavior
  4543. Counseling Adolescents
  4544. FIG 31-2 Although many adolescents choose oral contraceptives, the nurse emphasizes the need to use condoms for protection against sexually transmitted diseases. Demonstrating with actual contraceptives increases understanding.
  4545. CRITICAL THINKING EXERCISE 31-1
  4546. Perimenopausal Women
  4547. Contraception ExemplarMethods of Contraception
  4548. Sterilization
  4549. Tubal Sterilization
  4550. Vasectomy
  4551. Intrauterine Devices (IUDs)
  4552. FIG 31-3 The Copper T 380A (ParaGard) intrauterine device (IUD) and the levonorgestrel intrauterine system (LNG-IUS or Mirena). Currently, IUDs are considered a very safe method for preventing pregnancy.
  4553. Action
  4554. Side Effects
  4555. Teaching
  4556. Hormonal Contraceptives
  4557. Hormone Implant
  4558. Hormone Injections
  4559. Oral Contraceptives
  4560. Progestin Only
  4561. Combination
  4562. Benefits, Risks, and Cautions
  4563. SAFETY ALERT: Cautions in Using Oral Contraceptives
  4564. BOX 31-1 POTENTIAL BENEFITS, DISADVANTAGES, AND RISKS OF ORAL CONTRACEPTIVES
  4565. Side Effects
  4566. Teaching
  4567. Blood Hormone Levels
  4568. Missed Doses
  4569. Postpartum and Lactation
  4570. Other Medications
  4571. Follow-up
  4572. Emergency Contraception
  4573. TABLE 31-3 ACHES∗Warning Signs of Oral Contraceptive Complications
  4574. Transdermal Contraceptive Patch
  4575. FIG 31-4 The vaginal contraceptive ring (NuvaRing) is 5 cm (2 in) across and 4 mm thick.
  4576. Contraceptive Vaginal Ring
  4577. Barrier Methods
  4578. Chemical Barriers
  4579. Mechanical Barriers
  4580. Male Condom
  4581. Female Condom
  4582. FIG 31-5 The female condom. A woman can protect herself from sexually transmitted diseases without relying on use of the male condom.
  4583. COUPLES WANT TO KNOW: What Is the Proper Way to Use Condoms?
  4584. Sponge
  4585. Diaphragm
  4586. WOMEN WANT TO KNOW: How to Use a Diaphragm
  4587. Cervical Cap
  4588. Lea’s Shield
  4589. Natural Family Planning Methods
  4590. Calendar or Rhythm Method
  4591. Standard Days Method
  4592. Cervical Mucus and Two-Day Method
  4593. TABLE 31-4 NATURAL FAMILY PLANNING METHODS
  4594. COUPLES WANT TO KNOW: How to Assess Cervical Mucus and Basal Body Temperature
  4595. Cervical Mucus Assessment
  4596. Basal Body Temperature (BBT)
  4597. Symptothermal Method
  4598. Abstinence
  4599. Least Reliable Methods of Contraception
  4600. Breastfeeding
  4601. Coitus Interruptus
  4602. Nursing Care
  4603. Choosing a Contraceptive Method
  4604. Assessment
  4605. Introducing the Subject
  4606. Determining the Woman’s Understanding
  4607. Assessing the Woman’s Satisfaction
  4608. Assessing Appropriate Choices
  4609. Nursing Diagnosis and Planning
  4610. Expected Outcomes
  4611. Interventions
  4612. Increasing Understanding of the Chosen Method
  4613. Teaching about Other Methods
  4614. Protecting Against Sexually Transmitted Diseases
  4615. Including the Woman’s Partner
  4616. Ongoing Teaching
  4617. Evaluation
  4618. Infertility ExemplarRole of the Nurse in Infertility Care
  4619. Extent of Infertility
  4620. Factors Contributing to Infertility
  4621. Factors in the Man
  4622. Abnormalities of the Sperm
  4623. Erectile dysfunction ExemplarAbnormal Erections
  4624. Abnormal Ejaculation
  4625. Abnormalities of Seminal Fluid
  4626. Factors in the Woman
  4627. Disorders of Ovulation
  4628. Abnormalities of the Fallopian Tubes
  4629. Abnormalities of the Cervix
  4630. Repeated Pregnancy Loss
  4631. Abnormalities of the Fetal Chromosomes
  4632. Abnormalities of the Cervix or Uterus
  4633. FIG 31-6 Types of uterine malformations that may cause infertility or repeated pregnancy loss.
  4634. Endocrine Abnormalities
  4635. Immunologic Factors
  4636. Environmental Agents
  4637. Infections
  4638. Evaluation of Infertility
  4639. Preconception Counseling
  4640. History and Physical Examination
  4641. INFERTILE COUPLES WANT TO KNOW: What Is Infertility Treatment Like?
  4642. General
  4643. Men
  4644. Women
  4645. History
  4646. Physical Examination
  4647. Diagnostic Tests
  4648. Therapies to Facilitate Pregnancy
  4649. TABLE 31-5 SELECTED DIAGNOSTIC TESTS IN INFERTILITY
  4650. TABLE 31-6 SELECTED MEDICATIONS FOR INFERTILITY THERAPY
  4651. Medications
  4652. Surgical Procedures
  4653. Therapeutic Insemination
  4654. Egg Donation
  4655. Surrogate Parenting
  4656. Assisted Reproductive Techniques
  4657. In Vitro Fertilization (IVF)
  4658. FIG 31-7 In vitro fertilization (IVF). Multiple oocytes are obtained by using a transvaginal or laparoscopic approach. The retrieved oocytes are mixed with prepared sperm, incubated approximately 18 hours, and then evaluated for cell division. Embryos are then transferred to the uterus immediately or after 48 to 96 more hours to allow 5 days of further cell division before implantation.
  4659. Gamete Intrafallopian Transfer (GIFT)
  4660. Zygote Intrafallopian Transfer (ZIFT)
  4661. Comparison of In Vitro Fertilization, Gamete Intrafallopian Transfer, and Zygote Intrafallopian Transfer
  4662. Intracytoplasmic Sperm Injection (ICSI)
  4663. Responses to Infertility
  4664. Assumption of Fertility
  4665. Growing Awareness of a Problem
  4666. Seeking Help for Infertility
  4667. Identifying the Importance of Having a Baby
  4668. Sharing Intimate Information
  4669. Considering Financial Resources
  4670. Ethical Issues
  4671. Committing to Involvement in Care
  4672. Reactions During Evaluation and Treatment
  4673. Influences on Decision Making
  4674. Social, Cultural, and Religious Values
  4675. Difficulty of Treatment
  4676. Probability of Success
  4677. Financial Concerns
  4678. Psychological Reactions
  4679. Guilt
  4680. Isolation
  4681. Depression
  4682. Stress on the Relationship
  4683. Outcomes After Infertility Therapy
  4684. Pregnancy Loss After Infertility Therapy
  4685. Parenthood After Infertility Therapy
  4686. Choosing to Adopt
  4687. Menopause After Infertility
  4688. Nursing Care
  4689. The Infertile Couple
  4690. Assessment
  4691. Nursing Diagnosis and Planning
  4692. Expected Outcomes
  4693. Interventions
  4694. Assisting Communication
  4695. Increasing the Couple’s Sense of Control
  4696. Reducing Isolation
  4697. Promoting a Positive Self-Image
  4698. Evaluation
  4699. Key Concepts
  4700. References and Readings
  4701. Chapter 32 Women’s Health Care
  4702. Learning Objectives
  4703. Women’s Health Initiative
  4704. Healthy People 2020
  4705. Health Maintenance
  4706. Health History
  4707. Physical Assessment
  4708. Health promotion ExemplarPreventive Counseling
  4709. BOX 32-1 HEALTH HISTORY
  4710. Personal History
  4711. Menstrual History
  4712. Obstetric History
  4713. Sexual History
  4714. Family History
  4715. Psychosocial History
  4716. Screening Procedures
  4717. Breast Self-Examination
  4718. Clinical Breast Examination
  4719. WOMEN WANT TO KNOW: How to Perform Breast Self-Examination (BSE)
  4720. Inspection
  4721. Palpation
  4722. TABLE 32-1 SCREENING PROCEDURES
  4723. BOX 32-2 RISK FACTORS FOR BREAST CANCER
  4724. Mammography
  4725. Vulvar Self-Examination
  4726. Pelvic Examination
  4727. External Organs
  4728. Speculum Examination
  4729. Bimanual Examination
  4730. FIG 32-1 Bimanual palpation provides information about the uterus, fallopian tubes, and ovaries.
  4731. Pap Test
  4732. Purpose
  4733. Procedure
  4734. Classification of Cervical Cytology
  4735. Rectal Examination
  4736. Breast Disorders
  4737. Benign Disorders of the Breast
  4738. Fibrocystic Breast Changes
  4739. Fibroadenoma
  4740. Ductal Ectasia
  4741. Intraductal Papilloma
  4742. Diagnostic Evaluation
  4743. Nursing Considerations
  4744. Breast cancer mortality ExemplarBreast cancer ExemplarMalignant Tumors of the Breast
  4745. Incidence
  4746. Predisposing Factors
  4747. Pathophysiology
  4748. Manifestations
  4749. Staging
  4750. Therapeutic Management
  4751. Surgical Treatment
  4752. Adjuvant Therapy
  4753. Radiation Therapy
  4754. Chemotherapy
  4755. Hormonal Therapy
  4756. Immunotherapy
  4757. Breast Reconstruction
  4758. Timing
  4759. Methods
  4760. Psychosocial Consequences of Breast Cancer
  4761. Nursing Considerations
  4762. Cardiovascular Disease
  4763. EVIDENCE-BASED PRACTICE
  4764. Recognition of Coronary Artery Disease (CAD)
  4765. Risk Factors
  4766. BOX 32-3 RISK FACTORS FOR CORONARY ARTERY DISEASE IN WOMEN
  4767. Prevention
  4768. Hypertension
  4769. Smoking Cessation
  4770. Diet and Glucose Control
  4771. Increased Activity
  4772. Aspirin
  4773. Menstrual Cycle Disorders
  4774. Amenorrhea
  4775. Primary Amenorrhea
  4776. Etiology
  4777. Therapeutic Management
  4778. Secondary Amenorrhea
  4779. Nursing Considerations
  4780. Abnormal Uterine Bleeding
  4781. Etiology
  4782. Management
  4783. Nursing Considerations
  4784. Pain Associated with the Menstrual Cycle
  4785. Mittelschmerz
  4786. Primary Dysmenorrhea
  4787. Manifestations
  4788. Etiology
  4789. Therapeutic Management
  4790. Endometriosis
  4791. FIG 32-2 Common sites of endometriosis.
  4792. Etiology
  4793. Pathophysiology
  4794. Manifestations
  4795. Therapeutic Management
  4796. Nursing Considerations
  4797. BOX 32-4 SYMPTOMS OF PREMENSTRUAL SYNDROME (PMS)
  4798. Physical Symptoms
  4799. Behavioral Symptoms
  4800. Premenstrual Syndrome (PMS)
  4801. WOMEN WANT TO KNOW: How to Relieve Symptoms of Premenstrual Syndrome (PMS)
  4802. Diet
  4803. Exercise
  4804. Stress Management
  4805. Sleep and Rest
  4806. Etiology
  4807. Manifestations
  4808. Therapeutic Management
  4809. Nursing Considerations
  4810. FIG 32-3 The woman uses a calendar to record occurrence and severity of premenstrual symptoms.
  4811. Elective Termination of Pregnancy
  4812. WOMEN WANT TO KNOW: Guidelines for Self-Care After Elective Termination of Pregnancy
  4813. Methods of Induced Abortion
  4814. Nursing Considerations Related to Elective Pregnancy Termination
  4815. Menopause
  4816. Age at Menopause
  4817. Physiologic Changes
  4818. Psychological Responses
  4819. Therapy for Menopause
  4820. Nursing Considerations Related to Menopause
  4821. Osteoporosis
  4822. Predisposing Factors
  4823. Manifestations
  4824. FIG 32-4 With progression of osteoporosis, the vertebral column collapses, causing loss of height and back pain. Dowager’s hump is the term used for this curvature of the upper back.
  4825. Prevention and Therapeutic Management
  4826. Drug Therapy
  4827. Calcium and Vitamin D
  4828. Exercise
  4829. Nursing Considerations
  4830. Nursing Diagnoses
  4831. Pelvic Floor Dysfunction
  4832. Vaginal Wall Prolapse
  4833. Cystocele
  4834. Enterocele
  4835. FIG 32-5 Three types of vaginal wall prolapse. A, Note bulging of bladder into the vagina. B, Note loop of bowel between rectum and uterus. C, Note bulging of rectum into vagina. More than one type of vaginal wall prolapse may exist in the same woman.
  4836. Rectocele
  4837. FIG 32-6 Three degrees of uterine prolapse.
  4838. Uterine Prolapse
  4839. Manifestations
  4840. Therapeutic Management
  4841. Nursing Considerations
  4842. Pelvic Exercises
  4843. Stress incontinence ExemplarUrinary Incontinence
  4844. Disorders of the Reproductive Tract
  4845. Benign Disorders
  4846. Cervical Polyps
  4847. Uterine Leiomyomas
  4848. Ovarian Cysts
  4849. SAFETY ALERT: Signs and Symptoms that Should Always Be Investigated
  4850. BOX 32-5 RISK FACTORS FOR CANCER OF THE REPRODUCTIVE ORGANS
  4851. Uterus
  4852. Cervix
  4853. Ovaries
  4854. Malignant Disorders
  4855. Manifestations
  4856. Diagnostic Evaluation
  4857. Therapeutic Management
  4858. Cervical Cancer
  4859. Endometrial Cancer
  4860. Ovarian Cancer
  4861. Infectious Disorders of the Reproductive Tract
  4862. Candidiasis
  4863. Sexually Transmitted Diseases (STDs)
  4864. Incidence
  4865. Types of Sexually Transmitted Diseases (STDs)
  4866. Trichomoniasis
  4867. Bacterial Vaginosis
  4868. Chlamydial Infection
  4869. WOMEN WANT TO KNOW: About Sexually Transmitted Diseases
  4870. Gonorrhea
  4871. Syphilis
  4872. Herpes Genitalis
  4873. Human Papillomavirus (HPV)
  4874. Acquired Immunodeficiency Syndrome
  4875. Nursing Considerations
  4876. Pelvic Inflammatory Disease (PID)
  4877. Etiology and Pathophysiology
  4878. Manifestations
  4879. Therapeutic Management
  4880. Nursing Considerations
  4881. Toxic Shock Syndrome
  4882. Nursing Considerations
  4883. Key Concepts
  4884. References and Readings
  4885. Pageburst Integrated Resource
  4886. Animation
  4887. Pediatric Nursing Care
  4888. Interactive Review – Pediatric Nursing Care
  4889. Chapter 33 Physical Assessment of Children
  4890. Learning Objectives
  4891. General Approaches to Physical Assessment
  4892. Infants from Birth to 6 Months
  4893. Infants from 6 to 12 Months
  4894. NURSING QUALITY ALERT: Adapting the Physical Examination to the Child
  4895. Toddlers
  4896. Preschoolers
  4897. FIG 33-1 During the assessment, the nurse allows the child to remain on her mother’s lap, enlisting the child’s trust and increasing the likelihood of a successful physical examination.
  4898. School-Age Children
  4899. Adolescents
  4900. Techniques for Physical Examination
  4901. Inspection
  4902. Palpation
  4903. NURSING QUALITY ALERT: Using the Hands for Palpation
  4904. Percussion
  4905. Auscultation
  4906. Smell
  4907. Sequence of Physical Examination
  4908. General Appearance
  4909. BOX 33-1 SOUNDS IDENTIFIED DURING PERCUSSION
  4910. History Taking
  4911. BOX 33-2 POTENTIAL INDICATORS OF CHILD ABUSE
  4912. CRITICAL THINKING EXERCISE 33-1
  4913. Recording Data
  4914. BOX 33-3 THE COMPLETE HISTORY
  4915. Vital Signs
  4916. BOX 33-4 PROBLEM-ORIENTED HISTORY
  4917. Temperature
  4918. TABLE 33-1 NORMAL VITAL SIGNS BY AGE
  4919. Pulse
  4920. Respirations
  4921. Blood Pressure
  4922. Pain Assessment
  4923. Anthropometric Measurement
  4924. Height
  4925. NURSING QUALITY ALERT: Importance of Anthropometric Measurements
  4926. Weight
  4927. Head Circumference
  4928. FIG 33-2 Measuring head circumference. The head circumference is measured from birth through age 36 months. The nurse uses a nonstretching tape and measures in a “hat band” position, just above the eyebrows and around the occipital prominence in the back. Chest circumference is also routinely measured in the newborn; it is usually smaller than the newborn’s head circumference.
  4929. Chest Circumference
  4930. Midarm Circumference
  4931. Triceps Skinfold
  4932. Use of Growth Charts
  4933. Skin, Hair, and Nails
  4934. Skin
  4935. Inspection
  4936. BOX 33-5 SKIN COLOR TERMINOLOGY
  4937. NURSING QUALITY ALERT: Skin Inspection in Dark-Skinned Children
  4938. Palpation
  4939. Hair
  4940. Nails
  4941. Lymph Nodes
  4942. FIG 33-3 Location of superficial lymph nodes.
  4943. Head, Neck, and Face
  4944. Head
  4945. BOX 33-6 CHARACTERISTICS OF ENLARGED LYMPH NODES AND MASSES
  4946. BOX 33-7 HEAD SHAPE TERMINOLOGY
  4947. FIG 33-4 Fontanels are inspected and palpated for size, tenseness, and pulsation.
  4948. Neck
  4949. Face
  4950. FIG 33-5 The child’s ears are inspected for alignment. Low-set ears could indicate an intellectual disability or renal anomalies.
  4951. Nose, Mouth, and Throat
  4952. Nose
  4953. Mouth and Throat
  4954. FIG 33-6 The frontal, ethmoid, and maxillary sinuses.
  4955. FIG 33-7 Sequence of eruption of primary and secondary teeth.
  4956. Eyes
  4957. Visual Acuity
  4958. BOX 33-8 TYPES OF EYE CHARTS
  4959. Color Vision
  4960. Peripheral Vision
  4961. Binocular Vision and Strabismus
  4962. Corneal Light Reflex Test
  4963. Field-of-Vision Test
  4964. FIG 33-8 Visual fields (cranial nerve II) are tested in each eye separately. One eye is covered as the child stares straight ahead. An object is slowly moved from the side of the head into the field of vision. The child says “now” upon first seeing the object.
  4965. Tests for Eye Muscle Function
  4966. External Eye
  4967. FIG 33-9 External structures of the eye.
  4968. FIG 33-10 The cover/uncover test detects small degrees of deviated eye alignment. With one eye covered, the child gazes straight ahead with the uncovered eye. The cover is then removed, and the eye should continue to stare straight ahead. Movement in either eye suggests muscle weakness. Extraocular muscle function is controlled by cranial nerves III, IV, and VI.
  4969. Ophthalmoscopic Examination
  4970. Ears
  4971. Hearing Acuity
  4972. Infant Assessment
  4973. Preschool and School-Age Assessment by Audiometry
  4974. FIG 33-11 Landmarks of the external ear.
  4975. Preschool, School-Age, and Adolescent Assessment: The Whisper Test
  4976. Conduction Tests (Tuning Fork Hearing Tests)
  4977. External Ear
  4978. Otoscopic Examination
  4979. Thorax and Lungs
  4980. Inspection
  4981. Palpation
  4982. FIG 33-12 Inspection of the tympanic membrane with the otoscope. The auditory canal is inspected before the otoscope is inserted to see the child’s tympanic membrane.
  4983. To straighten the ear canal of a child older than 3 years, the nurse pulls the child’s pinna up and back.
  4984. For children younger than 3 years, the pinna is pulled down and back.
  4985. Auscultation
  4986. FIG 33-13 Anatomic landmarks of the thorax in infants and children.
  4987. Adventitious Breath Sounds
  4988. FIG 33-14 Common alterations in chest configuration.
  4989. Heart
  4990. Inspection
  4991. FIG 33-15 To identify areas of fremitus, tenderness, symmetry, and depth and equality of expansion, the nurse palpates the child’s posterior and anterior chest. When palpating any area, warm hands increase the child’s comfort.
  4992. Palpation
  4993. FIG 33-16 Auscultation is most easily done when the child is quiet, so this part of the examination is best performed first if the child is quiet or asleep. To allay fears, the child can play with the stethoscope first and can be distracted with a toy while the nurse is listening. Warming the stethoscope bell increases comfort. Infants and toddlers can be held sitting upright in the parent’s lap while the nurse listens to breath sounds.
  4994. If the child is upset, the examiner may have to listen to breath sounds between cries. Keeping this child in the comfort of her mother’s arms lessens distress.
  4995. Auscultation
  4996. FIG 33-17 Sequence for listening to breath sounds.
  4997. TABLE 33-2 ORIGIN AND CHARACTERISTICS OF ADVENTITIOUS BREATH SOUNDS
  4998. Normal Rate and Rhythm
  4999. Extra Heart Sounds, Including Murmurs
  5000. Peripheral Vascular System
  5001. NURSING QUALITY ALERT: Normal Findings in Children
  5002. FIG 33-18 Location of the heart within the thorax in the infant and the older child, showing landmarks and areas of auscultation.
  5003. Breast
  5004. Abdomen
  5005. FIG 33-19 Abdominal quadrants and structures.
  5006. FIG 33-20 Abdominal contours. The contour of the abdomen provides an indication of the child’s overall nutritional state.
  5007. Inspection
  5008. Auscultation
  5009. Percussion
  5010. Palpation
  5011. Male Genitalia
  5012. FIG 33-21 When a boy’s scrotum is examined, the cremasteric reflex may cause the testes to withdraw into the inguinal canal. To prevent this reflex, the examiner can have the boy sit in a tailor position. The examiner uses one hand to block the inguinal canal and the other to palpate.
  5013. Female Genitalia
  5014. FIG 33-22 Postpubertal female genitalia.
  5015. Musculoskeletal System
  5016. Infants
  5017. Toddlers, Preschoolers, and School-Age Children
  5018. Adolescents
  5019. Range of Motion
  5020. Muscle Strength and Mass
  5021. Joints
  5022. Gait
  5023. BOX 33-9 SCREENING PROCEDURE FOR SCOLIOSIS
  5024. Adam’s position demonstrates the rib hump of structural scoliosis. Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies. Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. It may be compensatory for other abnormalities such as leg-length discrepancy.
  5025. Structural scoliosis is fixed; the curvature is evident both when the individual stands and when the individual bends forward. Note the rib hump with forward flexion. When the child is standing, unequal shoulder elevation, unequal scapulae, obvious curvature, unequal elbow level, and unequal hip level is seen.
  5026. Neurologic System
  5027. TABLE 33-3 GROSS MOTOR DEVELOPMENT IN THE INFANT: PROGRESSION TO WALKING
  5028. Cerebral Function
  5029. TABLE 33-4 ASSESSING CRANIAL NERVES∗
  5030. BOX 33-10 SPECIFIC CEREBRAL FUNCTION TESTS
  5031. Cranial Nerves
  5032. Cerebellar Function
  5033. Motor System
  5034. Sensory System
  5035. Reflex Status
  5036. Neurologic “Soft” Signs
  5037. BOX 33-11 CEREBELLAR FUNCTION: TESTS OF BALANCE AND COORDINATION
  5038. Conclusion and Documentation
  5039. TABLE 33-5 EVALUATING COMMON REFLEXES
  5040. BOX 33-12 TESTS FOR EVALUATING SENSORY FUNCTION
  5041. Primary Forms of Sensation
  5042. Cortical and Discriminatory Forms of Sensation
  5043. BOX 33-13 EXAMPLES OF NEUROLOGIC “SOFT” SIGNS
  5044. Key Concepts
  5045. References and Readings
  5046. Pageburst Integrated Resource
  5047. Animation
  5048. Chapter 34 Emergency Care of the Child
  5049. Learning Objectives
  5050. CLINICAL REFERENCE
  5051. General Guidelines for Emergency Nursing Care
  5052. Encouraging parents to remain with their child in the emergency setting can bolster the family’s coping.
  5053. PEDIATRIC EMERGENCY EQUIPMENT
  5054. PEDIATRIC EMERGENCY MEDICATIONS
  5055. BOX 34-1 WORKING WITH CHILDREN IN EMERGENCIES: DEVELOPMENTAL GUIDELINES
  5056. Infants
  5057. Toddlers
  5058. Preschoolers
  5059. School-Age Children
  5060. Adolescents
  5061. Growth and Development Issues in Emergency Care
  5062. The Infant
  5063. The Toddler
  5064. The Preschooler
  5065. The School-Age Child
  5066. The Adolescent
  5067. The Family of a Child in Emergency Care
  5068. Emergency Assessment of Infants and Children
  5069. Primary Assessment
  5070. Airway Assessment
  5071. NURSING QUALITY ALERT: Initial Observations for Triage
  5072. TABLE 34-1 PRIMARY ASSESSMENT IN PEDIATRIC EMERGENCIES
  5073. Breathing Assessment
  5074. Cardiovascular Assessment
  5075. Disability: Neurologic Assessment
  5076. Hypothermia ExemplarExposure
  5077. Secondary Assessment
  5078. Vital Signs
  5079. TABLE 34-2 SECONDARY ASSESSMENT IN PEDIATRIC EMERGENCIES
  5080. History and Head-to-Toe Assessment
  5081. Diagnostic Tests
  5082. Weight
  5083. Parent-Child Relationship
  5084. EVIDENCE-BASED PRACTICE
  5085. Cardiopulmonary Resuscitation of the Child
  5086. Airway and Breathing
  5087. Initial Assessment and Intervention
  5088. Obstructed Airway Management
  5089. SAFETY ALERT: Airway Obstruction in Children
  5090. Circulation
  5091. TABLE 34-3 HEALTH CARE PROFESSIONAL BASIC LIFE SUPPORT ELEMENTS FOR INFANTS AND CHILDREN
  5092. Shock ExemplarThe Child in Shock
  5093. Etiology
  5094. Hypovolemic Shock
  5095. Distributive Shock
  5096. Cardiogenic Shock
  5097. PATHOPHYSIOLOGY: Shock
  5098. Hypovolemic Shock
  5099. Distributive Shock
  5100. Cardiogenic Shock
  5101. BOX 34-2 MANIFESTATIONS OF SHOCK IN CHILDREN
  5102. Hypovolemic Shock
  5103. Distributive (Septic) Shock: Early
  5104. Septic Shock: Late
  5105. Cardiogenic Shock
  5106. Manifestations
  5107. SAFETY ALERT: Hypotension in Children with Shock
  5108. TABLE 34-4 ASSESSING A CHILD’S GENERAL APPEARANCE: “LOOKS GOOD” VERSUS “LOOKS BAD”
  5109. Diagnostic Evaluation
  5110. Therapeutic Management
  5111. Hypovolemic Shock
  5112. Distributive Shock
  5113. Cardiogenic Shock
  5114. Nursing Care
  5115. The Child in Shock
  5116. Assessment
  5117. Hypovolemic Shock
  5118. Distributive Shock
  5119. Cardiogenic Shock
  5120. Nursing Diagnosis and Planning
  5121. Expected Outcome
  5122. Expected Outcome
  5123. Expected Outcome
  5124. Expected Outcomes
  5125. Interventions
  5126. Maintaining Tissue Perfusion
  5127. Ensuring Oxygenation
  5128. Preventing Infection
  5129. Enhancing Coping
  5130. Evaluation
  5131. Pediatric Trauma
  5132. Mechanism of Injury
  5133. Blunt Trauma
  5134. Motor Vehicle Trauma
  5135. Pedestrian Injury
  5136. Penetrating Trauma
  5137. Multiple Trauma
  5138. Primary Survey
  5139. FIG 34-1 Waddell’s triad of injuries.
  5140. Airway Assessment and Management
  5141. Breathing Assessment and Management
  5142. FIG 34-2 The child with multiple trauma injuries must remain on an immobilization board (long backboard) with a cervical immobilization device in place until the child has been evaluated for spinal injuries.
  5143. Circulation Assessment and Management
  5144. NURSING QUALITY ALERT: Artificial Airways
  5145. Disability
  5146. Secondary Survey
  5147. Obtaining a History of the Injury
  5148. Trauma Scoring
  5149. Assessing for Child Abuse
  5150. BOX 34-3 HISTORY OF INJURY QUESTIONS
  5151. For a Victim of a Motor Vehicle Collision
  5152. For a Victim of a Fall
  5153. For a Victim of a Penetrating Injury
  5154. BOX 34-4 Trauma Scoring Systems
  5155. Trauma Score (TS)
  5156. Revised Trauma Score (RTS)
  5157. Pediatric Trauma Score (PTS)
  5158. Nursing Considerations
  5159. The Child and Family
  5160. The Child during Recovery
  5161. Ingestions and Poisonings
  5162. CRITICAL THINKING EXERCISE 34-1
  5163. Incidence
  5164. Manifestations
  5165. Diagnostic Evaluation
  5166. Therapeutic Management
  5167. TABLE 34-5 COMMON POISONOUS SUBSTANCES
  5168. Removal of Dermal and Ocular Toxins
  5169. Diluting the Ingested Toxin
  5170. Activated Charcoal
  5171. Antidotes
  5172. Nursing Care
  5173. The Child Who Has Ingested a Toxic Substance
  5174. Assessment
  5175. Nursing Diagnosis and Planning
  5176. Expected Outcome
  5177. Expected Outcome
  5178. Expected Outcome
  5179. Expected Outcomes
  5180. Expected Outcome
  5181. Interventions
  5182. NURSING QUALITY ALERT: Assessment of Poison Ingestion
  5183. Evaluation
  5184. Environmental Emergencies
  5185. Animal, Human, Snake, and Spider Bites
  5186. Etiology
  5187. Animal and Human Bites
  5188. Snake and Spider Bites
  5189. Incidence
  5190. Manifestations
  5191. Animal and Human Bites
  5192. Snake Bites
  5193. Spider Bites
  5194. Therapeutic Management
  5195. Animal Bites
  5196. Snake Bites
  5197. Spider Bites
  5198. Nursing Considerations
  5199. Submersion Injuries (Near Drowning)
  5200. Etiology
  5201. Incidence
  5202. Manifestations
  5203. PATHOPHYSIOLOGY: Submersion Injury
  5204. Therapeutic Management
  5205. Prehospital Emergency Management
  5206. Hospital Management
  5207. Nursing Care
  5208. The Child with a Submersion Injury
  5209. Assessment
  5210. Nursing Diagnosis and Planning
  5211. Expected Outcomes
  5212. Expected Outcomes
  5213. Expected Outcome
  5214. Expected Outcomes
  5215. Interventions
  5216. Providing Respiratory Support
  5217. Restoring Appropriate Circulatory Status
  5218. Identifying and Preventing Neurologic Consequences
  5219. Restoring Fluid Balance
  5220. Controlling Infection
  5221. Maintaining Nutritional Status
  5222. Providing Emotional Care for the Family
  5223. Evaluation
  5224. NURSING QUALITY ALERT: Needs Expressed by Families of Critically Ill Children
  5225. Heat-Related Illnesses
  5226. Incidence
  5227. Manifestations and Therapeutic Management
  5228. Nursing Considerations
  5229. TABLE 34-6 Heatstroke Exemplar HEAT-RELATED ILLNESS
  5230. CRITICAL THINKING EXERCISE 34-2
  5231. Dental Emergencies
  5232. Incidence and Etiology
  5233. Therapeutic Management
  5234. Nursing Considerations
  5235. KEY CONCEPTS
  5236. References and Readings
  5237. Pageburst Integrated Resource
  5238. Animation
  5239. Chapter 35 The Ill Child in the Hospital and Other Care Settings
  5240. Learning Objectives
  5241. Settings of Care
  5242. The Hospital
  5243. 24-Hour Observation
  5244. Emergency Hospitalization
  5245. Outpatient and Day Facilities
  5246. Rehabilitative Care
  5247. The Medical-Surgical Unit
  5248. The Intensive Care Unit
  5249. School based services exemplarSchool-Based Clinics
  5250. FIG 35-1 Parents are encouraged to stay with their child whenever possible. This mother is holding her child in the postanesthesia recovery room, a setting that in the past was off limits to parents.
  5251. Community Clinics
  5252. FIG 35-2 Nurses today help take health care on the road to provide services to those who otherwise might not obtain them. This mobile van is stationed at a public school, where it offers health screenings and prevention services to children.
  5253. Home Care
  5254. Stressors Associated with Illness and Hospitalization
  5255. NURSING QUALITY ALERT: Children’s Responses to Illness
  5256. The Infant and Toddler
  5257. Separation Anxiety
  5258. BOX 35-1 STAGES OF SEPARATION
  5259. Fear of Injury and Pain
  5260. Loss of Control
  5261. FIG 35-3 Separation is one of the stressors of hospitalization that affects both child and parent. A toddler exhibits separation anxiety by reacting with protest to leaving her parent’s arms.
  5262. Rooming-in reduces the stress of hospitalization and provides opportunities for parent teaching.
  5263. The Preschooler
  5264. Separation Anxiety
  5265. Fear of Injury and Pain
  5266. NURSING QUALITY ALERT: Maintaining a Safe Place
  5267. Loss of Control
  5268. Guilt and Shame
  5269. The School-Age Child
  5270. Separation
  5271. Fear of Injury and Pain
  5272. FIG 35-4 Activities for the hospitalized child are important for growth and development, stress relief, socialization, and a sense of control. This model railroad “trainscape” in a pediatric hospital provides children and adults with a welcome respite from real-life stresses.
  5273. Hospitalized teens need to interact with their peers, as they do when they are well. A lounge area that is separate from the playroom used by younger children fulfills this need.
  5274. Loss of Control
  5275. The Adolescent
  5276. Separation
  5277. Fear of Injury and Pain
  5278. Loss of Control
  5279. Fear of the Unknown
  5280. Regression
  5281. Factors Affecting a Child’s Response to Illness and Hospitalization
  5282. Age and Cognitive Development
  5283. Parental Response
  5284. EVIDENCE-BASED PRACTICE
  5285. BOX 35-2 DEVELOPMENTAL APPROACHES TO THE HOSPITALIZED CHILD
  5286. Neonate
  5287. Infant
  5288. Toddler
  5289. Preschooler
  5290. School-Age Child
  5291. Adolescent
  5292. Preparing the Child and Family
  5293. Coping Skills of the Child and Family
  5294. Psychological Benefits of Hospitalization
  5295. Play for the Ill Child
  5296. FIG 35-5 To provide diversion and allow interaction with other children, the play therapist wheels the child, while still in bed with traction in place, to the playroom.
  5297. Playrooms
  5298. Therapeutic Play
  5299. FIG 35-6 Therapeutic play can be used to teach children about medical procedures or help them work through their feelings about what has happened to them in the health care setting. Child life specialists are often members of the team in children’s hospitals to provide expert guidance for therapeutic play. Art materials allow children to express their thoughts and feelings about illness and hospitalization.
  5300. Giving a doll an injection can help a child work through anxiety and anger about injections she may be receiving.
  5301. Emotional Outlet Play
  5302. Teaching through Play
  5303. Enhancing Cooperation through Play
  5304. Unstructured Play
  5305. Evaluation of Play
  5306. Admitting the Child to a Hospital Setting
  5307. Taking the History
  5308. FIG 35-7 To reduce the stress of unfamiliar surroundings and people, the nurse assesses the child who remains in the security of her mother’s arms.
  5309. Physical Examination
  5310. Initial Inspection
  5311. Baseline Data
  5312. NURSING CARE PLAN: The Child and Family in a Hospital Setting
  5313. Focused Assessment
  5314. Nursing Diagnosis
  5315. Planning
  5316. Expected Outcomes
  5317. Interventions and Rationales
  5318. Evaluation
  5319. Nursing Diagnosis
  5320. Planning
  5321. Expected Outcomes
  5322. Interventions and Rationales
  5323. Evaluation
  5324. Nursing Diagnosis
  5325. Planning
  5326. Expected Outcome
  5327. Interventions and Rationales
  5328. Evaluation
  5329. Nursing Diagnosis
  5330. Planning
  5331. Expected Outcomes
  5332. Interventions and Rationales
  5333. Evaluation
  5334. Nursing Diagnosis
  5335. Planning
  5336. Expected Outcomes
  5337. Interventions and Rationales
  5338. Evaluation
  5339. The Ill Child’s Family
  5340. Parents
  5341. FIG 35-8 The family of a hospitalized child may not speak the prevailing language. Interpreters are available (on-site or on-call) at many hospitals to help parents and children communicate with health care team members. This arrangement provides a familiar link to the parents’ and child’s culture and language.
  5342. PARENTS WANT TO KNOW: Information for Discharge
  5343. CRITICAL THINKING EXERCISE 35-1
  5344. Siblings
  5345. BOX 35-3 CARING FOR THE SIBLINGS OF AN ILL OR HOSPITALIZED CHILD
  5346. Factors that Add to the Stress of Siblings
  5347. Nursing Care Guidelines for Meeting the Needs of Siblings
  5348. Siblings of ill children may experience jealousy, insecurity, resentment, confusion, and anxiety. The nurse can help them cope by assessing and implementing care to meet their needs.
  5349. KEY CONCEPTS
  5350. References and Readings
  5351. Chapter 36 The Child with a Chronic Condition or Terminal Illness
  5352. Learning Objectives
  5353. Chronic Illness Defined
  5354. The Family of the Child with Special Health Care Needs
  5355. Family Dynamics and Impact on the Family
  5356. BOX 36-1 COMMON CHRONIC CONDITIONS OF CHILDHOOD
  5357. Coping and the Grieving Process
  5358. The Child with Special Health Care Needs
  5359. Coping and Growth and Development Concerns
  5360. BOX 36-2 THE ILLNESS EXPERIENCE: THE CHILD AND ADOLESCENT
  5361. Infant
  5362. Toddler
  5363. Preschooler
  5364. School-Age Child
  5365. Adolescent
  5366. Coping and Parental Responses to Developmental Issues
  5367. NURSING QUALITY ALERT: Goals for Chronic Care
  5368. Goals for the Child
  5369. Goals for the Family
  5370. The Child With a Chronic Illness
  5371. FIG 36-1 The nurse or a child life specialist can use therapeutic play, medical play, and therapeutic art to enhance self-expression, education, and growth and development.
  5372. Ongoing Care
  5373. Education
  5374. Communication
  5375. Caring for Parents
  5376. Grief Education and Support
  5377. Cultural and Religious Beliefs
  5378. Referrals
  5379. Schooling
  5380. The Nurse as Liaison
  5381. Caring for Siblings
  5382. FIG 36-2 Chronic illness is stressful for the siblings of an ill child. Siblings’ emotional needs may be overlooked. Siblings should be given the opportunity to express negative feelings, such as anger and jealousy, through therapeutic art and play, as well as through physical outlets, such as striking a punching bag, as this little girl is doing.
  5383. NURSING QUALITY ALERT: Nursing Care for Children with Chronic Conditions and Their Families
  5384. NURSING CARE PLAN: The Child with a Chronic Condition in the Community Setting
  5385. Focused Assessment
  5386. Nursing Diagnosis
  5387. Planning
  5388. Expected Outcomes
  5389. Interventions and Rationales
  5390. Because more children with chronic conditions are living longer, more attend public school. However, these children are likely to be frequently hospitalized, so hospitals often provide an area where teachers can help them with their studies.
  5391. Evaluation
  5392. Nursing Diagnosis
  5393. Planning
  5394. Expected Outcomes
  5395. Interventions and Rationales
  5396. Evaluation
  5397. CRITICAL THINKING EXERCISE 36-1
  5398. Death dying ExemplarThe Terminally Ill or Dying Child
  5399. Coping and the Child’s Concept of Death
  5400. Infants and Toddlers
  5401. TABLE 36-1 THE CHILD’S CONCEPT OF DEATH
  5402. Preschoolers
  5403. School-Age Children
  5404. Adolescents
  5405. Coping and Responses to Death and Dying
  5406. The Child’s Response
  5407. The Parents’ Response
  5408. The Siblings’ Response
  5409. Caring for the Dying Child
  5410. Nursing Professionalism and Boundaries
  5411. FIG 36-3 The family of the child with a terminal condition needs compassion and support from the nurse. Nursing care includes physical care and support of the family’s care giving efforts, and assistance with the grieving process.
  5412. Communication with patient or family ExemplarCommunication
  5413. Family Dynamics, Beliefs, and Practices
  5414. BOX 36-3 RESOURCES ON DEATH AND DYING FOR FAMILIES AND HEALTH PROFESSIONALS
  5415. Internet Resources
  5416. Book Selections for Children
  5417. Book Selections for Adults—Parents and Nurses
  5418. Book Selections for Nurses
  5419. Pain Control
  5420. Hospice Care
  5421. The Dying Process and the Time of Death
  5422. Privacy for the Child and Family
  5423. Changes in Family Routines
  5424. Family Concerns about Oral Intake
  5425. Fluids and Oral Care
  5426. Responsiveness and Communication
  5427. Indicators of Imminent Death
  5428. NURSING QUALITY ALERT: Nursing Care for the Dying Child and the Child’s Family
  5429. NURSING CARE PLAN: The Terminally Ill or Dying Child
  5430. Focused Assessment
  5431. Nursing Diagnosis
  5432. Planning
  5433. Expected Outcomes
  5434. Interventions and Rationales
  5435. Evaluation
  5436. Nursing Diagnosis
  5437. Planning
  5438. Expected Outcomes
  5439. Interventions and Rationales
  5440. Evaluation
  5441. The Family after Death
  5442. The Nurse’s Response to the Dying Child
  5443. KEY CONCEPTS
  5444. References and Readings
  5445. Chapter 37 Principles and Procedures for Nursing Care of Children
  5446. LEARNING OBJECTIVES
  5447. Preparing Children for Procedures
  5448. Explaining Procedures
  5449. SAFETY ALERT: Standard Precautions
  5450. BOX 37-1 TIPS FOR PREPARING AND SUPPORTING CHILDREN UNDERGOING PROCEDURES
  5451. Before the Procedure
  5452. During the Procedure
  5453. After the Procedure
  5454. FIG 37-1 Because a child should feel that the hospital room is a safe place, a treatment room is used for invasive or painful procedures. The parent is present, not to restrain the child, but to provide emotional support.
  5455. Consent for Procedures
  5456. NURSING QUALITY ALERT: Preparation for Procedures
  5457. Holding and Transporting Infants and Children
  5458. Safety Issues in the Hospital Setting
  5459. FIG 37-2 Methods of transporting infants and children. The nurse carries the infant securely, anticipating sudden movement. A, Cradle carry. B, Football hold. C, Over-the-shoulder carry, which can be used until the infant is 6 to 7 months old. D, Transport can be fun for young children, especially when it is on wheels.
  5460. SAFETY ALERT: Using Restraints
  5461. Infection Control
  5462. Hand Hygiene
  5463. Standard Precautions
  5464. Implementing Precautions
  5465. Family Teaching
  5466. Bathing Infants and Children
  5467. Special Considerations
  5468. FIG 37-3 Using hand to support infant’s neck and head. When giving an infant a tub bath, the nurse supports the infant’s body at all times.
  5469. Documentation
  5470. Parent Teaching
  5471. Oral Hygiene
  5472. Feeding
  5473. Special Considerations
  5474. Documentation
  5475. Parent Teaching
  5476. Vital Signs
  5477. Measuring Temperature
  5478. FIG 37-4 Four methods of temperature measurement.
  5479. NURSING QUALITY ALERT: Measuring Temperature
  5480. Measuring Pulse
  5481. Evaluating Respirations
  5482. Measuring Blood Pressure
  5483. FIG 37-5 Locating the apical pulse. Apical pulse is lateral to the left midclavicular line (MCL) and fourth intercostal space (ICS) in children younger than 7 years and to the left MCL and fifth ICS in children older than 7 years.
  5484. FIG 37-6 Blood pressures can be measured in the upper arm, lower arm, thigh, calf, or ankle. An appropriate-size cuff must be used to obtain accurate results.
  5485. TABLE 37-1 RECOMMENDED DIMENSIONS FOR BLOOD PRESSURE CUFF BLADDERS
  5486. Documenting Vital Sign Measurement
  5487. Preparing the Child and Family
  5488. Parent Teaching
  5489. NURSING QUALITY ALERT: Measuring Vital Signs
  5490. Special Considerations: Cardiorespiratory Monitors
  5491. Fever-Reducing Measures
  5492. Description of Fever
  5493. Medications and Environmental Management
  5494. DRUG GUIDE: Acetaminophen (Tylenol, Tempra, Panadol)
  5495. Specimen Collection
  5496. Urine Specimens
  5497. Voided Specimens
  5498. Urinary Catheterization
  5499. PROCEDURE: Urine Specimen Collection from the Incontinent Child
  5500. Purpose
  5501. Home Adaptations
  5502. PROCEDURE: Urinary Catheterization
  5503. Purpose
  5504. Home Adaptations
  5505. BOX 37-2 GUIDELINES FOR URINARY CATHETER SELECTION BY AGE
  5506. Stool Specimens
  5507. PROCEDURE: Venipuncture
  5508. Purpose
  5509. Blood Specimens
  5510. Jugular and Femoral Venipuncture
  5511. FIG 37-7 Two additional sites for obtaining blood specimens from infants and young children are the large superficial external jugular veins and the femoral veins.
  5512. Capillary Blood Sampling
  5513. PROCEDURE: Capillary Blood Sampling
  5514. Purpose
  5515. Sputum Specimens
  5516. Throat and Nasopharyngeal Specimens
  5517. PROCEDURE: Nasal Washing
  5518. Purpose
  5519. PROCEDURE: Throat or Nasopharyngeal Culture
  5520. Purpose
  5521. SAFETY ALERT: Throat Cultures
  5522. Cerebrospinal Fluid Specimens
  5523. Bone Marrow Aspiration
  5524. Gastrointestinal Tubes and Enteral Feedings
  5525. Tube Route and Placement
  5526. Tube Selection
  5527. Safety Issues Related to Tube Placement
  5528. PROCEDURE: Feeding Tube Insertions
  5529. Purpose
  5530. Home Adaptations
  5531. Contraindications to Tube Placement
  5532. Enteral Feedings
  5533. NURSING QUALITY ALERT: Enteral Feedings
  5534. PROCEDURE: Administering Enteral Feedings (via the Orogastric, Nasogastric, or Nasointestinal Route)
  5535. Purpose
  5536. Intermittent Feedings (Bolus)
  5537. Continuous Feedings
  5538. Home Adaptations
  5539. Gastrostomy Tubes and Buttons
  5540. CRITICAL THINKING EXERCISE 37-1
  5541. Enemas
  5542. Enema Administration
  5543. Solutions and Volumes
  5544. Ostomies
  5545. TABLE 37-2 RECOMMENDED VOLUME AND DEPTH FOR ENEMA TIP INSERTION, BY AGE
  5546. Oxygen Therapy
  5547. Oxygen Administration
  5548. FIG 37-8 When administering oxygen to children, special consideration is given to the size and type of equipment selected, and the needs of the child and family for education and support. A, Nasal cannula. B, Simple facemask.
  5549. Documentation
  5550. Parent Teaching
  5551. FIG 37-9 A, The pulse oximeter is a reliable, noninvasive method that allows periodic or continuous measurement of blood oxygen saturation. The sensor is applied to a child’s finger (B) or an infant’s toe (C).
  5552. Assessing Oxygenation
  5553. PROCEDURE: Pulse Oximetry
  5554. Purpose
  5555. NURSING QUALITY ALERT: Assisting with Arterial Blood Gas Sampling
  5556. Tracheostomy Care
  5557. Suctioning
  5558. Stoma Care
  5559. PROCEDURE: Suctioning a Tracheostomy Tube
  5560. Purpose
  5561. Home Adaptations
  5562. PROCEDURE: Care of a Tracheostomy
  5563. Purpose
  5564. Home Adaptations
  5565. Surgical Procedures
  5566. Preparation for Surgery
  5567. Preoperative Medication and Anesthesia Induction
  5568. BOX 37-3 GUIDELINES FOR PREOPERATIVE FASTING
  5569. Postanesthesia Care
  5570. Postoperative Care
  5571. KEY CONCEPTS
  5572. References and Readings
  5573. Pageburst Integrated Resource
  5574. Animation
  5575. Chapter 38 Medication Administration and Safety for Infants and Children
  5576. LEARNING OBJECTIVES
  5577. Pharmacokinetics in Children
  5578. Absorption
  5579. Oral Route
  5580. FIG 38-1 Physiologic differences between children and adults affect drug absorption, metabolism, distribution, and excretion. These differences are most significant for infants.
  5581. Gastric Acidity
  5582. Gastric Emptying
  5583. Gastrointestinal Motility
  5584. Enzyme Activity
  5585. Other Routes
  5586. Distribution
  5587. Differences in Body Fluids
  5588. Differences in Fat Percentages
  5589. Differences in Proteins
  5590. Blood-Brain Barrier
  5591. Metabolism
  5592. Excretion
  5593. Concentration
  5594. Psychological and Developmental Factors
  5595. PARENTS WANT TO KNOW: Medication Administration and Parent Roles
  5596. Infants
  5597. Toddlers and Preschoolers
  5598. School-Age Children
  5599. Adolescents
  5600. Calculating Dosages
  5601. FIG 38-2 Nomogram for calculating body surface area (BSA), which is used for determining medication dosages for infants and children.
  5602. Medication Administration Procedures
  5603. Medication Reconciliation
  5604. Administering Oral Medications
  5605. CRITICAL THINKING EXERCISE 38-1
  5606. Preparation
  5607. FIG 38-3 Administering an oral medication to an infant using an oral syringe.
  5608. CRITICAL THINKING EXERCISE 38-2
  5609. Administration
  5610. FIG 38-4 Two methods of holding a child for an intramuscular (IM) injection at the vastus lateralis site.
  5611. Alternative Routes for Oral Medications
  5612. Administering Injections
  5613. Intramuscular Injections
  5614. TABLE 38-1 PREFERRED INTRAMUSCULAR INJECTION SITES IN CHILDREN
  5615. SAFETY ALERT: Guidelines for Maximum Safe Volumes for Intramuscular Injections∗
  5616. CRITICAL THINKING EXERCISE 38-3
  5617. Subcutaneous Injections
  5618. Intradermal Injections
  5619. Rectal Administration
  5620. FIG 38-5 Two of the preferred subcutaneous injection sites for infants and toddlers.
  5621. FIG 38-6 Intradermal injection site and technique.
  5622. Vaginal Administration
  5623. Ophthalmic Administration
  5624. Otic Administration
  5625. Nasal Administration
  5626. Topical Administration
  5627. PROCEDURE: Administering Otic Drops
  5628. Purpose
  5629. PROCEDURE: Administering an Ophthalmic Preparation
  5630. Purpose
  5631. Inhalation Therapy
  5632. FIG 38-7 Administration of nebulized medication to an infant.
  5633. Intravenous Therapy
  5634. Intravenous Catheter Insertion
  5635. FIG 38-8 Venous access sites in children.
  5636. PROCEDURE: Using a Metered-Dose Inhaler (MDI)
  5637. Purpose
  5638. NURSING QUALITY ALERT: Using EMLA Anesthetic Cream
  5639. FIG 38-9 Intravenous (IV) sites in children are secured and well-protected to allow for activities and prevent dislodging the IV catheter. A foot vein is an acceptable IV site for an infant who is not walking or crawling. A padded arm board gently limits movement of the hand, and a plastic shield allows visibility yet keeps the IV site intact.
  5640. Intravenous Catheter Monitoring
  5641. Intravenous Infusion Monitoring
  5642. FIG 38-10 Alaris® System intravenous (IV) infusion pump.
  5643. Infusion Rates and Methods
  5644. Administering Intravenous Medications
  5645. Intravenous Bolus Administration
  5646. BOX 38-1 DAILY MAINTENANCE FLUID REQUIREMENTS AND RATES Formula for Calculating Daily Fluid Requirements∗
  5647. Example 1:
  5648. Example 2:
  5649. Example 3:
  5650. Intravenous Intermittent Infusion Administration
  5651. CRITICAL THINKING EXERCISE 38-4
  5652. Venous Access Devices
  5653. Intermittent Infusion Ports
  5654. Central Venous Access Devices
  5655. Administration of Blood Products
  5656. Child and Family Education
  5657. PARENTS WANT TO KNOW: Medication Administration at Home
  5658. KEY CONCEPTS
  5659. References and Readings
  5660. Pageburst Integrated Resource
  5661. Animation
  5662. Chapter 39 Pain Management for Children
  5663. LEARNING OBJECTIVES
  5664. Definitions and Theories of Pain
  5665. Gate Control Theory
  5666. Acute and Chronic Pain
  5667. Research on Pain in Children
  5668. TABLE 39-1 PAIN AND PAIN MANAGEMENT IN CHILDREN: MYTHS AND REALITIES
  5669. Obstacles to Pain Management in Children
  5670. BOX 39-1 PAIN MANAGEMENT RESOURCES ON THE INTERNET
  5671. Assessment of Pain in Children
  5672. BOX 39-2 INDICATORS OF PAIN ACCORDING TO DEVELOPMENTAL LEVELS
  5673. Neonate and Infant
  5674. Toddler
  5675. Preschooler
  5676. School-Age Child
  5677. Adolescent
  5678. Assessment According to Developmental Level
  5679. Neonates and Infants
  5680. Toddlers
  5681. FIG 39-1 Infant total body response to pain with arms thrashing, tremors, and vigorous crying.
  5682. CRITICAL THINKING EXERCISE 39-1
  5683. Preschoolers
  5684. School-Age Children
  5685. FIG 39-2 Toddlers and preschoolers may express pain by guarding or touching the painful area. The toddler pulling on his ear is a characteristic expression of ear pain from otitis media.
  5686. FIG 39-3 School-age children may become very quiet and withdrawn when ill or in pain. The child with asthma is not attentive or active; his mother knew that something was wrong because of his withdrawn behavior.
  5687. Adolescents
  5688. TABLE 39-2 PAIN ASSESSMENT TOOLS
  5689. NURSING QUALITY ALERT: Assessing Pain in Children
  5690. Assessment Tools
  5691. Non-Pharmacologic and Pharmacologic Pain Interventions
  5692. FIG 39-4 A, The Hispanic version of the Oucher pain scale. B, The African-American version.
  5693. FIG 39-5 FACES Pain Rating Scale. Explain to the child that each face is for a person who feels happy because he or she has no pain (hurt) or sad because he or she has some or a lot of pain. Ask the child to choose the face that best describes his or her own pain.
  5694. FIG 39-6 Adolescent and Pediatric Pain Tool (APPT). Use with 8- to 17-year-olds.
  5695. BOX 39-3 PAIN EXPERIENCE HISTORY
  5696. Child Form∗
  5697. Parent Form
  5698. Non-Pharmacologic Interventions
  5699. PATIENT-CENTERED TEACHING: Pain Management for Children at Home
  5700. FIG 39-7 The boy listens to music, which serves as a distraction to refocus attention and reduce pain.
  5701. TABLE 39-3 NON-PHARMACOLOGIC PAIN RELIEF TECHNIQUES
  5702. Pharmacologic Interventions
  5703. Administration of Analgesics
  5704. NURSING QUALITY ALERT: Disadvantages of Intramuscular (IM) Analgesics
  5705. Patient-Controlled Analgesia
  5706. FIG 39-8 Patient-controlled analgesia (PCA) allows the child greater control over her own pain management.
  5707. BOX 39-4 ASPECTS OF PATIENT-CONTROLLED ANALGESIA (PCA) ORDERS
  5708. Topical Anesthetic Agents
  5709. Acetaminophen and Antiinflammatory Drugs
  5710. DRUG GUIDE: Ibuprofen
  5711. DRUG GUIDE: Acetaminophen
  5712. DRUG GUIDE: Ketorolac
  5713. Opioids
  5714. DRUG GUIDE: Codeine
  5715. DRUG GUIDE: Hydrocodone
  5716. DRUG GUIDE: Oxycodone
  5717. DRUG GUIDE: Morphine
  5718. DRUG GUIDE: Hydromorphone
  5719. DRUG GUIDE: Fentanyl
  5720. Procedural Sedation
  5721. NURSING QUALITY ALERT: Pain Management for Children
  5722. DRUG GUIDE: Methadone
  5723. Epidural Analgesia
  5724. KEY CONCEPTS
  5725. References and Readings
  5726. Chapter 40 The Child with a Fluid and Electrolyte Alteration
  5727. LEARNING OBJECTIVES
  5728. Clinical Reference
  5729. Review of Fluid and Electrolyte Imbalances in Children
  5730. PEDIATRIC DIFFERENCES RELATED TO FLUID AND ELECTROLYTE BALANCE
  5731. Infants
  5732. Infants and Young Children
  5733. Infants and Children
  5734. Alterations in Acid-Base Balance in Children
  5735. NURSING QUALITY ALERT: Treatment Goals in Acid-Base Imbalance
  5736. OVERVIEW OF FLUID AND ELECTROLYTE DISORDERS
  5737. ASSESSMENT OF FLUID DISTURBANCES
  5738. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR FLUID AND ELECTROLYTE IMBALANCE∗
  5739. SELECTED LABORATORY VALUES FOR ACID-BASE DISTURBANCES
  5740. • ACID-BASE DISTURBANCES: PRINCIPAL CAUSES, CLINICAL MANIFESTATIONS, AND TREATMENT
  5741. Dehydration ExemplarDehydration
  5742. Etiology and Incidence
  5743. Manifestations
  5744. TABLE 40-1 TYPES OF DEHYDRATION: ETIOLOGY, CLINICAL MANIFESTATIONS, AND LABORATORY VALUES
  5745. SAFETY ALERT: Signs of Impending Shock in the Dehydrated Child
  5746. TABLE 40-2 ASSESSMENT OF THE SEVERITY OF DEHYDRATION
  5747. PATHOPHYSIOLOGY: Dehydration
  5748. Diagnostic Evaluation
  5749. Therapeutic Management
  5750. Minimal Dehydration
  5751. TABLE 40-3 ORAL REPLACEMENT AND REHYDRATION THERAPY IN CHILDREN WITH VOMITING OR DIARRHEA
  5752. Mild to Moderate Dehydration
  5753. Severe Dehydration
  5754. BOX 40-1 MAINTENANCE FLUID REQUIREMENTS AND MINIMUM URINE OUTPUT
  5755. Daily Fluid Requirements by Body Weight
  5756. Minimum Urine Output by Age-Group
  5757. SAFETY ALERT: Guidelines When Administering Potassium
  5758. Adjunctive Management
  5759. Nursing Care
  5760. The Child with Dehydration
  5761. Assessment
  5762. FIG 40-1 Testing skin turgor. Turgor refers to the elasticity of the skin, which is affected by the extent of hydration. The nurse tests turgor by gently grasping the skin. When the skin is released, it should instantly spring back into place; if it does not, tissue turgor is considered poor.
  5763. Nursing Diagnosis and Planning
  5764. Expected Outcome
  5765. Expected Outcomes
  5766. Interventions
  5767. PATIENT-CENTERED TEACHING: Dehydration
  5768. Signs and Symptoms of Dehydration
  5769. Evaluation
  5770. Diarrhea ExemplarDiarrhea
  5771. EVIDENCE-BASED PRACTICE
  5772. CRITICAL THINKING EXERCISE 40-1
  5773. Etiology and Incidence
  5774. PATHOPHYSIOLOGY: Diarrhea
  5775. Manifestations
  5776. Diagnostic Evaluation
  5777. Therapeutic Management
  5778. TABLE 40-4 CAUSES AND MANIFESTATIONS OF DIARRHEA IN INFANTS AND CHILDREN
  5779. Prognosis
  5780. Nursing Care
  5781. The Child with Diarrhea
  5782. Assessment
  5783. Nursing Diagnosis and Planning
  5784. Expected Outcomes
  5785. Expected Outcomes
  5786. Expected Outcomes
  5787. Expected Outcome
  5788. Interventions
  5789. PATIENT-CENTERED TEACHING: Caring for a Child with Diarrhea
  5790. Diet
  5791. Mild Diarrhea (Mushy Stools) in Children of Any Age
  5792. Moderate Diarrhea (Watery or Frequent Stools) in Children Younger than 1 Year
  5793. Moderate Diarrhea (Watery or Frequent Stools) in Children Older than 1 Year
  5794. Preventing the Spread of Infection
  5795. Skin Care
  5796. When to Call the Physician
  5797. Oral Rehydration Therapy
  5798. Evaluation
  5799. CRITICAL THINKING EXERCISE 40-2
  5800. Vomiting ExemplarVomiting
  5801. Etiology
  5802. Manifestations
  5803. Diagnostic Evaluation
  5804. Therapeutic Management
  5805. PATHOPHYSIOLOGY: Vomiting
  5806. Nursing Care
  5807. The Vomiting Child
  5808. Assessment
  5809. NURSING QUALITY ALERT: Caring for the Child Who Is Vomiting
  5810. Nursing Diagnosis and Planning
  5811. Expected Outcomes
  5812. Expected Outcomes
  5813. Interventions
  5814. Evaluation
  5815. KEY CONCEPTS
  5816. References and Readings
  5817. Chapter 41 The Child with an Infectious Disease
  5818. Learning Objectives
  5819. Clinical Reference
  5820. Review of Disease Transmission
  5821. Chain of Infection
  5822. Transmission of Pathogens
  5823. Epidemiologic Investigations
  5824. Infection and Host Defenses
  5825. Immunity
  5826. Viral Exanthems
  5827. Nursing Considerations for the Child with a Viral Exanthem Infection
  5828. Rubeola (Measles)
  5829. Manifestations
  5830. FIG 41-1 Sample notification letter from school nurse informing parents and caregivers about an exposure to an infectious disease.
  5831. NURSING CARE PLAN: The Child with an Infection in the Community Setting
  5832. Focused Assessment
  5833. Nursing Diagnosis
  5834. Planning
  5835. Expected Outcomes
  5836. Interventions and Rationales
  5837. Evaluation
  5838. Nursing Diagnosis
  5839. Planning
  5840. Expected Outcomes
  5841. Interventions and Rationales
  5842. Evaluation
  5843. Nursing Diagnosis
  5844. Planning
  5845. Expected Outcome
  5846. Interventions and Rationales
  5847. Evaluation
  5848. Nursing Diagnosis
  5849. Planning
  5850. Expected Outcomes
  5851. Interventions and Rationales
  5852. Evaluation
  5853. Nursing Diagnosis
  5854. Planning
  5855. Expected Outcomes
  5856. Interventions and Rationales
  5857. Evaluation
  5858. PATIENT-CENTERED TEACHING: How to Care for the Child with a Viral Exanthem
  5859. Complications
  5860. FIG 41-2 Rubeola (measles) lesions and rash distribution.
  5861. Therapeutic Management
  5862. Rubella (German Measles, 3-Day Measles)
  5863. Manifestations
  5864. Complications
  5865. FIG 41-3 Rubella (German measles) lesions and rash distribution.
  5866. FIG 41-4 Erythema infectiosum lesions and rash distribution.
  5867. Therapeutic Management
  5868. SAFETY ALERT: Congenital Rubella
  5869. Erythema Infectiosum (Fifth Disease, Parvovirus B19)
  5870. Manifestations
  5871. Complications
  5872. FIG 41-5 Roseola infantum lesions and rash distribution.
  5873. Therapeutic Management
  5874. Roseola Infantum (Exanthem Subitum)
  5875. Manifestations
  5876. Complications
  5877. Therapeutic Management
  5878. Enterovirus (Nonpolio) Infections (Coxsackieviruses, Group A and Group B), Echoviruses, and Enteroviruses
  5879. Manifestations
  5880. Complications
  5881. Therapeutic Management
  5882. FIG 41-6 Coxsackievirus mouth lesions.
  5883. Nursing Considerations
  5884. Varicella-Zoster Infections (Chickenpox, Shingles)
  5885. FIG 41-7 Chickenpox and shingles lesions and rash distribution.
  5886. Manifestations
  5887. Varicella
  5888. Herpes Zoster (Shingles)
  5889. Complications
  5890. Therapeutic Management
  5891. Nursing Considerations
  5892. SAFETY ALERT: Varicella and the Immunocompromised Child
  5893. Other Viral Infections
  5894. Mumps
  5895. Manifestations
  5896. Complications
  5897. Therapeutic Management
  5898. Nursing Considerations
  5899. Cytomegalovirus (CMV)
  5900. Therapeutic Management
  5901. Nursing Considerations
  5902. Epstein-Barr Virus (Infectious Mononucleosis)
  5903. Manifestations
  5904. Complications
  5905. Therapeutic Management
  5906. Nursing Considerations
  5907. PATIENT-CENTERED TEACHING: How to Care for the Child with Infectious Mononucleosis
  5908. Rabies
  5909. Manifestations
  5910. Therapeutic Management
  5911. Nursing Considerations
  5912. Bacterial Infections
  5913. Pertussis (Whooping Cough)
  5914. Manifestations
  5915. Complications
  5916. Therapeutic Management
  5917. BOX 41-1 STAGES OF MANIFESTATION OF PERTUSSIS
  5918. Catarrhal
  5919. Paroxysmal
  5920. Convalescent
  5921. Nursing Considerations
  5922. Scarlet Fever
  5923. Manifestations
  5924. Complications
  5925. Therapeutic Management
  5926. Nursing Considerations
  5927. Methicillin-Resistant Staphylococcus aureus (MRSA)
  5928. FIG 41-8 Scarlet fever rash distribution and appearance. Note the characteristic skin peeling.
  5929. PATIENT-CENTERED TEACHING: How to Care for the Child with Scarlet Fever
  5930. Manifestations
  5931. Therapeutic Management
  5932. Nursing Considerations
  5933. Clostridium difficile
  5934. Manifestations
  5935. Therapeutic Management
  5936. Nursing Considerations
  5937. Serious Bacterial Illness in Infants
  5938. Rare Viral and Bacterial Infections
  5939. Fungal Infections
  5940. Rickettsial Infections
  5941. Rocky Mountain Spotted Fever
  5942. Manifestations
  5943. Therapeutic Management
  5944. TABLE 41-1 RARE VIRAL AND BACTERIAL INFECTIONS
  5945. Nursing Considerations
  5946. Borrelia Infections
  5947. Relapsing Fever
  5948. FIG 41-9 Lesions of variola are at the same stage of development on all body parts.
  5949. BOX 41-2 PREVENTIVE MEASURES TO AVOID INSECT AND TICK BITES
  5950. Manifestations
  5951. FIG 41-10 Dog (wood) ticks and deer (black-legged) ticks compared with a pencil. Dog ticks: A, engorged female; B, female; C, male. Deer ticks: D, larvae; E, nymphs; F, males; G, females; H, engorged female.
  5952. Therapeutic Management
  5953. Nursing Considerations
  5954. Lyme Disease
  5955. FIG 41-11 Characteristic lesion of Lyme disease.
  5956. Manifestations
  5957. Therapeutic Management
  5958. Nursing Considerations
  5959. Helminths
  5960. Therapeutic Management
  5961. Nursing Considerations
  5962. TABLE 41-2 COMMON HELMINTHS
  5963. PATIENT-CENTERED TEACHING: How to Prevent Parasitic Infections
  5964. Sexually transmitted infections ExemplarSexually Transmitted Diseases
  5965. Chlamydial Infection
  5966. PATIENT-CENTERED TEACHING: Sexually Transmitted Diseases
  5967. Manifestations
  5968. Therapeutic Management
  5969. Gonorrhea
  5970. Manifestations
  5971. Therapeutic Management
  5972. Herpes Simplex Virus
  5973. Manifestations
  5974. Therapeutic Management
  5975. CRITICAL THINKING EXERCISE 41-1
  5976. Human Papillomavirus
  5977. Manifestations
  5978. Therapeutic Management
  5979. Bacterial Vaginosis
  5980. Manifestations
  5981. Syphilis
  5982. Manifestations
  5983. Therapeutic Management
  5984. Trichomoniasis
  5985. Manifestations
  5986. Therapeutic Management
  5987. Nursing Considerations
  5988. EVIDENCE-BASED PRACTICE
  5989. KEY CONCEPTS
  5990. References and Readings
  5991. Chapter 42 The Child with an Immunologic Alteration
  5992. Learning Objectives
  5993. CLINICAL REFERENCE
  5994. Review of the Immune System
  5995. Nonspecific Immune Functions
  5996. Specific Immune Functions
  5997. The Humoral Response
  5998. CELLS INVOLVED IN THE IMMUNE RESPONSE
  5999. PEDIATRIC DIFFERENCES IN THE IMMUNE SYSTEM
  6000. The Organs of the Immune System Mature during Infancy and Childhood
  6001. Immaturity of the Immunologic System Places the Infant and Young Child at Greater Risk for Infection
  6002. Disorders of the Immune System Manifest Differently in Children than in Adults
  6003. The Cell-Mediated Response
  6004. Development of Immunity
  6005. Active Acquired Immunity
  6006. Passive Acquired Immunity
  6007. IMMUNOGLOBULIN FUNCTION AND PEDIATRIC IMPLICATIONS
  6008. Common Laboratory and Diagnostic Tests of Immune Function
  6009. Immunodeficiencies
  6010. Allergy
  6011. COMMON LABORATORY AND DIAGNOSTIC TESTS OF IMMUNE FUNCTION
  6012. LABORATORY AND CLINICAL SCREENING TESTS FOR ALLERGY
  6013. Human Immunodeficiency Virus Infection
  6014. Etiology
  6015. CRITICAL THINKING EXERCISE 42-1
  6016. Incidence
  6017. PATHOPHYSIOLOGY: HIV Infection
  6018. Manifestations
  6019. BOX 42-1 CLINICAL FINDINGS ASSOCIATED WITH IMMUNODEFICIENCY
  6020. Frequently Present, Highly Indicative Signs
  6021. Frequently Present, Somewhat Suggestive Signs
  6022. Diagnostic Evaluation
  6023. Diagnosing HIV-Exposed Infants
  6024. Ongoing Diagnostic Monitoring
  6025. Therapeutic Management
  6026. HIV-Exposed Infants
  6027. HIV-Infected Infants and Children
  6028. Treatment Considerations
  6029. Treatment Initiation
  6030. Additional Issues Related to the Child with HIV Infection
  6031. Multigenerational Problems
  6032. TABLE 42-1 CONSIDERATIONS FOR INITIATING ANTIRETROVIRAL MEDICATIONS IN INFANTS AND CHILDREN WITH HIV
  6033. Disclosure
  6034. NURSING CARE PLAN: The Child with HIV Infection in the Community
  6035. Focused Assessment
  6036. Nursing Diagnosis
  6037. Planning
  6038. Expected Outcome
  6039. Interventions and Rationales
  6040. Evaluation
  6041. Nursing Diagnosis
  6042. Planning
  6043. Expected Outcomes
  6044. Interventions and Rationales
  6045. Evaluation
  6046. Nursing Diagnosis
  6047. Planning
  6048. Expected Outcomes
  6049. Interventions and Rationales
  6050. Evaluation
  6051. TABLE 42-2 RECOMMENDATIONS FOR ROUTINE IMMUNIZATION OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN IN THE UNITED STATES
  6052. HIV and School Settings
  6053. PATIENT-CENTERED TEACHING: How to Care for the Child with an HIV Infection
  6054. Transmission
  6055. Prevention
  6056. Testing
  6057. Illness (AIDS)
  6058. Medications
  6059. Home Care
  6060. NURSING CARE PLAN: The Adolescent with HIV Infection
  6061. Focused Assessment
  6062. Nursing Diagnosis
  6063. Planning
  6064. Expected Outcomes
  6065. Interventions and Rationales
  6066. Evaluation
  6067. Corticosteroid Therapy
  6068. Incidence
  6069. Pathophysiology
  6070. DRUG GUIDE: Prednisolone (Pediapred, Prelone)
  6071. Manifestations
  6072. Diagnostic Evaluation
  6073. Therapeutic Management
  6074. Nursing Care
  6075. The Child Receiving Corticosteroids
  6076. Assessment
  6077. Nursing Diagnosis and Planning
  6078. Expected Outcome
  6079. Expected Outcome
  6080. Expected Outcome
  6081. Expected Outcomes
  6082. Expected Outcome
  6083. Interventions
  6084. SAFETY ALERT: The Child Taking Oral Corticosteroids
  6085. Evaluation
  6086. Immune Complex and Autoimmune Disorders
  6087. Immune Complex Disorders
  6088. Autoimmune Disorders
  6089. Systemic Lupus Erythematosus
  6090. Etiology
  6091. Incidence
  6092. Manifestations
  6093. PATHOPHYSIOLOGY: Systemic Lupus Erythematosus
  6094. Diagnostic Evaluation
  6095. FIG 42-1 The butterfly rash of systemic lupus erythematosus.
  6096. Therapeutic Management
  6097. Nursing Care
  6098. The Child with Systemic Lupus Erythematosus
  6099. Assessment
  6100. Nursing Diagnosis and Planning
  6101. Expected Outcome
  6102. Expected Outcome
  6103. Expected Outcome
  6104. Expected Outcome
  6105. Expected Outcome
  6106. Interventions
  6107. TABLE 42-3 CLASSIFICATION OF ALLERGIC REACTIONS
  6108. Evaluation
  6109. Allergic Reactions
  6110. TABLE 42-4 COMMON ALLERGIC CONDITIONS IN CHILDREN
  6111. Anaphylaxis
  6112. Etiology
  6113. Incidence
  6114. PATHOPHYSIOLOGY: Anaphylaxis
  6115. Manifestations
  6116. Diagnostic Evaluation
  6117. Therapeutic Management
  6118. Nursing Care
  6119. The Child with Anaphylaxis
  6120. Assessment
  6121. Nursing Diagnosis and Planning
  6122. Expected Outcome
  6123. Expected Outcome
  6124. Interventions
  6125. PATIENT-CENTERED TEACHING: Communicating with the School about Peanut Allergies
  6126. Evaluation
  6127. PATIENT-CENTERED TEACHING: How to Prevent Insect Stings
  6128. KEY CONCEPTS
  6129. References and Readings
  6130. Chapter 43 The Child with a Gastrointestinal Alteration
  6131. Learning Objectives
  6132. CLINICAL REFERENCE
  6133. Review of the Gastrointestinal System
  6134. Upper Gastrointestinal System
  6135. Lower Gastrointestinal System
  6136. Prenatal Development
  6137. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR GI DISORDERS
  6138. MAJOR DIGESTIVE ENZYMES
  6139. PEDIATRIC DIFFERENCES IN THE GASTROINTESTINAL SYSTEM
  6140. Disorders of Prenatal Development
  6141. Cleft Lip and Palate
  6142. Incidence
  6143. PATHOPHYSIOLOGY: Cleft Lip and Palate
  6144. Child born with a cleft lip and palate, before (A) and after (B) repair. Repair of facial clefts usually requires multiple surgeries at different stages in the child’s growth. Early repair of a cleft lip facilitates parent-infant bonding and improves feeding. Children generally experience good outcomes with today’s surgical, orthodontic, and speech therapy techniques.
  6145. Manifestations and Diagnostic Evaluation
  6146. Therapeutic Management
  6147. FIG 43-1 Before and after repair of a cleft lip or palate, special feeding techniques are essential for adequate nutrition. A feeder with compressible plastic sides allows gentle squeezing of the sides of the bottle to help eject the breast milk or formula. A slightly longer nipple allows the milk to be swallowed with less chance of milk entering the nasopharynx and without stimulating the gag reflex.
  6148. Esophageal Atresia with Tracheoesophageal Fistula
  6149. Etiology and Incidence
  6150. Manifestations
  6151. Diagnostic Evaluation
  6152. NURSING CARE PLAN: The Child with a Cleft Lip or Palate
  6153. Focused Assessment
  6154. Nursing Diagnoses
  6155. Planning
  6156. Expected Outcomes
  6157. Interventions and Rationales
  6158. Evaluation
  6159. Nursing Diagnosis
  6160. Planning
  6161. Expected Outcomes
  6162. Interventions and Rationales
  6163. Evaluation
  6164. Nursing Diagnoses
  6165. Planning
  6166. Expected Outcomes
  6167. Interventions and Rationales
  6168. Evaluation
  6169. Nursing Diagnosis
  6170. Planning
  6171. Expected Outcome
  6172. Interventions and Rationales
  6173. Evaluation
  6174. Nursing Diagnosis
  6175. Plannning
  6176. Expected Outcomes
  6177. Interventions and Rationales
  6178. Evaluation
  6179. Nursing Diagnosis
  6180. Planning
  6181. Expected Outcomes
  6182. Interventions and Rationales
  6183. Evaluation
  6184. PATIENT-CENTERED TEACHING: Home Care of the Child with Cleft Lip or Palate
  6185. FIG 43-2 Most common type of esophageal atresia (EA) and tracheoesophageal fistula (TEF).
  6186. Therapeutic Management
  6187. PATHOPHYSIOLOGY: Esophageal Atresia and Tracheoesophageal Fistula
  6188. Nursing Care
  6189. The Infant with Tracheoesophageal Fistula
  6190. Assessment
  6191. Nursing Diagnosis and Planning
  6192. Expected Outcome
  6193. Expected Outcomes
  6194. Expected Outcome
  6195. Expected Outcomes
  6196. Expected Outcome
  6197. Expected Outcome
  6198. Expected Outcome
  6199. SAFETY ALERT: Assessing and Managing the Child with Esophageal Atresia and Tracheoesophageal Fistula
  6200. Interventions
  6201. Minimizing Aspiration Risk
  6202. Postoperative Care
  6203. Gastrostomy Tube Use
  6204. Home Care
  6205. FIG 43-3 The skin-level gastrostomy button is good for children who require long-term gastrostomy feeding. It is relatively flat, reduces skin breakdown, increases comfort, and is fully immersible in water.
  6206. Evaluation
  6207. Upper Gastrointestinal Hernias
  6208. Other Developmental Disorders
  6209. Motility Disorders
  6210. Gastroesophageal Reflux Disease
  6211. Etiology
  6212. Incidence
  6213. TABLE 43-1 UPPER GI HERNIAS
  6214. Manifestations and Diagnostic Evaluation
  6215. Therapeutic Management
  6216. TABLE 43-2 DEVELOPMENTAL GI DEFECTS
  6217. BOX 43-1 TYPES OF GASTROESOPHAGEAL REFLUX
  6218. Physiologic (Gastroesophageal Reflux [GER])
  6219. Pathologic (Gastroesophageal Reflux Disease [GERD])
  6220. PATIENT-CENTERED TEACHING: Home Care of the Child with a Gastrostomy Tube
  6221. Diet
  6222. Positioning
  6223. Medications
  6224. Treatment of Acute Bleeding
  6225. PATHOPHYSIOLOGY: Gastroesophageal Reflux
  6226. Surgery
  6227. Nursing Care
  6228. The Infant with Gastroesophageal Reflux Disease
  6229. Assessment
  6230. Nursing Diagnosis and Planning
  6231. Expected Outcome
  6232. Expected Outcomes
  6233. Expected Outcomes
  6234. Expected Outcomes
  6235. Expected Outcomes
  6236. Interventions
  6237. Minimizing Reflux
  6238. Family Education and Support
  6239. Evaluation
  6240. Constipation ExemplarConstipation and Encopresis
  6241. PATHOPHYSIOLOGY: Constipation and Encopresis
  6242. Etiology and Incidence
  6243. Manifestations
  6244. Constipation
  6245. Encopresis
  6246. Diagnostic Evaluation
  6247. Therapeutic Management
  6248. Nursing Care
  6249. The Child with Constipation or Encopresis
  6250. Assessment
  6251. Nursing Diagnosis and Planning
  6252. Expected Outcome
  6253. Expected Outcomes
  6254. Expected Outcomes
  6255. Expected Outcome
  6256. Interventions
  6257. Overcoming Withholding
  6258. Dietary Changes
  6259. Changing the Retention Habit
  6260. Emotional Support
  6261. Home Care
  6262. Evaluation
  6263. Recurrent Abdominal Pain/Irritable Bowel Syndrome
  6264. Etiology and Incidence
  6265. Manifestations and Diagnostic Evaluation
  6266. Therapeutic Management and Nursing Considerations
  6267. PATHOPHYSIOLOGY: Irritable Bowel Syndrome
  6268. Inflammatory and Infectious Disorders
  6269. Ulcers
  6270. PATHOPHYSIOLOGY: Ulcers
  6271. Etiology
  6272. Incidence
  6273. Manifestations and Diagnostic Evaluation
  6274. Therapeutic Management
  6275. Nursing Considerations
  6276. Providing Information
  6277. Home Care
  6278. Infectious Gastroenteritis
  6279. Etiology
  6280. PARENTS WANT TO KNOW: Care of the Child with an Ulcer
  6281. Incidence
  6282. TABLE 43-3 CHARACTERISTICS OF INFECTIOUS GASTROENTERITIS
  6283. Manifestations
  6284. PATHOPHYSIOLOGY: Infectious Gastroenteritis
  6285. Diagnostic Evaluation
  6286. Therapeutic Management
  6287. Nursing Care
  6288. The Child with Infectious Gastroenteritis
  6289. Assessment
  6290. Nursing Diagnosis and Planning
  6291. Expected Outcomes
  6292. Expected Outcome
  6293. Expected Outcome
  6294. Expected Outcomes
  6295. Expected Outcomes
  6296. Expected Outcome
  6297. Interventions
  6298. Maintaining Fluid Balance
  6299. Decreasing Risk
  6300. Home Care
  6301. PATIENT-CENTERED TEACHING: Care of the Child with Infectious Gastroenteritis
  6302. Evaluation
  6303. Appendicitis
  6304. Etiology and Incidence
  6305. Manifestations and Diagnostic Evaluation
  6306. PATHOPHYSIOLOGY: Appendicitis
  6307. FIG 43-4 McBurney point is midway between the right anterior superior iliac crest and the umbilicus. It is usually the location of greatest pain in the child with appendicitis.
  6308. Therapeutic Management
  6309. Nursing Care
  6310. The Child with Appendicitis
  6311. Assessment
  6312. Nursing Diagnosis and Planning
  6313. Expected Outcome
  6314. Expected Outcomes
  6315. Expected Outcome
  6316. Expected Outcomes
  6317. NURSING QUALITY ALERT: Assessing Appendicitis in the Young Child
  6318. Interventions
  6319. Uncomplicated Appendicitis
  6320. Ruptured Appendix
  6321. Home Care
  6322. Evaluation
  6323. Ulcerative colitis ExemplarInflammatory Bowel Disease
  6324. Etiology
  6325. Incidence, Manifestations, and Diagnostic Evaluation
  6326. Therapeutic Management
  6327. TABLE 43-4 CROHN DISEASE AND ULCERATIVE COLITIS
  6328. Nursing Care
  6329. The Child with Inflammatory Bowel Disease
  6330. Assessment
  6331. Nursing Diagnosis and Planning
  6332. Expected Outcomes
  6333. Expected Outcome
  6334. Expected Outcome
  6335. Expected Outcome
  6336. Expected Outcomes
  6337. Expected Outcomes
  6338. Expected Outcomes
  6339. Interventions
  6340. Medications
  6341. Nutritional Management
  6342. Family Education and Support
  6343. PATHOPHYSIOLOGY: Inflammatory Bowel Disease
  6344. Home Care
  6345. Evaluation
  6346. Obstructive Disorders
  6347. Hypertrophic Pyloric Stenosis
  6348. Etiology and Incidence
  6349. Manifestations
  6350. PATHOPHYSIOLOGY: Hypertrophic Pyloric Stenosis
  6351. Diagnostic Evaluation
  6352. Therapeutic Management
  6353. NURSING QUALITY ALERT: Gathering Information from a Parent About Infant Vomiting
  6354. Nursing Care
  6355. The Child with Hypertrophic Pyloric Stenosis
  6356. Assessment
  6357. Nursing Diagnosis and Planning
  6358. Expected Outcomes
  6359. Expected Outcomes
  6360. Expected Outcomes
  6361. Expected Outcomes
  6362. Expected Outcomes
  6363. Expected Outcomes
  6364. Interventions
  6365. Preoperative Care
  6366. Postoperative Care
  6367. Home Care
  6368. Evaluation
  6369. CRITICAL THINKING EXERCISE 43-1
  6370. Intussusception
  6371. Etiology and Incidence
  6372. Manifestations and Diagnostic Evaluation
  6373. Therapeutic Management
  6374. Nursing Care
  6375. The Child with Intussusception
  6376. Assessment
  6377. PATHOPHYSIOLOGY: Intussusception
  6378. Nursing Diagnosis and Planning
  6379. Expected Outcome
  6380. Expected Outcome
  6381. Expected Outcomes
  6382. Expected Outcomes
  6383. Expected Outcomes
  6384. Expected Outcome
  6385. Interventions
  6386. Initial Care
  6387. Post Reduction Care
  6388. Family Education and Support
  6389. Evaluation
  6390. Volvulus
  6391. Hirschsprung Disease
  6392. Etiology and Incidence
  6393. Manifestations and Diagnostic Evaluation
  6394. PATHOPHYSIOLOGY: Hirschsprung Disease
  6395. Therapeutic Management
  6396. Nursing Care
  6397. The Child with Hirschsprung Disease
  6398. Assessment
  6399. Nursing Diagnoses and Planning
  6400. Expected Outcome
  6401. Expected Outcomes
  6402. Expected Outcomes
  6403. Expected Outcome
  6404. Expected Outcomes
  6405. Expected Outcomes
  6406. Expected Outcomes
  6407. Expected Outcomes
  6408. Expected Outcomes
  6409. Interventions
  6410. Preparing the Child for Surgery
  6411. Preventing Infection and Maintaining Skin Integrity
  6412. Maintaining Nutritional and Hydration Status
  6413. Reducing Pain
  6414. Providing Education and Relieving Anxiety
  6415. Evaluation
  6416. Malabsorption syndromes ExemplarMalabsorption Disorders
  6417. Lactose Intolerance
  6418. Etiology and Incidence
  6419. Manifestations and Diagnostic Evaluation
  6420. Therapeutic Management
  6421. PATHOPHYSIOLOGY: Lactose Intolerance
  6422. Nursing Care
  6423. The Child with Lactose Intolerance
  6424. Assessment
  6425. PARENTS WANT TO KNOW: Care of the Child with Lactose Intolerance
  6426. Nursing Diagnosis and Planning
  6427. Expected Outcomes
  6428. Expected Outcome
  6429. Expected Outcomes
  6430. Interventions
  6431. Evaluation
  6432. Celiac Disease
  6433. Etiology and Incidence
  6434. Manifestations
  6435. Diagnostic Evaluation
  6436. PATHOPHYSIOLOGY: Celiac Disease
  6437. Therapeutic Management
  6438. Nursing Care
  6439. The Child with Celiac Disease
  6440. Assessment
  6441. Nursing Diagnosis and Planning
  6442. Expected Outcome
  6443. Expected Outcome
  6444. Expected Outcome
  6445. Expected Outcomes
  6446. Expected Outcome
  6447. Interventions
  6448. PATIENT-CENTERED TEACHING: Care of the Child with Celiac Disease
  6449. Evaluation
  6450. Short Bowel Syndrome
  6451. Etiology and Incidence
  6452. Pathophysiology
  6453. Manifestations
  6454. Therapeutic Management
  6455. Nursing Considerations
  6456. Hepatic Disorders
  6457. Viral Hepatitis
  6458. Etiology
  6459. Incidence
  6460. TABLE 43-5 DIFFERENTIATION OF VIRAL HEPATITIS
  6461. Manifestations
  6462. PATHOPHYSIOLOGY: Viral Hepatitis
  6463. Diagnostic Evaluation
  6464. Therapeutic Management
  6465. Hepatitis A
  6466. Hepatitis B
  6467. Nursing Care
  6468. The Child with Viral Hepatitis
  6469. Assessment
  6470. TABLE 43-6 HEPATITIS PROPHYLAXIS
  6471. Nursing Diagnosis and Planning
  6472. Expected Outcomes
  6473. Expected Outcomes
  6474. Expected Outcomes
  6475. Expected Outcomes
  6476. Interventions
  6477. Child and Parent Teaching
  6478. Home Care
  6479. Evaluation
  6480. Biliary Atresia
  6481. Etiology and Incidence
  6482. Manifestations
  6483. Diagnostic Evaluation
  6484. Therapeutic Management
  6485. Nursing Considerations
  6486. Nutritional Support
  6487. Skin Care
  6488. Developmental Stimulation
  6489. Continued Assessment
  6490. Family Education and Support
  6491. PATHOPHYSIOLOGY: Biliary Atresia
  6492. Home Care
  6493. Cirrhosis
  6494. PATHOPHYSIOLOGY: Cirrhosis
  6495. Etiology
  6496. Incidence
  6497. Manifestations
  6498. Diagnostic Evaluation
  6499. Therapeutic Management
  6500. Nursing Considerations
  6501. Nutritional Support
  6502. Skin Care
  6503. Prevention of Complications
  6504. Developmental and Parental Support
  6505. Home Care
  6506. KEY CONCEPTS
  6507. References and Readings
  6508. Pageburst Integrated Resource
  6509. Animation
  6510. Chapter 44 The Child with a Genitourinary Alteration
  6511. Learning Objectives
  6512. CLINICAL REFERENCE
  6513. Review of the Genitourinary System
  6514. Structure
  6515. PEDIATRIC DIFFERENCES IN THE GENITOURINARY SYSTEM
  6516. Function
  6517. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR GENITOURINARY DISORDERS
  6518. Enuresis
  6519. Etiology
  6520. Incidence
  6521. PATHOPHYSIOLOGY: Enuresis
  6522. Manifestations
  6523. Nocturnal Enuresis
  6524. Diurnal Enuresis
  6525. Diagnostic Evaluation
  6526. Therapeutic Management
  6527. Nursing Care
  6528. The Child with Enuresis
  6529. Assessment
  6530. Nursing Diagnosis and Planning
  6531. Expected Outcome
  6532. Expected Outcome
  6533. Expected Outcomes
  6534. Expected Outcome
  6535. Interventions
  6536. Evaluation
  6537. CRITICAL THINKING EXERCISE 44-1
  6538. Urinary tract infection ExemplarUrinary Tract Infections
  6539. Etiology
  6540. Incidence
  6541. PATHOPHYSIOLOGY: Urinary Tract Infections
  6542. BOX 44-1 MANIFESTATIONS OF URINARY TRACT INFECTION IN INFANTS AND CHILDREN
  6543. Infants
  6544. Children
  6545. Children with Pyelonephritis
  6546. Manifestations
  6547. PATHOPHYSIOLOGY: Hydronephrosis
  6548. PATHOPHYSIOLOGY: Vesicoureteral Reflux
  6549. Diagnostic Evaluation
  6550. Therapeutic Management
  6551. Nursing Care
  6552. The Child with a Urinary Tract Infection
  6553. Assessment
  6554. Nursing Diagnosis and Planning
  6555. Expected Outcome
  6556. Expected Outcome
  6557. Expected Outcomes
  6558. Interventions
  6559. NURSING QUALITY ALERT: Evaluation after a Documented Urinary Tract Infection
  6560. PATIENT-CENTERED TEACHING: How to Manage and Prevent Urinary Tract Infections
  6561. Evaluation
  6562. Cryptorchidism
  6563. Incidence
  6564. PATHOPHYSIOLOGY: Cryptorchidism
  6565. Manifestations
  6566. Diagnostic Evaluation
  6567. Therapeutic Management
  6568. NURSING QUALITY ALERT: Assessing for Cryptorchidism
  6569. Nursing Care
  6570. The Child with Cryptorchidism
  6571. Assessment
  6572. Nursing Diagnosis and Planning
  6573. Expected Outcomes
  6574. Expected Outcomes
  6575. Interventions
  6576. Evaluation
  6577. Hypospadias and Epispadias
  6578. Etiology and Incidence
  6579. FIG 44-1 Epispadias and hypospadias are congenital anomalies in which the urethral opening is above or below its normal location on the glans of the penis. Stenosis of the opening could occur, leading to possible urinary tract infections (UTIs) or hydronephrosis. Hypospadias might interfere with fertility if it is left uncorrected.
  6580. PATHOPHYSIOLOGY: Hypospadias
  6581. Manifestations and Diagnostic Evaluation
  6582. Therapeutic Management
  6583. Nursing Care
  6584. The Child with Hypospadias
  6585. Assessment
  6586. Nursing Diagnosis and Planning
  6587. Expected Outcomes
  6588. Expected Outcome
  6589. Expected Outcomes
  6590. Expected Outcome
  6591. Interventions
  6592. Evaluation
  6593. Miscellaneous Disorders and Anomalies of the Genitourinary Tract
  6594. Acute Poststreptococcal Glomerulonephritis
  6595. Etiology and Incidence
  6596. Manifestations
  6597. TABLE 44-1 MISCELLANEOUS DISORDERS AND ANOMALIES OF THE GENITOURINARY TRACT
  6598. Diagnostic Evaluation
  6599. Therapeutic Management
  6600. PATHOPHYSIOLOGY: Acute Poststreptococcal Glomerulonephritis
  6601. Nursing Care
  6602. The Child with Acute Poststreptococcal Glomerulonephritis
  6603. Assessment
  6604. Nursing Diagnosis and Planning
  6605. Expected Outcome
  6606. Expected Outcome
  6607. Expected Outcome
  6608. Expected Outcome
  6609. Expected Outcomes
  6610. Interventions
  6611. Preventing the Consequences of Fluid Excess
  6612. Providing Adequate Rest
  6613. Maintaining Skin Integrity
  6614. Maintaining Nutritional Status
  6615. Relieving Anxiety
  6616. Evaluation
  6617. Nephrotic Syndrome
  6618. NURSING QUALITY ALERT: Differences between Children with Glomerulonephritis and Children with Nephrotic Syndrome
  6619. Etiology
  6620. Incidence
  6621. Manifestations
  6622. Diagnostic Evaluation
  6623. Therapeutic Management
  6624. PATHOPHYSIOLOGY: Nephrotic Syndrome
  6625. Remission Induction
  6626. NURSING CARE PLAN: The Child with Nephrotic Syndrome
  6627. Focused Assessment
  6628. Nursing Diagnosis
  6629. Planning
  6630. Expected Outcome
  6631. Interventions and Rationales
  6632. Evaluation
  6633. Nursing Diagnosis
  6634. Planning
  6635. Expected Outcome
  6636. Interventions and Rationales
  6637. Evaluation
  6638. Nursing Diagnosis
  6639. Planning
  6640. Expected Outcome
  6641. Interventions and Rationales
  6642. Evaluation
  6643. Nursing Diagnosis
  6644. Planning
  6645. Expected Outcome
  6646. Interventions and Rationales
  6647. Evaluation
  6648. Nursing Diagnoses
  6649. Planning
  6650. Expected Outcomes
  6651. Interventions and Rationales
  6652. Evaluation
  6653. Additional Therapy
  6654. FIG 44-2 This child has nephrotic syndrome. He previously received steroid therapy and is now receiving CellCept immunosuppressant therapy to control the process. During the acute phase of the nephrotic syndrome, the child may have massive edema because blood proteins are lost in the urine. Skin pallor is also common.
  6655. Acute Renal Failure
  6656. Etiology and Incidence
  6657. PATHOPHYSIOLOGY: Acute Renal Failure
  6658. Manifestations
  6659. Diagnostic Evaluation
  6660. History
  6661. Fluid Volume Status
  6662. Laboratory Data
  6663. PATHOPHYSIOLOGY: Hemolytic Uremic Syndrome
  6664. Physical Examination
  6665. Imaging Studies
  6666. Therapeutic Management
  6667. Fluid Imbalances
  6668. Electrolyte Imbalances
  6669. Potassium
  6670. Sodium
  6671. Acid-Base Imbalances
  6672. Nutrition
  6673. NURSING QUALITY ALERT: Indications for Dialysis in Acute Renal Failure
  6674. Dialysis
  6675. Nursing Considerations
  6676. BOX 44-2 DIALYSIS
  6677. Hemodialysis
  6678. Teenager receiving hemodialysis.
  6679. Peritoneal Dialysis
  6680. Peritoneal dialysis. Implanted line allows instillation of the dialyzing fluid into this child’s peritoneal cavity.
  6681. Infection of the peritoneal cavity is the chief hazard of peritoneal dialysis. When the lines are open to begin or end the dialyzing cycle, both adult and child wear masks.
  6682. Peritoneal dialysis catheter exit site.
  6683. Chronic Renal Failure and End-Stage Renal Disease
  6684. Etiology
  6685. Incidence
  6686. Pathophysiology
  6687. Manifestations
  6688. Diagnostic Evaluation
  6689. Therapeutic Management
  6690. Chronic Renal Failure
  6691. End-Stage Renal Disease
  6692. Kidney Transplantation
  6693. Nursing Care
  6694. The Child with Chronic Renal Failure and End-Stage Renal Disease
  6695. Assessment
  6696. Nursing Diagnosis and Planning
  6697. Expected Outcome
  6698. Expected Outcomes
  6699. Expected Outcome
  6700. Expected Outcome
  6701. Expected Outcomes
  6702. Expected Outcome
  6703. Interventions
  6704. Evaluation
  6705. KEY CONCEPTS
  6706. References and Readings
  6707. Pageburst Integrated Resource
  6708. Animation
  6709. Chapter 45 The Child with a Respiratory Alteration
  6710. Learning Objectives
  6711. CLINICAL REFERENCE
  6712. Review of the Respiratory System
  6713. The Upper Airway
  6714. The Lower Airway
  6715. Prenatal Respiratory Development
  6716. Postnatal Respiratory Changes
  6717. Gas Exchange and Transport
  6718. Diagnostic Tests
  6719. Blood Gas Analysis
  6720. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR RESPIRATORY DISORDERS
  6721. Pulmonary Function Tests
  6722. Pulse Oximetry
  6723. Transcutaneous Monitoring
  6724. End-Tidal Carbon Dioxide Monitoring
  6725. PEDIATRIC DIFFERENCES IN THE RESPIRATORY SYSTEM
  6726. Respiratory Illness in Children
  6727. Allergic Rhinitis
  6728. Etiology and Incidence
  6729. PATHOPHYSIOLOGY: Allergic Rhinitis
  6730. Manifestations
  6731. FIG 45-1 Children with allergic rhinitis often have dark circles under their eyes, called allergic shiners, and may be seen rubbing their noses upward with the palm—the “allergic salute.”
  6732. Diagnostic Evaluation
  6733. Therapeutic Management
  6734. Nursing Considerations
  6735. PATIENT-CENTERED TEACHING: How to Implement Environmental Modifications
  6736. Pollen and Dust
  6737. Mold
  6738. Dander
  6739. Sinusitis
  6740. Etiology and Incidence
  6741. Manifestations
  6742. PATHOPHYSIOLOGY: Sinusitis
  6743. Diagnostic Evaluation
  6744. Therapeutic Management
  6745. Nursing Considerations
  6746. Otitis media ExemplarOtitis Media
  6747. Etiology
  6748. Incidence
  6749. Manifestations
  6750. PATHOPHYSIOLOGY: Otitis Media
  6751. Diagnostic Evaluation
  6752. Therapeutic Management
  6753. FIG 45-2 Appearance of tympanic membrane in otitis media compared with normal tympanic membrane. A, Normal right tympanic membrane and middle ear. B, Acute otitis media: bulging right tympanic membrane. C, Otitis media with effusion: air-fluid level and bubbles visible through right retracted, translucent tympanic membrane. D, Otitis media with effusion: severely retracted, opaque right tympanic membrane.
  6754. Nursing Care
  6755. The Child with Otitis Media
  6756. Assessment
  6757. Nursing Diagnosis and Planning
  6758. Expected Outcome
  6759. Expected Outcome
  6760. Expected Outcome
  6761. Expected Outcome
  6762. Interventions
  6763. Evaluation
  6764. EVIDENCE-BASED PRACTICE
  6765. Pharyngitis and Tonsillitis
  6766. Etiology
  6767. Incidence
  6768. Manifestations
  6769. TABLE 45-1 COMPARISON OF VIRAL AND BACTERIAL PHARYNGITIS
  6770. PATHOPHYSIOLOGY: Pharyngitis
  6771. Diagnostic Evaluation
  6772. Therapeutic Management
  6773. Nursing Considerations
  6774. Nursing Care
  6775. The Child Undergoing a Tonsillectomy
  6776. Assessment: Preoperative Period
  6777. Nursing Diagnosis and Planning: Preoperative Period
  6778. Expected Outcome
  6779. Expected Outcome
  6780. Interventions: Preoperative Period
  6781. Evaluation: Preoperative Period
  6782. Assessment: Postoperative Period
  6783. SAFETY ALERT: Caring for the Child Who Has Had a Tonsillectomy
  6784. Nursing Diagnosis and Planning: Postoperative Period
  6785. Expected Outcome
  6786. PATIENT-CENTERED TEACHING: Caring for a Child after a Tonsillectomy
  6787. Expected Outcome
  6788. Expected Outcome
  6789. Expected Outcome
  6790. Expected Outcome
  6791. Interventions: Postoperative
  6792. Evaluation: Postoperative
  6793. CRITICAL THINKING EXERCISE 45-1
  6794. Laryngomalacia (Congenital Laryngeal Stridor)
  6795. Manifestations
  6796. Therapeutic Management
  6797. Nursing Considerations
  6798. Croup
  6799. Etiology and Incidence
  6800. Manifestations
  6801. TABLE 45-2 COMPARISON OF TYPES OF CROUP
  6802. PATHOPHYSIOLOGY: Croup
  6803. Diagnostic Evaluation
  6804. Therapeutic Management
  6805. Nursing Care
  6806. The Child with Croup
  6807. Assessment
  6808. Nursing Diagnosis and Planning
  6809. Expected Outcome
  6810. Expected Outcome
  6811. Expected Outcome
  6812. Expected Outcome
  6813. Interventions
  6814. Facilitating Airway Clearance
  6815. Maintaining Fluid Balance
  6816. Decreasing Fear
  6817. Providing Teaching
  6818. Evaluation
  6819. Epiglottitis (Supraglottitis)
  6820. Etiology and Incidence
  6821. Manifestations
  6822. Diagnostic Evaluation
  6823. SAFETY ALERT: Cardinal Signs and Symptoms of Epiglottitis
  6824. PATHOPHYSIOLOGY: Epiglottitis
  6825. Therapeutic Management
  6826. Nursing Considerations
  6827. Bronchitis
  6828. Etiology and Incidence
  6829. PATHOPHYSIOLOGY: Bronchitis
  6830. Manifestations and Diagnostic Evaluation
  6831. Therapeutic Management
  6832. Nursing Considerations
  6833. Bronchiolitis
  6834. Etiology and Incidence
  6835. PATHOPHYSIOLOGY: Bronchiolitis
  6836. Manifestations
  6837. Diagnostic Evaluation
  6838. Therapeutic Management
  6839. Nursing Care
  6840. The Child with Bronchiolitis
  6841. Assessment
  6842. Nursing Diagnosis and Planning
  6843. Expected Outcome
  6844. Expected Outcome
  6845. Expected Outcome
  6846. Expected Outcome
  6847. Expected Outcomes
  6848. Interventions
  6849. Facilitating Gas Exchange
  6850. Preventing Transmission
  6851. Maintaining Fluid Balance
  6852. Reducing Fever
  6853. Decreasing Anxiety
  6854. Evaluation
  6855. Pneumonia ExemplarPneumonia
  6856. Nursing Care
  6857. The Child with Pneumonia
  6858. Assessment
  6859. TABLE 45-3 COMPARISON OF TYPES OF PNEUMONIA
  6860. Nursing Diagnosis and Planning
  6861. Expected Outcome
  6862. Expected Outcome
  6863. Expected Outcome
  6864. Expected Outcome
  6865. Expected Outcome
  6866. Expected Outcome
  6867. Expected Outcome
  6868. Interventions
  6869. PATIENT-CENTERED TEACHING: Home Management of the Child with Pneumonia
  6870. Evaluation
  6871. BOX 45-1 COMMON ITEMS OF ASPIRATION
  6872. Foreign Body Aspiration
  6873. Etiology and Incidence
  6874. Pathophysiology
  6875. Manifestations
  6876. Diagnostic Evaluation
  6877. Therapeutic Management
  6878. Nursing Considerations
  6879. Pulmonary Noninfectious Irritation
  6880. Acute Respiratory Distress Syndrome
  6881. Pathophysiology
  6882. Passive Smoking
  6883. Pathophysiology
  6884. Smoke Inhalation
  6885. Pathophysiology
  6886. TABLE 45-4 PULMONARY NONINFECTIOUS IRRITANTS
  6887. Apnea
  6888. Manifestations
  6889. Diagnostic Evaluation
  6890. TABLE 45-5 APNEA OF PREMATURITY COMPARED WITH INFANT APNEA
  6891. Nursing Care
  6892. The Infant with Apnea
  6893. Assessment
  6894. Nursing Diagnosis and Planning
  6895. Expected Outcome
  6896. Expected Outcome
  6897. Expected Outcome
  6898. Interventions
  6899. FIG 45-3 Teaching the family about using an apnea monitor and how to respond to alarms is an important element in caring for the child with infant apnea. The nurse must assess the parents’ ability to tolerate the stressors of living with a child who is prone to apnea and support them as they deal with these stressors.
  6900. Evaluation
  6901. Sudden Infant Death Syndrome
  6902. Etiology and Incidence
  6903. BOX 45-2 HOME APNEA MONITORING
  6904. PATHOPHYSIOLOGY: Sudden Infant Death Syndrome
  6905. Manifestations
  6906. Diagnostic Evaluation
  6907. Nursing Care
  6908. The Family of the Infant Who Has Died of SIDS
  6909. Assessment
  6910. Nursing Diagnosis and Planning
  6911. Expected Outcome
  6912. Expected Outcome
  6913. Expected Outcome
  6914. Interventions
  6915. Evaluation
  6916. Asthma ExemplarAsthma
  6917. Etiology
  6918. Incidence
  6919. PATHOPHYSIOLOGY: Asthma
  6920. Immediate Reaction (Early-Phase Response)
  6921. Delayed Reaction (Late-Phase Response)
  6922. Manifestations
  6923. Diagnostic Evaluation
  6924. Therapeutic Management
  6925. Acute Asthma Episode
  6926. Long-Term Management
  6927. Environmental Control
  6928. Irritants and Allergens
  6929. Exercise
  6930. Infection
  6931. Emotions
  6932. Monitoring Symptoms
  6933. SAFETY ALERT: Emergency Asthma Management
  6934. BOX 45-3 MONITORING BREATHING CAPACITY WITH A PEAK FLOW METER
  6935. Procedure
  6936. Medications
  6937. Rescue Medications
  6938. Routine Medications
  6939. FIG 45-4 Asthma action plan.
  6940. BOX 45-4 CLASSIFICATION OF ASTHMA SEVERITY
  6941. Intermittent
  6942. Mild Persistent
  6943. Moderate Persistent
  6944. Severe Persistent
  6945. Medication Delivery
  6946. Bronchopulmonary Dysplasia
  6947. Etiology
  6948. Incidence
  6949. PARENTS WANT TO KNOW: Tips on Using a Nebulizer
  6950. The powered nebulizer delivers a bronchodilator to the child who is having an acute asthma episode. This boy has a viral respiratory infection, which is a common trigger of acute asthma episodes in the pediatric population.
  6951. NURSING CARE PLAN: The Child Hospitalized with Asthma
  6952. Focused Assessment
  6953. Nursing Diagnoses
  6954. Planning
  6955. Expected Outcomes
  6956. Interventions and Rationales
  6957. Evaluation
  6958. Nursing Diagnosis
  6959. Planning
  6960. Expected Outcome
  6961. Interventions and Rationales
  6962. Evaluation
  6963. Nursing Diagnosis
  6964. Planning
  6965. Expected Outcomes
  6966. Interventions and Rationales
  6967. Evaluation
  6968. Nursing Diagnosis
  6969. Planning
  6970. Expected Outcomes
  6971. Interventions and Rationales
  6972. Evaluation
  6973. Nursing Diagnosis
  6974. Planning
  6975. Expected Outcomes
  6976. Interventions and Rationales
  6977. Evaluation
  6978. Nursing Diagnosis
  6979. Planning
  6980. Expected Outcomes
  6981. Interventions and Rationales
  6982. Evaluation
  6983. PATHOPHYSIOLOGY: Bronchopulmonary Dysplasia
  6984. Manifestations
  6985. Diagnostic Evaluation
  6986. Therapeutic Management
  6987. Oxygen Therapy
  6988. Medications
  6989. Nutrition
  6990. Prognosis
  6991. Nursing Considerations
  6992. Cystic Fibrosis
  6993. FIG 45-5 Example of a letter that can be used to notify the local public service company that a technology-dependent child is living in the service area.
  6994. PATIENT-CENTERED TEACHING: Safe Use of Oxygen at Home
  6995. Etiology
  6996. Incidence
  6997. FIG 45-6 Digital clubbing may be an indication of hypoxia, which often occurs in cystic fibrosis and other respiratory disorders.
  6998. Manifestations
  6999. Respiratory System
  7000. Digestive System
  7001. PATHOPHYSIOLOGY: Cystic Fibrosis
  7002. Respiratory System
  7003. Digestive System
  7004. Integumentary System
  7005. Reproductive System
  7006. Exocrine Glands
  7007. Reproductive System
  7008. Diagnostic Evaluation
  7009. Therapeutic Management
  7010. Respiratory Problems
  7011. Digestive Problems
  7012. Nursing Care
  7013. The Child with Cystic Fibrosis
  7014. Assessment
  7015. Respiratory Assessment
  7016. Digestive Assessment
  7017. Reproductive Assessment
  7018. Nursing Diagnosis and Planning
  7019. Expected Outcome
  7020. Expected Outcome
  7021. Expected Outcome
  7022. Expected Outcome
  7023. Expected Outcome
  7024. Expected Outcome
  7025. Expected Outcome
  7026. Expected Outcome
  7027. Interventions
  7028. Facilitating Airway Clearance and Gas Exchange
  7029. Preventing Infection
  7030. Providing Optimal Nutrition for Growth
  7031. Promoting Increased Exercise Tolerance
  7032. Meeting the Child’s and Family’s Emotional Needs
  7033. Home Care
  7034. Evaluation
  7035. Tuberculosis
  7036. Etiology
  7037. Incidence
  7038. PATHOPHYSIOLOGY: Tuberculosis
  7039. BOX 45-5 RISK FACTORS FOR THE DEVELOPMENT OF TUBERCULOSIS
  7040. Manifestations
  7041. Diagnostic Evaluation
  7042. Therapeutic Management and Nursing Considerations
  7043. Tuberculosis Infection
  7044. BOX 45-6 DEFINITION OF A POSITIVE MANTOUX SKIN TEST
  7045. Area of Induration ≥5 mm Considered Positive in:
  7046. Area of Induration ≥10 mm Considered Positive in:
  7047. Induration ≥15 mm Considered Positive in:
  7048. Tuberculosis Disease
  7049. Prevention and Screening
  7050. KEY CONCEPTS
  7051. References and Readings
  7052. Pageburst Integrated Resource
  7053. Animation
  7054. Chapter 46 The Child with a Cardiovascular Alteration
  7055. Learning Objectives
  7056. CLINICAL REFERENCE
  7057. Review of the Heart and Circulation
  7058. Normal Cardiac Anatomy and Physiology
  7059. Fetal Circulation
  7060. A, Normal heart cycle, represented as an electrocardiographic configuration. B, Cardiac electrical conduction system.
  7061. Normal pressures (in millimeters of mercury) and saturations (percents).
  7062. Transitional and Neonatal Circulation
  7063. DIFFERENCES IN THE HEART AND CIRCULATION OF NEONATES AND INFANTS
  7064. COMMON DIAGNOSTIC TESTS FOR CARDIAC DISORDERS
  7065. Congenital Heart Disease
  7066. Classification of CHD
  7067. TABLE 46-1 CLASSIFICATION OF CONGENITAL HEART DISEASE
  7068. Shunting: Saturation Considerations
  7069. Blood Flow Considerations
  7070. Physiologic Consequences of CHD in Children
  7071. Heart Failure
  7072. Etiology
  7073. Manifestations
  7074. PATHOPHYSIOLOGY: Heart Failure
  7075. Diagnostic Evaluation
  7076. Therapeutic Management
  7077. NURSING CARE PLAN: The Child with Heart Failure
  7078. Focused Assessment
  7079. Nursing Diagnosis
  7080. Planning
  7081. Expected Outcome
  7082. Interventions and Rationales
  7083. Evaluation
  7084. Nursing Diagnosis
  7085. Planning
  7086. Expected Outcome
  7087. Interventions and Rationales
  7088. Evaluation
  7089. Nursing Diagnosis
  7090. Planning
  7091. Expected Outcomes
  7092. Interventions and Rationales
  7093. Evaluation
  7094. Nursing Diagnosis
  7095. Planning
  7096. Expected Outcome
  7097. Interventions and Rationales
  7098. Evaluation
  7099. Nursing Diagnosis
  7100. Planning
  7101. Expected Outcomes
  7102. Interventions and Rationales
  7103. Evaluation
  7104. EVIDENCE-BASED PRACTICE
  7105. PATIENT-CENTERED TEACHING: Giving Your Child Digoxin Elixir
  7106. NURSING QUALITY ALERT: Feeding the Infant or Child with Heart Failure
  7107. Pulmonary Hypertension
  7108. CRITICAL THINKING EXERCISE 46-1
  7109. Cyanosis
  7110. Hypercyanotic Episode
  7111. Nursing Care
  7112. The Child with Cyanosis
  7113. Assessment
  7114. Nursing Diagnosis and Planning
  7115. Expected Outcomes
  7116. Expected Outcomes
  7117. Expected Outcomes
  7118. Expected Outcomes
  7119. Expected Outcomes
  7120. Expected Outcome
  7121. Interventions
  7122. Evaluation
  7123. Assessment of the Child with a Cardiovascular Alteration
  7124. TABLE 46-2 CARDIAC ASSESSMENT FOR THE CHILD WITH CHD∗
  7125. NURSING QUALITY ALERT: Assessing Murmurs
  7126. Cardiovascular Diagnosis
  7127. Cardiac Catheterization
  7128. Complications
  7129. Nursing Care
  7130. Congenital Cardiac Defects
  7131. The Child Undergoing Cardiac Surgery
  7132. Preoperative Preparation
  7133. Postoperative Management
  7134. TABLE 46-3 CONGENITAL CARDIAC DEFECTS
  7135. FIG 46-1 A, A preoperative visit to the intensive care unit and other units should be directed at an age-appropriate level for the child and the family before the child undergoes cardiac surgery. The experience prepares the family for the sights and sounds of the unit. B, Going home.
  7136. Monitoring Cardiac Output
  7137. Supporting Respiratory Function
  7138. Maintaining Fluid and Electrolyte Balance
  7139. Promoting Comfort
  7140. Promoting Healing and Recovery
  7141. Acquired Heart Disease
  7142. Infective Endocarditis
  7143. Etiology
  7144. PATIENT-CENTERED TEACHING: Care after Heart Surgery
  7145. Activity
  7146. Diet
  7147. Incision
  7148. School
  7149. When to Call the Physician
  7150. Checkup
  7151. Incidence
  7152. PATHOPHYSIOLOGY: Infective Endocarditis
  7153. Manifestations
  7154. Diagnostic Evaluation
  7155. Therapeutic Management
  7156. Nursing Care
  7157. The Child with IE
  7158. Assessment
  7159. Nursing Diagnosis and Planning
  7160. Expected Outcome
  7161. Expected Outcome
  7162. Expected Outcome
  7163. Expected Outcomes
  7164. Interventions
  7165. Evaluation
  7166. Cardiac Dysrhythmias ExemplarDysrhythmias
  7167. Etiology
  7168. Incidence
  7169. PATHOPHYSIOLOGY: Dysrhythmias
  7170. Tachydysrhythmias
  7171. Supraventricular tachycardia.
  7172. Bradydysrhythmias
  7173. Heart block—two or three P waves for every QRS. Cardiac output is based on the rate of the QRS complexes—ventricular contraction.
  7174. Manifestations
  7175. Diagnostic Evaluation
  7176. Therapeutic Management
  7177. Fast Pulse Rate
  7178. Supraventricular Tachycardia
  7179. Ventricular Tachycardia
  7180. Slow Pulse Rate
  7181. Bradydysrhythmias
  7182. Absent Rhythms
  7183. Nursing Care
  7184. The Child with a Dysrhythmia
  7185. Assessment
  7186. SAFETY ALERT: Dysrhythmias
  7187. Nursing Diagnosis and Planning
  7188. Expected Outcome
  7189. Expected Outcome
  7190. Expected Outcomes
  7191. Interventions
  7192. Evaluation
  7193. Rheumatic Fever
  7194. Etiology
  7195. PATHOPHYSIOLOGY: Rheumatic Fever
  7196. Incidence
  7197. Manifestations
  7198. FIG 46-2 Clinical manifestations of rheumatic fever.
  7199. Diagnostic Evaluation
  7200. BOX 46-1 DIAGNOSIS OF ACUTE RHEUMATIC FEVER BY THE JONES CRITERIA—1992 UPDATE
  7201. Major Manifestations
  7202. Minor Manifestations
  7203. Therapeutic Management
  7204. Nursing Care
  7205. The Child with RF
  7206. Assessment
  7207. Nursing Diagnosis and Planning
  7208. Expected Outcome
  7209. Expected Outcomes
  7210. Expected Outcomes
  7211. Expected Outcomes
  7212. Interventions
  7213. NURSING QUALITY ALERT: Streptococcal Prophylaxis for the Child with Rheumatic Fever
  7214. Evaluation
  7215. Kawasaki Disease
  7216. Etiology
  7217. Incidence
  7218. PATHOPHYSIOLOGY: Kawasaki Disease
  7219. Manifestations
  7220. Diagnostic Evaluation
  7221. FIG 46-3 Erythematous rash of Kawasaki disease.
  7222. Therapeutic Management
  7223. Nursing Care
  7224. The Child with Kawasaki Disease
  7225. Assessment
  7226. Nursing Diagnosis and Planning
  7227. Expected Outcome
  7228. Expected Outcomes
  7229. Expected Outcome
  7230. Interventions
  7231. Evaluation
  7232. Hypertension ExemplarHypertension
  7233. Etiology
  7234. Incidence
  7235. PATHOPHYSIOLOGY: Hypertension
  7236. Manifestations
  7237. Diagnostic Evaluation
  7238. Therapeutic Management
  7239. Primary Hypertension
  7240. Weight Reduction
  7241. Physical Conditioning
  7242. Dietary Modification
  7243. Relaxation Techniques
  7244. Pharmacologic Treatment
  7245. Secondary Hypertension
  7246. SAFETY ALERT: Infusing Intravenous Antihypertensive Medications
  7247. Nursing Care
  7248. The Child with Hypertension
  7249. Assessment
  7250. Blood Pressure Screening
  7251. Physical Assessment
  7252. Nursing Diagnosis and Planning
  7253. Expected Outcome
  7254. Expected Outcomes
  7255. Interventions
  7256. Evaluation
  7257. Cardiomyopathies
  7258. High Cholesterol Levels in Children and Adolescents
  7259. Assessment of Children at Risk
  7260. Therapeutic Management
  7261. Nursing Considerations
  7262. KEY CONCEPTS
  7263. References and Readings
  7264. Pageburst Integrated Resource
  7265. Animation
  7266. Chapter 47 The Child with a Hematologic Alteration
  7267. Learning Objectives
  7268. CLINICAL REFERENCE
  7269. Review of the Hematologic System
  7270. TYPES AND FUNCTIONS OF WHITE BLOOD CELLS
  7271. PEDIATRIC HEMATOLOGIC SYSTEM
  7272. Iron Deficiency Anemia
  7273. Etiology and Incidence
  7274. Manifestations
  7275. Diagnostic Evaluation
  7276. PATHOPHYSIOLOGY: Iron Deficiency Anemia
  7277. PARENTS WANT TO KNOW: Home Care of the Child with Iron Deficiency Anemia
  7278. Dietary Changes
  7279. Administration of Iron
  7280. Follow-up Care
  7281. Therapeutic Management
  7282. NURSING CARE PLAN: The Child with Iron Deficiency Anemia in the Community Setting
  7283. Focused Assessment
  7284. Nursing Diagnosis
  7285. Planning
  7286. Expected Outcome
  7287. Interventions and Rationales
  7288. Evaluation
  7289. NURSING QUALITY ALERT: Obtaining a Dietary Intake History
  7290. Sickle Cell Disease
  7291. CRITICAL THINKING EXERCISE 47-1
  7292. PATHOPHYSIOLOGY: Sickle Cell Disease
  7293. Etiology
  7294. Incidence
  7295. Manifestations
  7296. Diagnostic Evaluation
  7297. Therapeutic Management
  7298. TABLE 47-1 CLINICAL MANIFESTATIONS AND THERAPEUTIC MANAGEMENT OF SICKLE CELL DISEASE COMPLICATIONS
  7299. PATIENT-CENTERED TEACHING: Home Care of the Child with Sickle Cell Disease
  7300. NURSING CARE PLAN: The Child with Sickle Cell Disease
  7301. Focused Assessment
  7302. Nursing Diagnosis
  7303. Planning
  7304. Expected Outcomes
  7305. Interventions and Rationales
  7306. Evaluation
  7307. Nursing Diagnosis
  7308. Planning
  7309. Expected Outcome
  7310. Interventions and Rationales
  7311. Evaluation
  7312. Nursing Diagnosis
  7313. Planning
  7314. Expected Outcomes
  7315. Interventions and Rationales
  7316. Evaluation
  7317. Nursing Diagnosis
  7318. Planning
  7319. Expected Outcomes
  7320. Interventions and Rationales
  7321. Evaluation
  7322. EVIDENCE-BASED PRACTICE
  7323. Thalassemia
  7324. Etiology and Incidence
  7325. Manifestations
  7326. BOX 47-1 CHARACTERISTIC FEATURES OF A CHILD WITH BETA-THALASSEMIA
  7327. PATHOPHYSIOLOGY: Beta-Thalassemia
  7328. Diagnostic Evaluation
  7329. Therapeutic Management
  7330. PATIENT-CENTERED TEACHING: Home Chelation Therapy
  7331. Subcutaneous Route by Infusion Pump
  7332. Intravenous Route: Totally Implantable or Tunneled Access Device
  7333. Nursing Care
  7334. The Child with Beta-Thalassemia
  7335. Assessment
  7336. Nursing Diagnosis and Planning
  7337. Expected Outcome
  7338. Expected Outcomes
  7339. Expected Outcomes
  7340. Expected Outcomes
  7341. Interventions
  7342. Evaluation
  7343. Hemophilia ExemplarHemophilia
  7344. Etiology and Incidence
  7345. Manifestations
  7346. PATHOPHYSIOLOGY: Hemophilia
  7347. FIG 47-1 Hemarthrosis and joint destruction are characteristic of hemophilia.
  7348. NURSING CARE PLAN: The Child with Hemophilia
  7349. Focused Assessment
  7350. Nursing Diagnosis
  7351. Planning
  7352. Expected Outcome
  7353. Interventions and Rationales
  7354. Evaluation
  7355. Nursing Diagnosis
  7356. Planning
  7357. Expected Outcomes
  7358. Interventions and Rationales
  7359. Evaluation
  7360. Nursing Diagnosis
  7361. Planning
  7362. Expected Outcomes
  7363. Interventions and Rationales
  7364. Evaluation
  7365. Diagnostic Evaluation
  7366. Therapeutic Management
  7367. SAFETY ALERT: Acetylsalicylic Acid: Contraindication
  7368. NURSING QUALITY ALERT: Interviewing a Child with Hemophilia
  7369. Von Willebrand Disease
  7370. Etiology
  7371. Pathophysiology
  7372. PATIENT-CENTERED TEACHING: Home Care of the Child with Hemophilia
  7373. Control of deficient blood clotting in hemophilia requires injection of the missing clotting factors. This young man is injecting his factor into an implanted central venous access port. Sterile technique is essential.
  7374. Manifestations
  7375. Diagnostic Evaluation
  7376. Therapeutic Management
  7377. Nursing Care
  7378. The Child with Von Willebrand Disease
  7379. Assessment
  7380. Nursing Diagnosis and Planning
  7381. Expected Outcome
  7382. Expected Outcomes
  7383. Interventions
  7384. Evaluation
  7385. Immune Thrombocytopenic Purpura
  7386. Etiology and Incidence
  7387. Pathophysiology
  7388. Manifestations
  7389. Diagnostic Evaluation
  7390. FIG 47-2 Multiple petechiae are characteristic of immune thrombocytopenic purpura. This disorder results in the destruction of circulating platelets and decreased bone marrow production of new platelets.
  7391. Therapeutic Management
  7392. Nursing Care
  7393. The Child with Immune Thrombocytopenic Purpura
  7394. Assessment
  7395. PATIENT-CENTERED TEACHING: Home Care of the Child with Immune Thrombocytopenic Purpura∗
  7396. Nursing Diagnosis and Planning
  7397. Expected Outcome
  7398. Expected Outcomes
  7399. Expected Outcomes
  7400. Interventions
  7401. SAFETY ALERT: Actions to Avoid in Children with Low Platelet Counts
  7402. Evaluation
  7403. Disseminated intravascular coagulation ExemplarDisseminated Intravascular Coagulation
  7404. Etiology
  7405. Manifestations
  7406. Diagnostic Evaluation
  7407. Therapeutic Management
  7408. Nursing Considerations
  7409. PATHOPHYSIOLOGY: Disseminated Intravascular Coagulation
  7410. BOX 47-2 CONFIRMATORY LABORATORY FINDINGS IN DISSEMINATED INTRAVASCULAR COAGULATION
  7411. Aplastic Anemia
  7412. Etiology and Incidence
  7413. Manifestations
  7414. Diagnostic Evaluation
  7415. PATHOPHYSIOLOGY: Aplastic Anemia
  7416. Therapeutic Management
  7417. Nursing Care
  7418. The Child with Aplastic Anemia
  7419. Assessment
  7420. Nursing Diagnosis and Planning
  7421. Expected Outcome
  7422. Expected Outcomes
  7423. Expected Outcome
  7424. Expected Outcomes
  7425. Interventions
  7426. Evaluation
  7427. KEY CONCEPTS
  7428. References and Readings
  7429. Pageburst Integrated Resource
  7430. Animation
  7431. Chapter 48 The Child with Cancer
  7432. Learning Objectives
  7433. Clinical Reference
  7434. Review of Cancer
  7435. CARDINAL SIGNS AND SYMPTOMS OF CANCER IN CHILDREN
  7436. Overt Signs
  7437. Signs and Symptoms That May Be Covert
  7438. DIAGNOSTIC TESTS AND PROCEDURES FOR CANCER
  7439. The Child With Cancer
  7440. Incidence
  7441. Childhood Cancer and Its Treatment
  7442. FIG 48-1 Incidence of Cancers in Children. Rate per million children younger than age 20 years, 2003-2007.
  7443. Therapeutic Management
  7444. Chemotherapy
  7445. BOX 48-1 COMMON SIDE EFFECTS OF CHEMOTHERAPY AND RADIATION THERAPY
  7446. Chemotherapy Side Effects
  7447. Suppression of the bone marrow because of chemotherapy or radiation therapy reduces the blood counts. Low platelet levels lead to spontaneous bruising, as shown. Nosebleeds and bleeding of the gums are other consequences. The nurse must make a special effort to observe for bruising in dark-skinned children because it will be more difficult to see.
  7448. Radiation Side Effects
  7449. Acute (During and Shortly after Irradiation)
  7450. Mucositis (inflammation of the mucous membranes) and mouth ulcers are common side effects of chemotherapeutic drugs. Any mucous membrane can be affected.
  7451. Subacute (1 to 6 Months after Irradiation)
  7452. Late Effects (More Than 6 Months after Irradiation)
  7453. Hair loss is a distressing side effect of cancer treatment. School-age children and adolescents are most likely to feel this distress. Activities such as crafts or playgroups help children feel more normal and provide interaction with others in an accepting environment.
  7454. Surgery
  7455. BOX 48-2 NURSING RESPONSIBILITIES AND PRECAUTIONS FOR CHEMOTHERAPY
  7456. Radiation Therapy
  7457. EVIDENCE-BASED PRACTICE
  7458. Hematopoietic Stem Cell Transplantation
  7459. Steroid Therapy
  7460. Biologic Agents
  7461. Complementary and Alternative Medical (CAM) Therapies
  7462. CRITICAL THINKING EXERCISE 48-1
  7463. Leukemia ExemplarLeukemia
  7464. Etiology
  7465. Incidence
  7466. Manifestations
  7467. Diagnostic Evaluation
  7468. Therapeutic Management
  7469. FIG 48-2 Varicella (chickenpox) can be deadly in the immunocompromised child. Thrombocytopenia (low platelet count) associated with chemotherapy can cause the varicella lesions to be hemorrhagic, like those shown here. Secondary infections of the lesions are also common because of low white blood cell (WBC) counts.
  7470. PARENTS WANT TO KNOW: Caring for the Child with Cancer
  7471. PATHOPHYSIOLOGY: Leukemia
  7472. NURSING CARE PLAN: The Child with Leukemia
  7473. Focused Assessment
  7474. Nursing Diagnosis
  7475. Planning
  7476. Expected Outcomes
  7477. Interventions and Rationales
  7478. Evaluation
  7479. Nursing Diagnosis
  7480. Planning
  7481. Expected Outcomes
  7482. Interventions and Rationales
  7483. Evaluation
  7484. Nursing Diagnosis
  7485. Planning
  7486. Expected Outcomes
  7487. Interventions and Rationales
  7488. Evaluation
  7489. Nursing Diagnosis
  7490. Planning
  7491. Expected Outcomes
  7492. Interventions and Rationales
  7493. Evaluation
  7494. Nursing Diagnosis
  7495. Planning
  7496. Expected Outcome
  7497. Interventions and Rationales
  7498. Evaluation
  7499. Nursing Diagnosis
  7500. Planning
  7501. Expected Outcomes
  7502. Interventions and Rationales
  7503. Evaluation
  7504. Nursing Diagnosis
  7505. Planning
  7506. Expected Outcome
  7507. Interventions and Rationales
  7508. Evaluation
  7509. Nursing Diagnosis
  7510. Planning
  7511. Expected Outcomes
  7512. Interventions and Rationales
  7513. Evaluation
  7514. Nursing Diagnosis
  7515. Planning
  7516. Expected Outcome
  7517. Interventions and Rationales
  7518. Evaluation
  7519. Malignant brain tumor ExemplarBrain Tumors
  7520. Etiology
  7521. Incidence
  7522. Manifestations
  7523. Diagnostic Evaluation
  7524. Therapeutic Management
  7525. FIG 48-3 Lobes of the brain.
  7526. PATHOPHYSIOLOGY: Brain Tumors
  7527. NURSING QUALITY ALERT: Signs of Brain Tumor in Children
  7528. Nursing Care
  7529. The Child with a Brain Tumor
  7530. Assessment
  7531. Nursing Diagnosis and Planning
  7532. Expected Outcome
  7533. Expected Outcomes
  7534. Expected Outcomes
  7535. Expected Outcomes
  7536. Expected Outcome
  7537. Interventions
  7538. BOX 48-3 POTENTIAL FUNCTIONAL DEFICITS RELATED TO A BRAIN TUMOR
  7539. Evaluation
  7540. Malignant Lymphomas
  7541. Non-Hodgkin Lymphoma
  7542. Etiology
  7543. Manifestations
  7544. Diagnostic Evaluation
  7545. Therapeutic Management
  7546. NURSING QUALITY ALERT: Tumor Lysis Syndrome
  7547. Nursing Care
  7548. The Child with Non-Hodgkin Lymphoma
  7549. Assessment
  7550. Nursing Diagnosis and Planning
  7551. Expected Outcome
  7552. Expected Outcome
  7553. Expected Outcome
  7554. Expected Outcomes
  7555. Interventions
  7556. Evaluation
  7557. Hodgkin lymphoma ExemplarHodgkin Disease
  7558. Etiology
  7559. SAFETY ALERT: Prevention of Urinary Tract Infection in the Immunocompromised Child
  7560. Manifestations
  7561. Diagnostic Evaluation
  7562. PATHOPHYSIOLOGY: Hodgkin Disease
  7563. Therapeutic Management
  7564. Nursing Considerations
  7565. Neuroblastoma
  7566. Etiology
  7567. Incidence
  7568. Pathophysiology
  7569. Manifestations
  7570. Diagnostic Evaluation
  7571. Therapeutic Management
  7572. Nursing Care
  7573. The Child with Neuroblastoma
  7574. Assessment
  7575. Nursing Diagnosis and Planning
  7576. Expected Outcome
  7577. Expected Outcome
  7578. Expected Outcomes
  7579. Interventions
  7580. Evaluation
  7581. Osteosarcoma
  7582. Etiology
  7583. Incidence
  7584. Pathophysiology
  7585. Manifestations
  7586. Diagnostic Evaluation
  7587. Therapeutic Management
  7588. Nursing Care
  7589. The Child with Osteosarcoma
  7590. Assessment
  7591. Nursing Diagnosis and Planning
  7592. Expected Outcome
  7593. Expected Outcomes
  7594. Expected Outcome
  7595. Expected Outcome
  7596. Expected Outcome
  7597. Expected Outcomes
  7598. Interventions
  7599. Evaluation
  7600. Ewing Sarcoma
  7601. Etiology
  7602. Incidence
  7603. Pathophysiology
  7604. Manifestations
  7605. Diagnostic Evaluation
  7606. Therapeutic Management
  7607. Nursing Considerations
  7608. Rhabdomyosarcoma
  7609. Etiology
  7610. Incidence
  7611. Pathophysiology
  7612. Manifestations
  7613. Diagnostic Evaluation
  7614. Therapeutic Management
  7615. Nursing Considerations
  7616. Wilms Tumor
  7617. Etiology
  7618. Incidence
  7619. Pathophysiology
  7620. Manifestations
  7621. Diagnostic Evaluation
  7622. Therapeutic Management
  7623. NURSING QUALITY ALERT: Assessing the Child with a Wilms Tumor
  7624. Nursing Care
  7625. The Child with Wilms Tumor
  7626. Assessment
  7627. Nursing Diagnosis and Planning
  7628. Expected Outcomes
  7629. Expected Outcome
  7630. Expected Outcomes
  7631. Expected Outcome
  7632. Interventions
  7633. Evaluation
  7634. Retinoblastoma
  7635. Etiology
  7636. Incidence
  7637. Pathophysiology
  7638. Manifestations
  7639. Diagnostic Evaluation
  7640. Therapeutic Management
  7641. Nursing Care
  7642. The Child with Retinoblastoma
  7643. Assessment
  7644. Nursing Diagnosis and Planning
  7645. Expected Outcomes
  7646. Expected Outcome
  7647. Expected Outcomes
  7648. Interventions
  7649. Evaluation
  7650. Rare Tumors of Childhood
  7651. KEY CONCEPTS
  7652. References and Readings
  7653. Chapter 49 The Child with an Alteration in Tissue Integrity
  7654. Learning Objectives
  7655. Clinical Reference
  7656. Review of the Integumentary System
  7657. PEDIATRIC DIFFERENCES IN THE SKIN
  7658. Variations in the Skin of Newborn Infants
  7659. Common Birthmarks
  7660. Etiology
  7661. Incidence
  7662. Manifestations
  7663. Diagnostic Evaluation
  7664. Therapeutic Management
  7665. Nursing Considerations
  7666. PARENTS WANT TO KNOW: Care of Newborn and Infant Skin
  7667. Skin Inflammation
  7668. Seborrheic Dermatitis
  7669. FIG 49-1 “Cradle cap,” the most frequent form of seborrheic dermatitis in infants. The condition often begins in the first 2 to 3 weeks of life and usually disappears by age 12 months.
  7670. Contact Dermatitis
  7671. Etiology
  7672. FIG 49-2 Seborrheic diaper dermatitis.
  7673. PATHOPHYSIOLOGY: Contact Dermatitis
  7674. Incidence
  7675. Manifestations
  7676. FIG 49-3 Contact diaper dermatitis.
  7677. Diagnostic Evaluation
  7678. Therapeutic Management
  7679. Nursing Care
  7680. The Child with Contact Dermatitis
  7681. Assessment
  7682. Nursing Diagnosis and Planning
  7683. Expected Outcomes
  7684. Expected Outcome
  7685. Expected Outcomes
  7686. Interventions
  7687. Evaluation
  7688. Atopic Dermatitis
  7689. Etiology
  7690. Incidence
  7691. Manifestations
  7692. FIG 49-4 Atopic dermatitis, an allergic skin condition, usually begins in infancy and clears by age 2 to 3 years. However, it can continue into childhood. A, Lesions on cheeks often spread to the forehead, scalp, and extensor surfaces of arms and legs. B, Flexor surfaces of wrists, ankles, knees, and elbows may be affected in the childhood form of the disease.
  7693. PATHOPHYSIOLOGY: Atopic Dermatitis
  7694. Diagnostic Evaluation
  7695. Therapeutic Management
  7696. Nursing Care
  7697. The Child with Atopic Dermatitis
  7698. Assessment
  7699. Nursing Diagnosis and Planning
  7700. DRUG GUIDE: Topical Corticosteroids
  7701. Expected Outcome
  7702. Expected Outcomes
  7703. Expected Outcome
  7704. Expected Outcomes
  7705. Expected Outcome
  7706. Expected Outcomes
  7707. Interventions
  7708. Evaluation
  7709. Skin Infections
  7710. Impetigo
  7711. Etiology
  7712. PATHOPHYSIOLOGY: Impetigo
  7713. Incidence
  7714. Manifestations
  7715. FIG 49-5 Impetigo lesions are usually located around the mouth and nose but may be located on the extremities.
  7716. Diagnostic Evaluation
  7717. Therapeutic Management
  7718. Nursing Care
  7719. The Child with Impetigo
  7720. Assessment
  7721. Nursing Diagnosis and Planning
  7722. Expected Outcomes
  7723. Expected Outcomes
  7724. Interventions
  7725. Evaluation
  7726. SAFETY ALERT: Caring for a Child with Impetigo
  7727. Cellulitis ExemplarCellulitis
  7728. Etiology and Incidence
  7729. Pathophysiology
  7730. Manifestations
  7731. Diagnostic Evaluation
  7732. Therapeutic Management
  7733. Nursing Care
  7734. The Child with Cellulitis
  7735. Assessment
  7736. Nursing Diagnosis and Planning
  7737. Expected Outcome
  7738. Expected Outcome
  7739. Expected Outcome
  7740. Interventions
  7741. Evaluation
  7742. Candidiasis
  7743. FIG 49-6 White, curdlike plaques of thrush (oral candidiasis, oral moniliasis), a common fungal infection in infants.
  7744. Etiology
  7745. Incidence
  7746. Manifestations
  7747. Diagnostic Evaluation
  7748. Therapeutic Management
  7749. FIG 49-7 Diaper candidiasis.
  7750. Nursing Care
  7751. The Child with Candidiasis
  7752. Assessment
  7753. Nursing Diagnosis and Planning
  7754. Expected Outcome
  7755. Expected Outcome
  7756. Expected Outcomes
  7757. Expected Outcomes
  7758. Interventions
  7759. FIG 49-8 Tinea (ringworm) is an infection caused by dermatophytes, a group of fungi. Tinea is classified according to the part of the body affected. Five common types of tinea are shown here. Tinea capitis (scalp); Tinea corporis (trunk, face, extremities); Tinea cruris (groin, buttocks, scrotum); Tinea pedis (feet); Tinea unguium (nails, nail beds).
  7760. Evaluation
  7761. Tinea Infection
  7762. Etiology
  7763. PATHOPHYSIOLOGY: Tinea Infection
  7764. Incidence
  7765. Manifestations
  7766. Diagnostic Evaluation
  7767. Therapeutic Management
  7768. Tinea Capitis
  7769. Tinea Corporis
  7770. Tinea Cruris
  7771. Tinea Pedis
  7772. Nursing Care
  7773. The Child with a Tinea Infection
  7774. Assessment
  7775. Nursing Diagnosis and Planning
  7776. Expected Outcomes
  7777. Expected Outcomes
  7778. Expected Outcomes
  7779. Expected Outcome
  7780. Interventions
  7781. Evaluation
  7782. Herpes Simplex Virus Infection
  7783. PATIENT-CENTERED TEACHING: Home Care for a Child or Adolescent with a Tinea Infection
  7784. Etiology
  7785. Incidence
  7786. PATHOPHYSIOLOGY: Herpes Simplex Type 1 Infection
  7787. Manifestations
  7788. Herpes Labialis (“Cold Sore,” “Fever Blister”)
  7789. FIG 49-9 Herpes simplex infection in an infant.
  7790. Herpetic Gingivostomatitis
  7791. Herpetic Ocular Infection
  7792. Herpetic Whitlow
  7793. Diagnostic Evaluation
  7794. Therapeutic Management
  7795. Nursing Care
  7796. The Child with a Herpes Simplex Infection
  7797. Assessment
  7798. Nursing Diagnoses and Planning
  7799. Expected Outcomes
  7800. Expected Outcome
  7801. Expected Outcome
  7802. Expected Outcomes
  7803. Interventions
  7804. Evaluation
  7805. Skin Infestations
  7806. Lice Infestation
  7807. Etiology
  7808. Incidence
  7809. PATHOPHYSIOLOGY: Pediculosis
  7810. Manifestations
  7811. Pediculosis Capitis (Head Lice)
  7812. FIG 49-10 Head lice (pediculosis capitis). Note the nits attached to the hair shafts.
  7813. Pediculosis Corporis (Body Lice)
  7814. Pediculosis Pubis (Pubic Lice, Crab Lice)
  7815. Diagnostic Evaluation
  7816. Therapeutic Management
  7817. Killing Active Lice and Nits
  7818. Addressing the Environment
  7819. Nursing Care
  7820. The Child with Pediculosis
  7821. Assessment
  7822. Nursing Diagnosis and Planning
  7823. Expected Outcomes
  7824. Expected Outcome
  7825. Expected Outcomes
  7826. Expected Outcomes
  7827. Interventions
  7828. Evaluation
  7829. CRITICAL THINKING EXERCISE 49-1
  7830. EVIDENCE-BASED PRACTICE
  7831. Mite Infestation (Scabies)
  7832. Etiology
  7833. Incidence
  7834. Pathophysiology
  7835. Manifestations
  7836. Diagnostic Evaluation
  7837. FIG 49-11 Scabies lesions on an infant.
  7838. Therapeutic Management
  7839. Nursing Considerations
  7840. Acne Vulgaris
  7841. Etiology
  7842. Incidence
  7843. PATHOPHYSIOLOGY: Acne Vulgaris
  7844. Manifestations and Diagnostic Evaluation
  7845. Therapeutic Management
  7846. FIG 49-12 An adolescent with acne vulgaris.
  7847. Nursing Care
  7848. The Adolescent with Acne Vulgaris
  7849. Assessment
  7850. Nursing Diagnosis and Planning
  7851. Expected Outcome
  7852. Expected Outcome
  7853. Expected Outcomes
  7854. Expected Outcome
  7855. Interventions
  7856. Evaluation
  7857. Miscellaneous Skin Disorders
  7858. TABLE 49-1 SKIN DISORDERS
  7859. Insect Bites or Stings
  7860. Burns ExemplarBurn Injuries
  7861. TABLE 49-2 SKIN LESIONS CAUSED BY INSECTS AND ARACHNIDS
  7862. Etiology
  7863. TABLE 49-3 AGE-RELATED RISKS FOR BURN INJURY
  7864. BOX 49-1 PEDIATRIC DIFFERENCES IN THE EFFECTS OF BURN INJURY
  7865. Incidence
  7866. FIG 49-13 These burns were sustained when the child’s pajamas caught fire while he was playing with matches.
  7867. FIG 49-14 These burns were sustained when the child sucked on an electrical socket.
  7868. Pathophysiology
  7869. PATIENT-CENTERED TEACHING: Measures to Prevent and Initially Manage a Burn
  7870. Prevention
  7871. Initial Emergency Burn Management
  7872. BOX 49-2 BURN CENTER REFERRAL CRITERIA
  7873. Depth of Burn Injury
  7874. Extent of Burn Injury
  7875. Severity of Burn Injury
  7876. FIG 49-15 Calculating total body surface area (TBSA) burned in children. The standard “rule of nines” and standard body surface charts must be adapted because of the difference in body proportions between adults and children.
  7877. TABLE 49-4 DEPTH OF BURN INJURY
  7878. Manifestations
  7879. Therapeutic Management
  7880. Superficial Burn Injuries
  7881. TABLE 49-5 CLASSIFICATION OF SEVERITY OF BURN INJURY IN CHILDREN
  7882. Superficial Partial-Thickness Burn Injuries
  7883. Wound Cleaning
  7884. Débridement
  7885. Application of Antimicrobial Agents and Dressings
  7886. FIG 49-16 Burn dressings can be changed in the hydrotherapy room. The room is kept warm because children who have been burned have poor body temperature control. The child life therapist reads a book to the child to distract her from the discomfort associated with the procedure.
  7887. TABLE 49-6 TOPICAL ANTIMICROBIAL AGENTS COMMONLY USED FOR BURNS
  7888. PATIENT-CENTERED TEACHING: Home Care for a Child with Burns
  7889. Parents will need to know the following to adequately care for the child:
  7890. Teach the parents the following:
  7891. NURSING CARE PLAN: The Child with a Minor Partial-Thickness Burn
  7892. Focused Assessment
  7893. Nursing Diagnosis
  7894. Planning
  7895. Expected Outcome
  7896. Interventions and Rationales
  7897. Evaluation
  7898. Nursing Diagnosis
  7899. Planning
  7900. Expected Outcome
  7901. Interventions and Rationales
  7902. Evaluation
  7903. Nursing Diagnosis
  7904. Planning
  7905. Expected Outcomes
  7906. Interventions and Rationales
  7907. Evaluation
  7908. Nursing Diagnosis
  7909. Planning
  7910. Expected Outcome
  7911. Interventions and Rationales
  7912. Evaluation
  7913. Nursing Diagnosis
  7914. Planning
  7915. Expected Outcomes
  7916. Interventions and Rationales
  7917. Evaluation
  7918. Conditions Associated with Major Burn Injuries
  7919. Conditions Associated with Electrical Injury
  7920. Cardiac Arrest or Dysrhythmia
  7921. Tissue Damage
  7922. Myoglobinuria
  7923. Metabolic Acidosis
  7924. TABLE 49-7 BODY SYSTEM ALTERATIONS AFTER MODERATE TO SEVERE BURNS
  7925. Other Complications
  7926. Key Concepts
  7927. References and Readings
  7928. Pageburst Integrated Resource
  7929. Animation
  7930. Chapter 50 The Child with a Musculoskeletal Alteration
  7931. Learning Objectives
  7932. Clinical Reference
  7933. Review of the Musculoskeletal System
  7934. Skeletal System
  7935. Child with hand differences.
  7936. Articular System
  7937. Muscular System
  7938. Cartilage
  7939. PEDIATRIC DIFFERENCES IN THE MUSCULOSKELETAL SYSTEM
  7940. Growth and Development
  7941. Diagnostic and Laboratory Tests
  7942. COMMON DIAGNOSTIC PROCEDURES FOR MUSCULOSKELETAL DISORDERS IN CHILDREN
  7943. Casts, Traction, and Other Immobilizing Devices
  7944. Splints
  7945. Casts
  7946. Traction
  7947. FIG 50-1 Child in a synthetic cast.
  7948. BOX 50-1 TYPES OF SKIN TRACTION
  7949. Buck
  7950. Bryant
  7951. Skin Traction
  7952. BOX 50-2 TYPES OF SKELETAL TRACTION
  7953. Halo
  7954. 90/90 Femoral
  7955. Skeletal Traction
  7956. External Fixation Devices
  7957. FIG 50-2 Skeletal traction is used to reduce and immobilize fractures and allows greater pull than would be possible with skin traction. Osteomyelitis may be a serious complication because skeletal traction is invasive.
  7958. SAFETY ALERT: The Child in a Cast or Traction
  7959. Nursing Considerations
  7960. Neurovascular Status
  7961. FIG 50-3 Ilizarov external fixator.
  7962. Special Considerations for the Child in Halo Traction
  7963. TABLE 50-1 NEUROLOGIC ASSESSMENT FOR PATIENTS REQUIRING HALO TRACTION
  7964. Assessing and Managing Compartment Syndrome
  7965. Immobility
  7966. Special Considerations for the Child in Traction
  7967. Home Care
  7968. TABLE 50-2 CONSEQUENCES OF IMMOBILITY
  7969. Fracture ExemplarFractures
  7970. Etiology
  7971. FIG 50-4 Upper extremity fractures in children often occur when the child attempts to break a fall with an outstretched arm.
  7972. PARENTS WANT TO KNOW: Home Care for the Child in a Cast
  7973. Check the Edges of the Cast as Follows:
  7974. To Assist with Drying the Cast, Do the Following:
  7975. Swelling Generally Peaks within 24 to 48 Hours. To Prevent Problems, Do the Following:
  7976. Protect the Cast as Follows:
  7977. Contact the Physician If Any of the Following Occurs:
  7978. When Preparing to Remove the Cast, Do the Following:
  7979. Incidence
  7980. Manifestations
  7981. Therapeutic Management
  7982. Reduction Methods
  7983. Retention
  7984. PATHOPHYSIOLOGY: Fractures and Physeal Growth Plate Injuries
  7985. Nursing Considerations
  7986. Initial Trauma Assessment
  7987. Assessing and Managing Complications
  7988. TABLE 50-3 SPORT-SPECIFIC INJURY RISK
  7989. Soft Tissue Injuries: Sprains, Strains, and Contusions
  7990. Etiology
  7991. Incidence
  7992. Manifestations and Diagnostic Evaluation
  7993. Therapeutic Management
  7994. Nursing Considerations
  7995. NURSING QUALITY ALERT: The Child with a Soft Tissue Injury
  7996. Osteomyelitis
  7997. Etiology
  7998. Incidence
  7999. PATHOPHYSIOLOGY: Osteomyelitis
  8000. Manifestations
  8001. Diagnostic Evaluation
  8002. Therapeutic Management
  8003. Nursing Care
  8004. The Child with Osteomyelitis
  8005. Assessment
  8006. Nursing Diagnosis and Planning
  8007. Expected Outcome
  8008. Expected Outcomes
  8009. Expected Outcomes
  8010. Expected Outcomes
  8011. Interventions
  8012. Administering IV Antibiotics
  8013. Providing Wound Care
  8014. Maintaining Nutritional Status
  8015. Teaching Home Management
  8016. Promoting Optimal Development
  8017. Evaluation
  8018. Scoliosis
  8019. TABLE 50-4 CLASSIFICATIONS OF SCOLIOSIS
  8020. Adolescent Idiopathic Scoliosis
  8021. Prevalence and Etiology
  8022. Manifestations
  8023. Diagnostic Evaluation
  8024. School Screening
  8025. FIG 50-5 Most spinal abnormalities in children are abnormal curvatures. In scoliosis, the spine curves laterally and the vertebrae rotate, pulling the ribs along. Kyphosis is a front-to-back rounding, usually of the thoracic spine; it is often accompanied by scoliosis. Lordosis is an exaggerated concave curvature of the spine, usually in the lumbar area.
  8026. Physical Examination
  8027. Radiographs
  8028. FIG 50-6 Plain radiographs of scoliosis before (A, B) and after spinal fusion (C, D).
  8029. Treatment
  8030. Nonsurgical Interventions
  8031. Surgical Intervention
  8032. FIG 50-7 Adolescent with scoliosis brace.
  8033. Surgical Complications
  8034. Postoperative Management
  8035. Follow-Up Care
  8036. Kyphosis
  8037. Scheuermann’s Kyphosis
  8038. NURSING CARE PLAN: The Adolescent Undergoing a Spinal Fusion
  8039. Focused Assessment
  8040. Preoperative Assessment
  8041. Postoperative Assessment
  8042. Nursing Diagnosis
  8043. Planning
  8044. Expected Outcome
  8045. Interventions and Rationales
  8046. Evaluation
  8047. Nursing Diagnosis
  8048. Planning
  8049. Expected Outcomes
  8050. Interventions and Rationales
  8051. Evaluation
  8052. Nursing Diagnosis
  8053. Planning
  8054. Expected Outcome
  8055. Interventions and Rationales
  8056. Evaluation
  8057. Other Causes of Hyperkyphosis
  8058. Limb Differences
  8059. Etiology and Incidence
  8060. Diagnostic Evaluation
  8061. Therapeutic Management
  8062. Nursing Considerations
  8063. Developmental Dysplasia of the Hip
  8064. Etiology and Incidence
  8065. TABLE 50-5 LIMB DIFFERENCES
  8066. Manifestations
  8067. FIG 50-8 Genu varum (bowlegs). In the child with genu varum, or bowlegs, a persistent space is present between the knees when the ankles are together. Genu varum is a normal finding for 1 year after the child begins walking.
  8068. FIG 50-9 Genu valgum (knock knees). In the child with genu valgum, or knock knees, a space is present between the ankles when the knees are together. To remember the terminology, liken the r’s and g’s: genu var um—knees apar t; genu valg um—knees tog ether.
  8069. Diagnostic Evaluation
  8070. Therapeutic Management
  8071. PATHOPHYSIOLOGY: Developmental Dysplasia of the Hip
  8072. Nursing Care
  8073. The Child with Developmental Dysplasia of the Hip
  8074. Assessment
  8075. FIG 50-10 An infant in a Pavlik harness to treat developmental dysplasia of the hip.
  8076. Nursing Diagnosis and Planning
  8077. Expected Outcomes
  8078. Expected Outcome
  8079. Expected Outcomes
  8080. Expected Outcome
  8081. Expected Outcomes
  8082. Interventions
  8083. Teaching about the Pavlik Harness
  8084. Teaching about Spica Cast Care
  8085. FIG 50-11 Regular assessment of circulation, sensation, and movement in the lower extremities is essential when a child has a hip spica cast.
  8086. Alleviating Anxiety
  8087. Preventing Injury
  8088. FIG 50-12 Use a car seat that can accommodate the wide leg spread caused by the spica cast or a car vest restraint for older children.
  8089. Evaluation
  8090. Legg-Calvé-Perthes Disease
  8091. Etiology and Incidence
  8092. PATHOPHYSIOLOGY: Legg-Calvé-Perthes Disease
  8093. Manifestations
  8094. Diagnostic Evaluation
  8095. Therapeutic Management
  8096. Nursing Care
  8097. The Child with Legg-Calvé-Perthes Disease
  8098. Assessment
  8099. Nursing Diagnosis and Planning
  8100. Expected Outcomes
  8101. Expected Outcomes
  8102. Interventions
  8103. Facilitating Appropriate Activity
  8104. Teaching Home Management
  8105. Evaluation
  8106. Slipped Capital Femoral Epiphysis
  8107. Etiology and Incidence
  8108. Pathophysiology
  8109. Manifestations and Diagnostic Evaluation
  8110. Therapeutic Management and Nursing Considerations
  8111. CRITICAL THINKING EXERCISE 50-1
  8112. Clubfoot
  8113. Etiology and Incidence
  8114. FIG 50-13 An infant with left clubfoot. Note the positional difference between the two feet.
  8115. Manifestations and Diagnostic Evaluation
  8116. Therapeutic Management
  8117. Ponseti Casting Method
  8118. Clubfoot Recurrence
  8119. Nursing Considerations
  8120. Education and Anticipatory Guidance
  8121. Reduction of Discomfort and Pain
  8122. Patient Advocacy
  8123. Muscular Dystrophies
  8124. Etiology
  8125. Incidence
  8126. Pathophysiology
  8127. Manifestations
  8128. Diagnostic Evaluation
  8129. Therapeutic Management
  8130. TABLE 50-6 MUSCULAR DYSTROPHIES OF CHILDHOOD
  8131. Nursing Considerations
  8132. TABLE 50-7 MAJOR TYPES OF JUVENILE IDIOPATHIC ARTHRITIS
  8133. Rheumatoid arthritis ExemplarJuvenile Idiopathic Arthritis
  8134. Etiology
  8135. Incidence
  8136. PATHOPHYSIOLOGY: Juvenile Idiopathic Arthritis
  8137. Manifestations
  8138. Diagnostic Evaluation
  8139. Therapeutic Management
  8140. Drug Therapy
  8141. DRUG GUIDE: Naproxen, Naproxen Sodium
  8142. Physical and Occupational Therapy
  8143. Surgical Treatment
  8144. Nursing Care
  8145. The Child with JIA
  8146. Assessment
  8147. Nursing Diagnosis and Planning
  8148. Expected Outcome
  8149. Expected Outcomes
  8150. Expected Outcomes
  8151. Expected Outcomes
  8152. Expected Outcome
  8153. Interventions
  8154. Managing Pain
  8155. Promoting Mobility
  8156. Managing Potential Infections
  8157. Facilitating Emotional and Social Development
  8158. Family Education
  8159. Evaluation
  8160. Syndromes and Conditions with Associated Orthopedic Anomalies
  8161. TABLE 50-8 SYNDROMES AND CONDITIONS WITH ASSOCIATED ORTHOPEDIC ANOMALIES
  8162. Key Concepts
  8163. References and Readings
  8164. Pageburst Integrated Resource
  8165. Animation
  8166. Chapter 51 The Child with an Endocrine or Metabolic Alteration
  8167. Learning Objectives
  8168. Clinical Reference
  8169. Review of the Endocrine System
  8170. PEDIATRIC DIFFERENCES IN THE ENDOCRINE SYSTEM
  8171. Diagnostic Tests and Procedures
  8172. COMMON LABORATORY AND DIAGNOSTIC TESTS OF ENDOCRINE FUNCTION
  8173. Phenylketonuria
  8174. Etiology
  8175. Incidence
  8176. Manifestations
  8177. Diagnostic Evaluation
  8178. PATHOPHYSIOLOGY: Phenylketonuria
  8179. Therapeutic Management
  8180. Nursing Considerations
  8181. Inborn Errors of Metabolism
  8182. Congenital Adrenal Hyperplasia
  8183. Etiology
  8184. Manifestations
  8185. TABLE 51-1 INBORN ERRORS OF METABOLISM
  8186. Diagnostic Evaluation
  8187. Therapeutic Management
  8188. Nursing Considerations
  8189. SAFETY ALERT: Congenital Adrenal Hyperplasia
  8190. Congenital Hypothyroidism
  8191. Etiology
  8192. PATHOPHYSIOLOGY: Congenital Hypothyroidism
  8193. Incidence
  8194. Manifestations
  8195. Diagnostic Evaluation
  8196. FIG 51-1 A, This untreated 6-month-old infant with congenital hypothyroidism fed poorly and was constipated. She was lethargic and had no social smile or head control. Note her puffy face, large tongue, dull expression, and excessive hair growth (hirsutism) on the forehead. B, The same infant 4 months after treatment. Note the decreased facial puffiness, decreased forehead hirsutism, and an alert appearance.
  8197. Therapeutic Management
  8198. Nursing Care
  8199. The Infant with Congenital Hypothyroidism
  8200. Assessment
  8201. Nursing Diagnosis and Planning
  8202. Expected Outcomes
  8203. Expected Outcomes
  8204. Expected Outcome
  8205. Interventions
  8206. NURSING QUALITY ALERT: The Child with Congenital Hypothyroidism
  8207. Evaluation
  8208. Acquired Hypothyroidism
  8209. Etiology
  8210. Pathophysiology
  8211. Manifestations
  8212. Diagnostic Evaluation
  8213. BOX 51-1 INDICATORS OF HYPOTHYROIDISM OR HYPERTHYROIDISM
  8214. Therapeutic Management
  8215. Nursing Care
  8216. The Child with Acquired Hypothyroidism
  8217. Assessment
  8218. Nursing Diagnosis and Planning
  8219. Expected Outcome
  8220. Expected Outcome
  8221. Expected Outcomes
  8222. Expected Outcome
  8223. Interventions
  8224. Evaluation
  8225. Hyperthyroidism (Graves Disease)
  8226. Incidence
  8227. Pathophysiology
  8228. Manifestations
  8229. NURSING QUALITY ALERT: Autoimmune Thyroid Disorders
  8230. Diagnostic Evaluation
  8231. Therapeutic Management
  8232. Nursing Care
  8233. The Child with Hyperthyroidism
  8234. Assessment
  8235. Nursing Diagnosis and Planning
  8236. Expected Outcome
  8237. Expected Outcomes
  8238. Expected Outcome
  8239. Expected Outcome
  8240. Expected Outcome
  8241. Interventions
  8242. Evaluation
  8243. Diabetes Insipidus
  8244. Etiology
  8245. Incidence
  8246. Manifestations
  8247. Diagnostic Evaluation
  8248. BOX 51-2 INDICATORS OF DIABETES INSIPIDUS OR SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH)
  8249. Therapeutic Management
  8250. NURSING QUALITY ALERT: Diabetes Insipidus
  8251. Nursing Considerations
  8252. PATHOPHYSIOLOGY: Diabetes Insipidus
  8253. Syndrome of Inappropriate Antidiuretic Hormone
  8254. Etiology
  8255. Manifestations
  8256. PATHOPHYSIOLOGY: Syndrome of Inappropriate Antidiuretic Hormone
  8257. Diagnostic Evaluation
  8258. Therapeutic Management
  8259. Nursing Considerations
  8260. NURSING QUALITY ALERT: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
  8261. BOX 51-3 SIGNS OF HYPONATREMIA
  8262. Precocious Puberty
  8263. Etiology
  8264. Incidence
  8265. Manifestations
  8266. Diagnostic Evaluation
  8267. Therapeutic Management
  8268. Nursing Care
  8269. The Child with Precocious Puberty
  8270. Assessment
  8271. PATHOPHYSIOLOGY: Precocious Puberty
  8272. Nursing Diagnosis and Planning
  8273. Expected Outcomes
  8274. Expected Outcomes
  8275. Expected Outcome
  8276. NURSING QUALITY ALERT: Precocious Puberty
  8277. Interventions
  8278. Evaluation
  8279. Growth Hormone Deficiency
  8280. Etiology
  8281. Incidence
  8282. Manifestations
  8283. PATHOPHYSIOLOGY: Growth Hormone Deficiency
  8284. Diagnostic Evaluation
  8285. Therapeutic Management
  8286. Nursing Care
  8287. The Child with Growth Hormone Deficiency
  8288. Assessment
  8289. Nursing Diagnosis and Planning
  8290. Expected Outcomes
  8291. Expected Outcome
  8292. Expected Outcome
  8293. Expected Outcomes
  8294. NURSING QUALITY ALERT: Criteria for Suspecting Growth Hormone Deficiency
  8295. Interventions
  8296. Evaluation
  8297. CRITICAL THINKING EXERCISE 51-1
  8298. Diabetes, Type 1 ExemplarDiabetes Mellitus
  8299. Type 1 Diabetes Mellitus
  8300. Etiology
  8301. Incidence
  8302. Manifestations
  8303. Diagnostic Evaluation
  8304. TABLE 51-2 ACTIONS OF INSULIN
  8305. TABLE 51-3 COMPARISON OF HYPOGLYCEMIA, HYPERGLYCEMIA, AND KETOACIDOSIS
  8306. Therapeutic Management
  8307. Insulin Therapy
  8308. PATHOPHYSIOLOGY: Type 1 Diabetes Mellitus
  8309. TABLE 51-4 INSULIN ACTION BY TYPE
  8310. Schedule
  8311. FIG 51-2 Peak action of insulin injections is timed to correspond with the child’s usual meal and snack times to minimize the chance of hypoglycemia. L/A, Lispro/Aspart (rapid-acting insulin).
  8312. Administration
  8313. FIG 51-3 Subcutaneous insulin injection sites most commonly used. Rate of absorption varies by site.
  8314. Nutrition Therapy
  8315. Physical Activity
  8316. NURSING QUALITY ALERT: Managing the Child with Type 1 Diabetes Mellitus
  8317. Insulin
  8318. Nutrition
  8319. Exercise
  8320. Blood Glucose Monitoring
  8321. Blood Glucose Monitoring
  8322. Developmental Issues
  8323. Infant and Toddler
  8324. Preschooler
  8325. School-Age Child
  8326. Adolescent
  8327. TABLE 51-5 EXAMPLES OF DIABETES MANAGEMENT TASKS DELEGATED TO CHILD (WITH SUPERVISION)
  8328. NURSING CARE PLAN: The Child with Type 1 Diabetes Mellitus in the Community Setting
  8329. Focused Assessment
  8330. Nursing Diagnosis
  8331. Planning
  8332. Expected Outcome
  8333. Interventions and Rationales
  8334. Evaluation
  8335. Nursing Diagnosis
  8336. Planning
  8337. Expected Outcomes
  8338. Interventions and Rationales
  8339. Evaluation
  8340. Nursing Diagnosis
  8341. Planning
  8342. Expected Outcomes
  8343. Interventions and Rationales
  8344. Evaluation
  8345. Nursing Diagnosis
  8346. Planning
  8347. Expected Outcomes
  8348. Interventions and Rationales
  8349. Evaluation
  8350. Delegating Diabetes Management Responsibilities
  8351. Diabetic ketoacidosis ExemplarDiabetic Ketoacidosis
  8352. Etiology
  8353. Manifestations
  8354. PATIENT-CENTERED TEACHING: Home Management of Type 1 Diabetes Mellitus
  8355. Outcomes
  8356. General Information
  8357. Medication Therapy
  8358. The school-age child is usually able to perform daily self-monitoring of blood glucose with parental help. However, the child should not be expected to adjust the insulin dose based on the reading. By early adolescence, the child can be in charge of recording blood glucose values in the diary.
  8359. Home Glucose Monitoring
  8360. Hypoglycemia
  8361. When other parts of the treatment regimen have become familiar, the injection technique can be taught. Initially, self-injecting insulin may be frightening for the school-age child, so the parent may insert the needle and have the child then push the plunger. The child can then progress to performing self-injection.
  8362. Hyperglycemia
  8363. Nutrition/Exercise
  8364. Complications
  8365. Psychological Adjustment and Family Involvement
  8366. Community Resources
  8367. BOX 51-4 SICK-DAY MANAGEMENT FOR THE CHILD WITH TYPE 1 DIABETES MELLITUS
  8368. Diagnostic Evaluation
  8369. Therapeutic Management
  8370. Long-Term Health Care Needs for the Child with Type 1 Diabetes Mellitus
  8371. NURSING CARE PLAN: The Child in Diabetic Ketoacidosis (DKA)
  8372. Focused Assessment
  8373. Nursing Diagnosis
  8374. Planning
  8375. Expected Outcome
  8376. Interventions and Rationales
  8377. Evaluation
  8378. Nursing Diagnosis
  8379. Planning
  8380. Expected Outcome
  8381. Interventions and Rationales
  8382. Evaluation
  8383. Nursing Diagnosis
  8384. Planning
  8385. Expected Outcome
  8386. Interventions and Rationales
  8387. Evaluation
  8388. Nursing Diagnosis
  8389. Planning
  8390. Expected Outcome
  8391. Interventions and Rationales
  8392. Evaluation
  8393. Diabetes, Type 2 ExemplarType 2 Diabetes Mellitus
  8394. Etiology
  8395. Incidence
  8396. Manifestations
  8397. Diagnostic Evaluation
  8398. Therapeutic Management
  8399. Medication Therapy
  8400. Nutrition Therapy
  8401. Physical Activity
  8402. Blood Glucose Monitoring
  8403. Prevention
  8404. KEY CONCEPTS
  8405. References and Readings
  8406. Pageburst Integrated Resource
  8407. Animation
  8408. Chapter 52 The Child with a Neurologic Alteration
  8409. Learning Objectives
  8410. Clinical Reference
  8411. Review of the Central Nervous System
  8412. Embryologic Development
  8413. The Myelin Sheath
  8414. PEDIATRIC DIFFERENCES IN THE CENTRAL NERVOUS SYSTEM
  8415. The Neural System
  8416. The Axial Skeleton
  8417. The Meninges
  8418. The Brain
  8419. The Cranial Nerves
  8420. The Spinal Cord
  8421. CSF ANALYSIS IN CHILDREN: NORMAL FINDINGS
  8422. CEREBROSPINAL FLUID ANALYSIS: FINDINGS IN PATHOLOGIC CONDITIONS
  8423. Cerebrospinal Fluid
  8424. Cerebral Blood Flow and Intracranial Regulation
  8425. COMMON DIAGNOSTIC TESTS AND PROCEDURES FOR NEUROLOGIC DISORDERS
  8426. LUMBAR PUNCTURE: EDUCATING THE FAMILY
  8427. For the lumbar puncture: Place one hand farther down, under the child’s neck. Your forearm moves behind the child’s head to support the neck. Place the other arm farther under the child’s upper thighs and curl the child’s body by bringing the knees up to the head. Note that this nurse’s weight is supported on the edge of the examination table, and the nurse leans slightly over the child, controlling the arms and legs. Because direct visibility of the child’s respiratory status is limited in this position, a cardiorespiratory monitor must be used for the child.
  8428. NURSING CARE PLAN: The Child with a Neurologic System Disorder
  8429. Focused Assessment
  8430. Nursing Diagnosis
  8431. Planning
  8432. Expected Outcomes
  8433. Interventions and Rationales
  8434. Evaluation
  8435. Nursing Diagnosis
  8436. Planning
  8437. Expected Outcome
  8438. Interventions and Rationales
  8439. Evaluation
  8440. Nursing Diagnosis
  8441. Planning
  8442. Expected Outcome
  8443. Interventions and Rationales
  8444. Evaluation
  8445. Nursing Diagnosis
  8446. Planning
  8447. Expected Outcome
  8448. Interventions and Rationales
  8449. Evaluation
  8450. Nursing Diagnosis
  8451. Planning
  8452. Expected Outcome
  8453. Interventions and Rationales
  8454. Evaluation
  8455. Increased Intracranial Pressure
  8456. Etiology
  8457. Manifestations
  8458. BOX 52-1 DEVELOPMENTAL MANIFESTATIONS OF INCREASED INTRACRANIAL PRESSURE
  8459. TABLE 52-1 GLASGOW COMA SCALE MODIFIED FOR CHILDREN
  8460. Level of Consciousness
  8461. Behavior
  8462. NURSING QUALITY ALERT: Delirium ExemplarStandard Terms for Level of Consciousness
  8463. Pupil Evaluation
  8464. Motor Function
  8465. Vital Signs
  8466. FIG 52-1 Flexion and extension posturing.
  8467. PATHOPHYSIOLOGY: Increased Intracranial Pressure
  8468. Diagnostic Evaluation and Therapeutic Management
  8469. EVIDENCE-BASED PRACTICE
  8470. BOX 52-2 INSTRUMENTS FOR MONITORING INCREASED INTRACRANIAL PRESSURE
  8471. Spina Bifida
  8472. Etiology and Incidence
  8473. Manifestations
  8474. FIG 52-2 Three forms of spina bifida.
  8475. PATHOPHYSIOLOGY: Spina Bifida
  8476. FIG 52-3 This infant has a repaired myelomeningocele. Note the left clubfoot. This deformity often accompanies the defect because normal intrauterine movement does not occur in the fetus with spina bifida, interfering with the development of the extremities. The legs are flaccid, and normal neonatal flexion is absent. The infant also dribbles stool and urine constantly. Hydrocephalus commonly accompanies these neural tube defects.
  8477. Diagnostic Evaluation
  8478. Therapeutic Management
  8479. Hydrocephalus
  8480. Etiology
  8481. Incidence
  8482. Manifestations and Diagnostic Evaluation
  8483. TABLE 52-2 EARLY AND LATE MANIFESTATIONS OF HYDROCEPHALUS
  8484. PATHOPHYSIOLOGY: Hydrocephalus
  8485. Therapeutic Management
  8486. Cerebral palsy ExemplarCerebral Palsy
  8487. Etiology and Incidence
  8488. FIG 52-4 A ventriculoperitoneal shunt may be implanted in the child with hydrocephalus to prevent excess accumulation of cerebrospinal fluid (CSF) in the ventricles. The tubing diverts the CSF from the ventricles into the peritoneal cavity, where it is reabsorbed. Nursing care includes monitoring for infection, obstruction, and pain, administering antibiotics and pain medications as ordered, and teaching the family how to change dressings and how to recognize shunt blockages or other problems.
  8489. BOX 52-3 FACTORS ASSOCIATED WITH CEREBRAL PALSY
  8490. Prenatal
  8491. Perinatal
  8492. Postnatal
  8493. Manifestations
  8494. Diagnostic Evaluation and Therapeutic Management
  8495. PATHOPHYSIOLOGY: Cerebral Palsy
  8496. NURSING CARE PLAN: The Child with Cerebral Palsy in the Community Setting
  8497. Focused Assessment
  8498. Nursing Diagnosis
  8499. Planning
  8500. Expected Outcomes
  8501. Interventions and Rationales
  8502. Evaluation
  8503. Nursing Diagnosis
  8504. Planning
  8505. Expected Outcome
  8506. Interventions and Rationales
  8507. Evaluation
  8508. Nursing Diagnosis
  8509. Planning
  8510. Expected Outcomes
  8511. Interventions and Rationales
  8512. Evaluation
  8513. Nursing Diagnosis
  8514. Planning
  8515. Expected Outcome
  8516. Interventions and Rationales
  8517. Evaluation
  8518. Head Injury
  8519. Types of Head Injuries
  8520. FIG 52-5 Epidural and subdural hematomas are the two most common cranial hematomas, occurring in 6% to 7% of all children with head injuries. With epidural hematoma, a rapid decline in neurologic function may occur 4 to 8 hours after a brief period of lucidity. If untreated, the increased intracranial pressure (ICP) can cause death in a short time. A subdural hematoma is often caused when the head strikes an immovable object. A subdural hematoma (along with retinal hemorrhage) in an infant or child may occur as a result of child abuse involving aggressive shaking, blunt impact, or both (abusive head trauma).
  8521. Skull Fractures
  8522. Contusion
  8523. Concussion
  8524. Intracranial Hemorrhage
  8525. Incidence
  8526. BOX 52-4 CLASSIFICATION OF SEVERITY OF HEAD INJURIES BASED ON GLASGOW COMA SCALE (GCS)∗
  8527. Manifestations
  8528. Diagnostic Evaluation
  8529. Therapeutic Management
  8530. PATHOPHYSIOLOGY: Head Injury
  8531. PARENTS WANT TO KNOW: Guidelines for the Child with a Head Injury∗
  8532. Postconcussion Syndrome
  8533. Second Impact Syndrome
  8534. Nursing Considerations
  8535. Spinal cord injury ExemplarSpinal Cord Injury
  8536. Etiology
  8537. PATHOPHYSIOLOGY: Spinal Cord Injury
  8538. Incidence
  8539. Manifestations
  8540. Diagnostic Evaluation
  8541. Therapeutic Management
  8542. FIG 52-6 Children who have injuries or birth defects that involve the upper spine may be placed in halo traction to stabilize the spine and prevent added nerve damage. Spinal cord injury is a catastrophic event for the child and family; intense nursing support and education as well as referral to support groups, will be needed.
  8543. Nursing Care
  8544. The Child with a Spinal Cord Injury
  8545. Assessment
  8546. Nursing Diagnosis and Planning
  8547. Expected Outcome
  8548. Expected Outcome
  8549. Expected Outcomes
  8550. Expected Outcome
  8551. Expected Outcome
  8552. Interventions
  8553. Evaluation
  8554. Seizure ExemplarSeizure Disorders
  8555. Etiology
  8556. Incidence
  8557. Pathophysiology
  8558. Manifestations
  8559. Diagnostic Evaluation
  8560. Therapeutic Management
  8561. BOX 52-5 INTERNATIONAL CLASSIFICATION OF SEIZURES
  8562. Generalized Seizures
  8563. Tonic, Clonic, and Tonic-Clonic Seizures
  8564. Atonic Seizures
  8565. Myoclonic Seizures
  8566. Absence Seizures
  8567. Focal Seizures
  8568. Unknown
  8569. TABLE 52-3 COMMON SEIZURE MEDICATIONS
  8570. NURSING CARE PLAN: The Child with a Seizure Disorder in the Community Setting
  8571. Focused Assessment
  8572. Nursing Diagnosis
  8573. Planning
  8574. Expected Outcomes
  8575. Interventions and Rationales
  8576. Evaluation
  8577. Nursing Diagnosis
  8578. Planning
  8579. Expected Outcomes
  8580. Interventions and Rationales
  8581. Evaluation
  8582. PATIENT-CENTERED TEACHING: Guidelines for the Child or Adolescent Taking Seizure Medication
  8583. Status Epilepticus
  8584. Etiology
  8585. Incidence
  8586. Pathophysiology
  8587. NURSING QUALITY ALERT: Observations and Nursing Care during a Seizure
  8588. Manifestations
  8589. Diagnostic Evaluation
  8590. Therapeutic Management
  8591. Nursing Care
  8592. The Child with Status Epilepticus
  8593. Assessment
  8594. Nursing Diagnosis and Planning
  8595. Expected Outcome
  8596. Expected Outcome
  8597. Expected Outcome
  8598. Expected Outcome
  8599. Interventions and Evaluation
  8600. SAFETY ALERT: Drug Therapy for Generalized Tonic-Clonic Status Epilepticus
  8601. Bacterial meningitis ExemplarViral meningitis ExemplarMeningitis
  8602. Etiology
  8603. FIG 52-7 As part of the assessment for meningitis, the nurse can attempt to elicit Kernig sign and Brudzinski sign. Both are early indicators of meningitis in children and adolescents. Kernig sign The child can easily extend the leg when in the supine position. However, when the thigh is flexed toward the abdomen, pain prevents complete extension of the leg. Brudzinski sign In the supine position, the child bends her head toward her chest (in the younger child, the nurse can bend the child’s head). This action usually produces involuntary hip and knee flexion in the child with meninigitis.
  8604. Incidence
  8605. Manifestations
  8606. Diagnostic Evaluation
  8607. Therapeutic Management
  8608. PATHOPHYSIOLOGY: Meningitis
  8609. Nursing Care
  8610. The Child with Meningitis
  8611. Assessment
  8612. Nursing Diagnosis and Planning
  8613. Expected Outcome
  8614. Interventions
  8615. NURSING QUALITY ALERT: Guidelines for the Child with Meningitis
  8616. CRITICAL THINKING EXERCISE 52-1
  8617. Evaluation
  8618. Guillain-Barré Syndrome
  8619. Incidence
  8620. Pathophysiology
  8621. Manifestations
  8622. Diagnostic Evaluation
  8623. Therapeutic Management
  8624. Nursing Care
  8625. The Child with Guillain-Barré Syndrome
  8626. Assessment
  8627. Nursing Diagnosis and Planning
  8628. Expected Outcome
  8629. Expected Outcome
  8630. Expected Outcome
  8631. Expected Outcome
  8632. Expected Outcome
  8633. Expected Outcome
  8634. Expected Outcomes
  8635. Expected Outcome
  8636. Interventions
  8637. Evaluation
  8638. Neurologic Conditions Requiring Critical Care
  8639. Headaches
  8640. Etiology
  8641. Incidence
  8642. Manifestations
  8643. Migraine
  8644. Tension-Type Headaches
  8645. Diagnostic Evaluation
  8646. TABLE 52-4 NEUROLOGIC CONDITIONS REQUIRING CRITICAL CARE
  8647. Nursing Care
  8648. The Child with Headaches
  8649. Assessment
  8650. Nursing Diagnosis and Planning
  8651. Expected Outcome
  8652. Expected Outcomes
  8653. Expected Outcome
  8654. Interventions
  8655. Evaluation
  8656. KEY CONCEPTS
  8657. References and Readings
  8658. Pageburst Integrated Resource
  8659. Animation
  8660. Chapter 53 Psychosocial Problems in Children and Families
  8661. Learning Objectives
  8662. Clinical Reference
  8663. Overview of Psychosocial Disorders of Childhood
  8664. PSYCHOSOCIAL DISORDERS TYPICALLY MANIFESTED IN CHILDHOOD
  8665. Precipitating Factors
  8666. Diagnostic Evaluation
  8667. MENTAL STATUS EXAMINATION OF CHILDREN
  8668. EVIDENCE-BASED PRACTICE
  8669. Emotional Disorders
  8670. Anxiety Disorders
  8671. Social Anxiety Disorder
  8672. Separation Anxiety
  8673. Panic attack ExemplarPanic Disorder
  8674. Posttraumatic distress disorder ExemplarPosttraumatic Stress Disorder
  8675. Obsessive compulsive disorder ExemplarObsessive-Compulsive Disorder
  8676. Mood Disorders
  8677. Depressive disorders ExemplarDepression ExemplarMajor Depressive Disorder and Dysthymic Disorder
  8678. Adjustment Disorder
  8679. Bipoar ExemplarBipolar disorder ExemplarBipolar Disorder
  8680. Etiology and Physiology of Emotional Disorders
  8681. Biologic Factors
  8682. Environmental Factors
  8683. Traumatic brain injury ExemplarTraumatic Brain Injury
  8684. Manifestations
  8685. Therapeutic Management of Children with Emotional Disorders
  8686. Nursing Care
  8687. The Child with an Emotional Disorder
  8688. Assessment
  8689. Nursing Diagnosis and Planning
  8690. Expected Outcome
  8691. Expected Outcome
  8692. Expected Outcome
  8693. Expected Outcome
  8694. Expected Outcome
  8695. Interventions
  8696. Evaluation
  8697. Self-harm ExemplarSuicide ExemplarSuicide
  8698. NURSING QUALITY ALERT: Resources for People with Thoughts of Suicide
  8699. Manifestations and Risk Factors
  8700. Therapeutic Management
  8701. Prevention
  8702. When Prevention and Intervention Fail
  8703. Nursing Care
  8704. The Child or Adolescent at Risk for Suicide
  8705. Assessment
  8706. BOX 53-1 QUESTIONS TO ASSESS SUICIDE POTENTIAL
  8707. Nursing Diagnosis and Planning
  8708. Expected Outcome
  8709. Expected Outcome
  8710. Expected Outcome
  8711. Expected Outcome
  8712. Expected Outcome
  8713. Interventions
  8714. Evaluation
  8715. Behavioral Disorders
  8716. Etiology
  8717. Manifestations
  8718. Diagnostic Evaluation
  8719. Therapeutic Management
  8720. Nursing Care
  8721. The Child with ADHD
  8722. Assessment
  8723. Nursing Diagnosis and Planning
  8724. Expected Outcomes
  8725. Expected Outcome
  8726. Expected Outcome
  8727. Expected Outcome
  8728. Interventions
  8729. Evaluation
  8730. Anorexia nervosa ExemplarBulimia ExemplarEating Disorders: Anorexia Nervosa and Bulimia Nervosa
  8731. Etiology
  8732. Manifestations
  8733. Anorexia Nervosa
  8734. FIG 53-1 In anorexia nervosa, the adolescent refuses to maintain adequate body weight, partly because of a distorted body image: She perceives herself as overweight when in fact she is below minimum weight.
  8735. Bulimia Nervosa
  8736. Diagnostic Evaluation
  8737. Therapeutic Management
  8738. Nursing Care
  8739. The Child or Adolescent with an Eating Disorder
  8740. Assessment
  8741. Nursing Diagnosis and Planning
  8742. Expected Outcome
  8743. Expected Outcome
  8744. Expected Outcome
  8745. Expected Outcome
  8746. Interventions
  8747. Evaluation
  8748. Substance Abuse
  8749. TABLE 53-1 Opioid ExemplarAlcohol intoxication ExemplarTobacco products Exemplar COMMONLY ABUSED DRUGS AND THEIR EFFECTS
  8750. Etiology
  8751. BOX 53-2 PHASES OF SUBSTANCE ABUSE
  8752. Phase 1: Experimentation
  8753. Phase 2: Early Drug Use
  8754. Phase 3: True Drug Addiction
  8755. Phase 4: Severe Drug Addiction
  8756. Manifestations
  8757. NURSING QUALITY ALERT: Relapse Among Substance Abusers
  8758. Therapeutic Management
  8759. Nursing Care
  8760. The Child or Adolescent with a Substance Abuse Problem
  8761. Assessment
  8762. Nursing Diagnosis and Planning
  8763. Expected Outcome
  8764. Expected Outcome
  8765. Expected Outcome
  8766. Expected Outcome
  8767. Expected Outcome
  8768. Expected Outcome
  8769. Interventions
  8770. Evaluation
  8771. Child abuse ExemplarChildhood Physical and Emotional Abuse and Child Neglect
  8772. Etiology
  8773. Incidence
  8774. BOX 53-3 CHARACTERISTICS OF THE ABUSIVE FAMILY
  8775. Manifestations
  8776. Indicators of Physical Abuse
  8777. Indicators of Neglect
  8778. FIG 53-2 Physical signs of child abuse. The nurse should be alert for the typical behavioral indicators of abuse.
  8779. Nonaccidental distribution of bruises: All four surfaces of the torso are involved, but there are no bruises on arms and legs.
  8780. Pattern of injury: Linear scars of various ages indicate repeated abuse with a switch or a whip. The loop pattern on the boy’s anterior torso is consistent with a looped electrical cord used as a whip.
  8781. Scald burn of shoulder and neck: The typical distribution of a scald burn in a toddler. This type of injury occurs when a toddler pulls a cup of coffee or pan of water off a stove.
  8782. Nonaccidental immersion scald: Involvement of virtually the entire posterior surface of the legs indicates that the legs were held under scalding water; even an infant this young would flex the knees to avoid the hot water.
  8783. Indicators of Emotional Abuse
  8784. Indicators of Sexual Abuse
  8785. Other Specific Abusive Situations
  8786. Abusive Head Trauma
  8787. Munchausen Syndrome by Proxy
  8788. CRITICAL THINKING EXERCISE 53-1
  8789. NURSING CARE PLAN: The Abused Child
  8790. Focused Assessment
  8791. Nursing Diagnosis
  8792. Planning
  8793. Expected Outcome
  8794. Interventions and Rationales
  8795. Evaluation
  8796. Nursing Diagnosis
  8797. Planning
  8798. Expected Outcomes
  8799. Interventions and Rationales
  8800. Evaluation
  8801. Nursing Diagnosis
  8802. Planning
  8803. Expected Outcomes
  8804. Interventions and Rationales
  8805. Evaluation
  8806. Nursing Diagnosis
  8807. Planning
  8808. Expected Outcome
  8809. Interventions and Rationales
  8810. Evaluation
  8811. FIG 53-3 Disclosure of abuse may be slow because the child often has difficulty trusting any adult. Physical examination and interview of children who may be victims of sexual abuse require particular sensitivity because physical inspection of the child’s genitalia to detect signs of injury or sexually transmitted disease may frighten the child, who associates handling of the genitalia with pain or shame. Anatomically correct dolls are often used in the assessment of abuse within a family. These dolls help children express what they cannot express in words; young children in particular have a limited vocabulary to use when describing the events that have occurred. Note the communication techniques designed to reassure the child and give the child some power. The little girl is not immediately positioned for a genital examination. The physician first sits to talk with the child at her eye level and makes eye contact with her. Drawings may help to identify the abused child and assist in therapy. Art can also help the child express what cannot be expressed in words.
  8812. KEY CONCEPTS
  8813. References and Readings
  8814. Chapter 54 The Child with a Developmental Disability
  8815. Learning Objectives
  8816. CLINICAL REFERENCE
  8817. Genetics and Genomics
  8818. COMMON DIAGNOSTIC TESTS FOR INTELLECTUAL AND DEVELOPMENTAL DISORDERS
  8819. Intellectual and Developmental Disorders
  8820. Developmental Disability and the Americans with Disabilities Act: The Impact of Public Policy
  8821. Terminology
  8822. Mental Age, Functional Age, Adaptive Functioning
  8823. Intellectual Impairment and Intellectual Disability
  8824. Intellectual Impairment versus Mental Retardation
  8825. Autism Spectrum Disorders versus Pervasive Developmental Disorders
  8826. Etiology of Intellectual Disabilities and Pervasive Developmental Disorders
  8827. BOX 54-1 CAUSES OF INTELLECTUAL DISABILITY
  8828. Genetic
  8829. Alterations Occurring during Pregnancy
  8830. Neonatal Alterations
  8831. Acquired Childhood Conditions or Diseases
  8832. Environmental Problems
  8833. EVIDENCE-BASED PRACTICE
  8834. Incidence of Intellectual and Developmental Disorders
  8835. BOX 54-2 PROBLEMS RELATED TO INTELLECTUAL DISABILITY
  8836. Mild
  8837. Severe
  8838. Manifestations
  8839. FIG 54-1 Children with intellectual impairments may have other dysfunctions as well. The family of a child with an intellectual impairment often feels continual grief because the child does not meet their expectations. This child has additional dysfunctions that require respiratory and nutritional support.
  8840. Diagnostic Evaluation
  8841. BOX 54-3 EXPECTED SKILLS ACCORDING TO INTELLIGENCE QUOTIENT (IQ) SCORES
  8842. Normal Intelligence (IQ 85 to 115)
  8843. Borderline Intellectual Disability (IQ 71 to 84)
  8844. Mild Intellectual Disability (IQ 50-55 to ~70)
  8845. Moderate Intellectual Disability (IQ 35-40 to 50-55)
  8846. Severe Intellectual Disability (IQ 20-25 to 35-40)
  8847. Profound Intellectual Disability (IQ <20 to 25)
  8848. TABLE 54-1 SAFETY CONCERNS FOR DEVELOPMENTALLY DELAYED OR IMPAIRED CHILDREN
  8849. Management
  8850. General Strategies
  8851. Safety Challenges
  8852. SAFETY ALERT: The Child with a Developmental Disorder
  8853. Disorders Resulting in Intellectual or Developmental Disability
  8854. NURSING CARE PLAN: The Child with a Developmental Disorder or Disability in the Community Setting
  8855. Focused Assessment: The Child
  8856. Focused Assessment: The Family
  8857. Nursing Diagnosis
  8858. Planning
  8859. Expected Outcome
  8860. Interventions and Rationales
  8861. Evaluation
  8862. Nursing Diagnosis
  8863. Planning
  8864. Expected Outcomes
  8865. Interventions and Rationales
  8866. Evaluation
  8867. Nursing Diagnosis
  8868. Planning
  8869. Expected Outcomes
  8870. Interventions and Rationales
  8871. Evaluation
  8872. Nursing Diagnosis
  8873. Planning
  8874. Expected Outcomes
  8875. Interventions and Rationales
  8876. Evaluation
  8877. FIG 54-2 Special Olympics International is the largest recreational program in the world for people with intellectual impairment. With more than 1 million athletes in 125 countries, Special Olympics offers opportunities for social interaction with peers and assists children who are intellectually disabled in reaching their maximum potential.
  8878. Down syndrome ExemplarDown Syndrome
  8879. FIG 54-3 Children with delayed motor or cognitive function, whether temporary or pervasive, benefit from early and vigorous therapy to help them reach their maximum development.
  8880. BOX 54-4 MEDICAL CONDITIONS ASSOCIATED WITH DOWN SYNDROME
  8881. Conditions Frequently Identified during the Neonatal Period
  8882. Conditions Frequently Identified during Childhood
  8883. Etiology
  8884. Incidence
  8885. PATHOPHYSIOLOGY: Down Syndrome
  8886. Manifestations
  8887. Diagnostic Evaluation
  8888. Therapeutic Management
  8889. Nursing Care
  8890. The Child with DS
  8891. Assessment
  8892. Nursing Diagnosis and Planning
  8893. Expected Outcome
  8894. Expected Outcome
  8895. Expected Outcomes
  8896. Interventions
  8897. Evaluation
  8898. Fragile X Syndrome
  8899. Etiology
  8900. Incidence
  8901. PATHOPHYSIOLOGY: Fragile X Syndrome
  8902. Manifestations
  8903. Intellectual Functioning
  8904. Physical Characteristics
  8905. Social and Emotional Relatedness
  8906. Speech and Language Capability and Sensory Impairment
  8907. Co-Morbid Disorders
  8908. Diagnostic Evaluation
  8909. Therapeutic Management
  8910. Nursing Considerations
  8911. Rett Syndrome
  8912. Fetal Alcohol Spectrum Disorder
  8913. Etiology and Incidence
  8914. PATHOPHYSIOLOGY: Fetal Alcohol Syndrome
  8915. Manifestations
  8916. Diagnostic Evaluation
  8917. FIG 54-4 Toddler with fetal alcohol syndrome. Subtle indicators are flat mid-face, indistinct philtrum, and low-set ears.
  8918. Nursing Care
  8919. The Infant with FAS
  8920. Assessment
  8921. Nursing Diagnosis and Planning
  8922. Expected Outcome
  8923. Expected Outcome
  8924. Expected Outcome
  8925. Expected Outcome
  8926. Interventions
  8927. Evaluation
  8928. Nonorganic Failure to Thrive
  8929. Etiology
  8930. Incidence
  8931. Manifestations and Risk Factors
  8932. Diagnostic Evaluation
  8933. Therapeutic Management
  8934. Nursing Considerations
  8935. Autism ExemplarAutism Spectrum Disorders
  8936. Asperger Syndrome
  8937. Autism
  8938. TABLE 54-2 Schizophrenia Exemplar DIFFERENTIAL DIAGNOSIS OF AUTISM, INTELLECTUAL DISABILITY, AND SCHIZOPHRENIA
  8939. Etiology
  8940. Incidence
  8941. Manifestations
  8942. Social
  8943. Language
  8944. Restricted Behavioral Repertoire
  8945. Diagnostic Evaluation
  8946. Therapeutic Management
  8947. CRITICAL THINKING EXERCISE 54-1
  8948. Nursing Care
  8949. The Child with Autism
  8950. Assessment
  8951. Nursing Diagnosis and Planning
  8952. Expected Outcome
  8953. Expected Outcomes
  8954. Expected Outcomes
  8955. Interventions
  8956. NURSING QUALITY ALERT: Maintaining Routine for the Child with Autism
  8957. Evaluation
  8958. KEY CONCEPTS
  8959. References and Readings
  8960. Chapter 55 The Child with a Sensory Alteration
  8961. Learning Objectives
  8962. CLINICAL REFERENCE
  8963. Review of the Eye
  8964. Structure and Function
  8965. Neonatal Development
  8966. Review of the Ear
  8967. Structure and Function
  8968. Neonatal Development
  8969. Speech Development
  8970. PEDIATRIC DIFFERENCES IN SENSORY FUNCTION
  8971. Vision
  8972. Hearing
  8973. Speech and Language
  8974. Vision screening ExemplarDisorders of the Eye
  8975. NURSING QUALITY ALERT: Vision Screening
  8976. Nursing Considerations for the Child with Color Deficiency
  8977. BOX 55-1 SIGNS AND SYMPTOMS OF POTENTIAL VISION PROBLEMS
  8978. Nursing Considerations for the Child with a Blocked Lacrimal Duct
  8979. Nursing Considerations for the Child with a Refractive Error
  8980. TABLE 55-1 TYPES OF REFRACTIVE DISORDERS
  8981. Nursing Considerations for the Child with Amblyopia
  8982. Nursing Considerations for the Child with Strabismus
  8983. PATIENT-CENTERED TEACHING: Information about Eye Patching
  8984. BOX 55-2 TYPES OF STRABISMUS
  8985. Child with early onset esotropia. The deviation may not be apparent until age 3 or 4 months.
  8986. Child with left exotropia. Most exodeviations in childhood are intermittent.
  8987. Glaucoma ExemplarNursing Considerations for the Child with Glaucoma
  8988. Cataracts ExemplarNursing Considerations for the Child with a Cataract
  8989. Eye Surgery
  8990. NURSING CARE PLAN: The Child Having Eye Surgery
  8991. Focused Assessment
  8992. Nursing Diagnosis
  8993. Planning
  8994. Expected Outcomes
  8995. Interventions and Rationales
  8996. Evaluation
  8997. Nursing Diagnosis
  8998. Planning
  8999. Expected Outcome
  9000. Interventions and Rationales
  9001. Evaluation
  9002. Nursing Diagnosis
  9003. Planning
  9004. Expected Outcome
  9005. Interventions and Rationales
  9006. Evaluation
  9007. Nursing Diagnosis
  9008. Planning
  9009. Expected Outcome
  9010. Interventions and Rationales
  9011. Evaluation
  9012. Eye Infections
  9013. Nursing Considerations for the Child with Conjunctivitis
  9014. Nursing Considerations for the Child with Orbital Cellulitis
  9015. Nursing Considerations for the Child with a Corneal Ulcer
  9016. Eye Trauma
  9017. Nursing Considerations for the Child with a Corneal Abrasion
  9018. Nursing Considerations for the Child with Hemorrhage
  9019. Nursing Considerations for the Child with Hyphema
  9020. PARENTS WANT TO KNOW: How to Prevent Eye Injuries While Participating in Sports
  9021. Nursing Considerations for the Child with a Chemical Splash Injury
  9022. Conductive hearing loss ExemplarHearing Loss in Children
  9023. Etiology
  9024. SAFETY ALERT: Working with a Child Who Has a Visual Impairment
  9025. Incidence
  9026. BOX 55-3 TYPES AND ETIOLOGY OF HEARING LOSS
  9027. BOX 55-4 RISK FACTORS INDICATING THE NEED FOR HEARING SCREENING
  9028. Neonates (Birth to 28 Days)
  9029. Infants (29 Days to 2 Years) Developing Certain Conditions Associated with Hearing Loss
  9030. Diagnostic Evaluation
  9031. PATHOPHYSIOLOGY: Hearing Loss
  9032. BOX 55-5 HEARING TESTS USED FOR INFANTS
  9033. Auditory Brainstem Response
  9034. Evoked Otoacoustic Emissions
  9035. Therapeutic Management
  9036. Nursing Considerations for the Child with Hearing Loss
  9037. PATIENT-CENTERED TEACHING: How to Encourage Language Development
  9038. Talk
  9039. Look
  9040. Control Distance
  9041. Loudness
  9042. Be a Good Speech Model
  9043. Play and Talk
  9044. Read
  9045. Do Not Wait
  9046. CRITICAL THINKING EXERCISE 55-1
  9047. Language Disorders
  9048. FIGURE 55-1 Expressive speech disorders include disorders of voice, articulation, and fluency. A speech therapist works with the child to help the child speak more clearly and be better understood. Early intervention is important to correct speech disorders. The nurse should therefore assess speech patterns during each health screening. Referrals should be made for any problems noted.
  9049. KEY CONCEPTS
  9050. References and Readings
  9051. Features
  9052. Critical to Remember
  9053. Drug Guide
  9054. Nursing Care Plan
  9055. Nursing Quality Alert
  9056. Patient-Centered Teaching
  9057. Procedure
  9058. Safety Alert
  9059. Want to Know
  9060. Temperature Equivalents and Pediatric Weight Conversion
  9061. Temperature Equivalents: Celsius and Fahrenheit
  9062. Pediatric Weight Conversion: Pounds to Kilograms
  9063. Glossary

 

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